bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reliability Study of the Sedation-Agitation Scale in an Intensive Care Unit
Authors:   , Ryder-Lewis Michelle 
Published: November 2021

<p>The management of sedation in critically ill patients is a complex issue for Intensive Care Units (ICU) worldwide. Notable complications of sedation practices have been identified and efforts to modify these practices in ICUs have begun. While sedation-scoring tools have been introduced into clinical practice in intensive care few have been tested for validity and reliability. One tool which has reliability and validity established is the Sedation-Agitation Scale (SAS). This study is an extension of a previous study by Riker, Picard and Fraser (1999) to determine whether doctors and nurses rate patients similarly using the SAS in a natural ICU setting. It is essential to establish whether these different professionals provide consistent scores and have a mutual understanding of the SAS and its constituent levels. This will help ensure that clinical decisions relating to sedation-needs can be made appropriately and consistently. This quasi-experimental reliability study was set in a 12-bed tertiary general ICU in New Zealand. The SAS had recently been introduced into this unit and a convenience sample of 42 nursing and medical staff performed paired ratings on 69 randomly selected adult ICU patients over an eight week time frame. The mean patient age was 58 years, and 79% of patients were on continuous infusions of Propofol. Intubated patients made up 91% of the sample. 74% of patients were given the same SAS score by the doctor-nurse pair. The weighted kappa score for inter-rater agreement was 0.82 indicating very good agreement. Of the 26% of scores where there was a difference, the two readings were only one score apart. Most of the difference occurred around SAS scores of 1-2 and 3-4. Further analysis found no staff or patient variables to be statistically significant in impacting on the ratings. The SAS was found to be a reliable sedation-scoring tool in a general ICU when used by nurses and doctors of varying experience. The implementation of the SAS should improve the quality of sedation management in critically ill patients, facilitate communication between nurses and medical staff with regard to the effectiveness of sedation regimes, and assist with the development of optimal sedation and analgesia guidelines for ICU patients.</p>
The Primacy of the Nurse in New Zealand 1960s-1990s: Attitudes, Beliefs and Responses over Time
Authors:   , Williams Barbara Gay 
Published: November 2021

<p>Exploring the past, and pulling ideas through to the present, to inform the future can make a valuable contribution to nurses and nursing in New Zealand. By gaining some understanding of the attitudes and beliefs nurses held, and how these influenced their responsiveness, we can learn what active responses might help inform our future. Nurses in New Zealand, as individuals and within the profession as a whole, reveal the primacy of the nurse – nurses who have made and can continue to make a difference to the health of the peoples of New Zealand. A hermeneutic process was used to interpret material, from international texts, national texts and public records over four decades, the 1960s to 1990s. This was supplemented and contrasted with material from twelve oral history participants. Analysis of the material led to the emergence of four themes: Nurses’ decision-making: changes over time; An emerging understanding of autonomy and accountability; Nurses as a driving force; and Creating a nursing future. These four themes revealed an overall pattern of attitudes, beliefs and responses of the New Zealand Registered Nurse. The themes surfaced major revelations about the primacy of the nurse in New Zealand, nurses confident in their ability to take the opportunity, seize the moment, and effect change. The contribution this thesis makes to the discipline of nursing is an understanding of how the nurse actively constructs the scope of a professional response to the context. The thesis demonstrates how nurses can learn from the past, that the attitudes and beliefs that underpin our active responses can either move us forward, or retard our progress. As nurses we can also learn that to move forward we need particular attitudes, beliefs and responses, that these are identifiable, and are key factors influencing our future, thus ensuring the continued primacy of the nurse.</p>
Sacred Memories: Creative Art Therapy for Children in Grief
Authors:   , Lowson Shona 
Published: November 2021

<p>This paper explores the creative opportunities children might have to attend to their emotions and feelings following the death of a parent, grandparent or close friend. It presents the position that often children are left out of the process of caring for an adult when they are terminally ill and that has long term psychological implications. It also suggests that this has antecedents for the white New Zealand culture that were noted historically. Hospice palliative care services in New Zealand identify the need to be proactive in their holistic care for the family when a person is dying and this care must include the family which invariably includes children. In this research the author describes a personal journey that has shaped her current work as a hospice practice manager. She has chosen to highlight a neglected aspect in services in New Zealand. The writer explores literature in psychological aspects of removing children from the dying room, creative therapies and the importance of sacred memories for the living child to be enfolded in through their life. The need to create memory that will embrace the child as a cloak enfolds them in their crisis stimulated the writer to offer a text in the personal narrative form. This text is presented in this form to enable other clinicians to access their own memories as survivors of grief in their own families. Through enabling children and family to explore the importance of relating in the palliative phase of a person’s life journey it is suggested that doors open that build good memories for the survivors. I regard my specific form of interest as pursuing the idea of building memory creative ‘corners’ and fun experiences for children at my work. The reasons why such an experience would be beneficial now and in the future for children and their families will be the focus for conducting my literature research. Children were important in the final days of her father’s life. He directed the family to accept the roles he saw would be theirs. Memories became their treasures.</p>
“Let my Spirit Always Sing”: a Descriptive Study of How Four Elderly Rest Home Residents View Spirituality and Spiritual Care at the End of Life
Authors:   , Brown Judith Anne 
Published: November 2021

<p>Over the last twenty years spiritual care has become recognised increasingly as an important component of holistic care, care that nurtures the spirit as well as addressing the person’s physical and psychosociocultural needs. This descriptive, qualitative study, believed to be the first of its kind conducted in a New Zealand setting, focuses on spirituality issues of a spiritually vulnerable group of people, older people in residential care. From this group of people I recruited four Rest Home residents who were prepared to talk to me about their spirituality, spiritual needs and how their spirits were nurtured, the role of care staff in providing spiritual care, and their satisfaction with the spiritual care they were being offered. They were also asked to predict their spiritual needs as they were dying, their wishes for spiritual care in the perideath period, whether they had communicated these wishes to anyone, their views on advance planning to ensure these wishes would be met, and their comfort with the research process. The research data was collected from semi-structured, audiotaped interviews that were later transcribed. The spirituality of all participants had a strongly Christian focus that was revealed in the ten themes to emerge from a modified application of Colaizzi’s analysis technique. The first themes to emerge were God as the focus of spirituality, God in control, the importance of relationship, and the purpose in life: serving God. Changes in spirituality with age, spirituality and residential care, and spiritual care: whose responsibility? were also identified as themes, as were end of life spirituality, planning for spiritual care, and the participants’ satisfaction with the research process. All were able to articulate their spirituality, were generally satisfied with the spiritual care they were receiving, and had views on the spiritual care they wished to receive in the perideath period. Moreover, the participants trusted their families and the care staff to ensure that these wishes would be honoured.Recommendations are made for improving the spiritual dimension of care, and for further research. Similar research, for example, should be carried out in different residential care settings, especially in the “for profit” sector. Research should also be undertaken to gauge the awareness care staff have of residents’ wishes for spiritual care in the perideath period.</p>
An Exploration of Issues of Primary Health Services for Taranaki Te Atiawa Children Based on the Expectations and Perceptions of Their Female Caregivers
Authors:   , Adams-Smith Patricia Helen 
Published: November 2021

<p>The debate about Maori child health in New Zealand continues perennially. The intention of this research is, through collaborative discussion and selective conversations, to explore female caregivers' expectations and perceptions of primary health services for some Te Atiawa Maori children. The research process was developed in a partnership between the Maori women participants and myself. In addition, two local kuia actively participated in and supported the process. It is hoped, through thls study, to contribute new knowledge to the discussion, as I found no published research on this topic. If female caregivers choose when to access primary health services for their children, it seemed to me that they should be asked what is important to them in terms of their children's health and access they have. Emancipatory critical social theory underpins and informs the project. Power relationships between the researcher and the participants can be overtly explored within this theoretical framework. In terms of this particular exploratory study, participatory research appeared to be applicable. The participants are female caregivers of Te Atiawa children. Data collection was done using group interactions and semi-structured interviews in the winter of the year 2000. A thematic analysis of the data was used, in which common themes were identified, compared and discussed. From the analysis of the data of the participants' conversations, I identified some key ideas. The major findings have been identified within two main themes. These are: a concept of health is not the same for Pakeha as for Maori, and access issues are still problematic for the participants in this study. Many quotes from the interview participants are included in order to keep the focus of the project on the voices of the women interviewed. In terms of the significant contribution of this research, this study aims to allow voices of female caregivers of Te Atiawa Maori children to be heard. Individual and collaborative interactions offer insights into what is important to them in terms of Maori child health. Clearly, the primary health initiatives promoted by the New Zealand government are not reaching at least some of the people for whom they are intended. The research participants offered their ideas as to how these deficits could be remedied in their community.</p>
Intertwining the Role of Partner and Caregiver: a Phenomenological Study of the Experiences of Four New Zealand Rural Women Who have Cared for Their Terminally Ill Partners
Authors:   , Campbell Karen Ann 
Published: November 2021

<p>The stories of the women who live and work in rural settings in New Zealand have begun to reveal unique contributions that they have made to their families and community. Meeting with and listening to rural women's stories reveals insights into the character of these powerful women. This research study evolved from a trend the researcher observed as a district nurse providing community palliative care in rural New Zealand; that the majority of carers of those who are terminally in home-settings are in fact women. This qualitative study aimed to explore through guided conversational interviews the experiences of four New Zealand women who have cared for their terminally ill partners who have subsequently died. The study investigated if these women's experiences were comparable to that of other women in existing palliative care literature. This research project focused particularly on elucidating the women's experience of intertwining the role of partner and caregiver. Heidegger's hermeneutic philosophy informed the methodology because he focused on what it meant to 'be' rather than 'how we know what we know'. The project focused on the meanings the women made of this dual role in their lives. Women already in the role of partner were now faced with the added responsibility of caregiver to meet the complex needs of their loved one. Usually they had no training to prepare them for this experience. The study reveals ways in which the visiting palliative care nurse becomes very important to them. The women's own voices reveal the high level of respect for their partners and address the harsh realities, revealing poignant and striking concerns in their lives. These stories are shared with the intent of enriching nurses' and other health professionals' understanding of the women's experiences. The intention of the study is to highlight the need for closer attention by nurses to women's requirements when caring for their partner at home. Understanding these women's experience is not only a way of honouring these remarkable women but more widely it will inform and possibly transform practice through guideline and policy refinement.</p>
Off the Beaten Track: a Postmodern Feminist Analysis of Rural Midwifery and Rural Media Health Discourses
Authors:   , Patterson Jean Ann 
Published: November 2021

<p>Change was a constant companion for New Zealand midwives during the 1990's. The Nurses Amendment Act 1990, that restored midwifery autonomy was only one of a constellation of changes that saw significant restructuring of the health services in small communities. The purpose of this study was to look at the issues for a group of midwives in rural South Otago who took the opportunity to work independently and offer local women a choice of maternity care during this time. In this study, five rural midwives were interviewed and met subsequently in a focus group. The transcripts were analyzed using discourse analysis informed by a postmodern/feminist theoretical framework. In addition the local newspapers covering the years 1990-1999 were read with a particular focus on the reports of health changes. These texts were also subjected to a discourse analysis using Lyotard's (1997) notion of language games, and bell hook's (1990) ideas around strategic positioning for the marginalised. To practise autonomously, the midwives in this study perform an intricate dance, balancing the contradictions of competing discourses. Their positioning and place of difference is tensioned primarily by a deep sense of community commitment and entanglement, and also by a feeling of physical and perceptual distance from their urban midwifery colleagues. This is underpinned by a staunch belief in women's ability to birth safely in their local area. The findings of this study suggest that the continuation of a comprehensive rural midwifery service is challenged by changes in the arrangement and funding of rural health, plus the increasing use of medical and technological intervention in childbirth. For rural midwifery to survive, this study shows that midwives need to remain flexible and alert while continuing to align themselves with women who are their primary source of support and inspiration. At the same time, they need to forge strategic linkages and alliances, both local and national that will allow them to move and reposition in order to continue their work and provide a realistic childbirth choice for rural women.</p>
Role Identification: an Impediment to Effective Core Primary Health Care Teamwork?
Authors:   , Ross Jean 
Published: November 2021

<p>This study, which is methodologically grounded in qualitative research and philosophically informed by critical social science, explores important aspects of the socio-political context in which practice nurses and general practitioners (core primary health care team) work within a team environment. It is indicated in the literature that there are benefits for improved health care through the development of collaborative teamwork. However, there have been many barriers identified which prevent collaborative teamwork. Amongst the many barriers, is the lack of role clarity and attitudinal differences. Role clarity and attitudinal differences are the topic of this thesis. This thesis explored and highlighted whether the lack of role clarity and attitudinal differences do indeed impede the team's success, and are barriers to teamwork. The views and opinions of practice nurses and general practitioners understanding of their own and each other's current roles within the general practice setting were explored. The participants had the opportunity to discuss together, in focus group meetings, their thoughts on the topic. This raised their awareness of their taken for granted ideas on role and teamwork. Focus groups offered the participants the added opportunity to question each other which allowed for a deeper and more fulfilling understanding of role. New understandings that emerged could lead to alternative models of health care and influence the future delivery and planning of general practice. The thesis concludes by offering a potentially suitable model/framework which has been developed to further the understanding of teamwork in the future.</p>
Distributed Small-Scale Wind in New Zealand: Advantages, Barriers and Policy Support Instruments
Authors:   , Barry Martin 
Published: November 2021

<p>Despite having one of the best wind resources in the world, New Zealand’s wind energy industry is growing at a slower rate than the OECD average. This is arguably due to a lack of appropriate government support, with industry development largely being left to the market. These conditions have created a wind industry with the following four characteristics: a trend toward large-scale wind farms (leading to increased local opposition), a small number of investors, a high geographic concentration of wind capacity and a limited local turbine manufacturing industry. These characteristics are arguably limiting the potential growth of New Zealand’s wind industry. This thesis investigates whether small-scale wind (SSW) farms can alleviate these limiting characteristics and thus provide for a higher rate of industry growth. The approach is to investigate the advantages of, barriers to, and most effective policy instruments for SSW internationally, and apply these to the New Zealand context. Local research was conducted through interviews with 19 energy industry stakeholders and a rural mail survey questionnaire, to which 338 people responded. Research found that SSW offers a number of advantages: significantly higher local public acceptance; facilitation of community ownership; the potential for distributed generation benefits and support for the local turbine manufacturing industry. Given these findings, it is argued that SSW can provide for a higher rate of industry growth in New Zealand. The key barriers constraining SSW in New Zealand are its high cost, obtaining resource consent, a high degree of perceived investment risk, the electricity pricing system and the electricity market structure. The feed-in tariff appears to be the best policy instrument to overcome these barriers, along with the provision of investment subsidies and the classification of SSW as a controlled activity under the Resource Management Act 1991 (RMA).</p>
Pacific Women's Stories of Becoming a Nurse in New Zealand: a Radical Hermeneutic Reconstruction of Marginality
Authors:   , Southwick Margaret R 
Published: November 2021

<p>This thesis examines Pacific women’s experiences of becoming a nurse and their first year of practice post Registration, within the New Zealand context. The participant’s stories of being students and beginning practitioners are inter-woven with my own reflections as a nurse and nurse educator who also claims a Pacific cultural heritage. To create the space in which our stories can be laid down, the thesis includes a description of the migration and settlement of Pacific peoples in Aotearoa/New Zealand. This description shows how Pacific people have been systematically stigmatised and locked into marginalised positions by mainstream dominant culture. The thesis deconstructs taken-for-granted and self perpetuating conceptualisations of marginality that currently underpins most theoretical explanations and proposes a reconstructed map of marginality. This deconstructed/reconstructed map of marginality is used as a template through which the experiences of the participants are filtered and interpreted. Radical Hermeneutics provides a philosophical underpinning for this project that has as one of its objectives the desire to resist reducing complexity to simplistic explanation and superficial solutions. The thesis challenges Nursing to examine its role in reproducing the hegemonic power of dominant culture by applying unexamined cultural normative values that create binary boundaries between ‘them’ and ‘us’. At the same time the thesis challenges Pacific people to move past hegemonically induced states of alienation and learn how to walk in multiple worlds with confidence and power.</p>
An Exploration of Language and Nursing Practice to Improve Communication in the Context of Ear Syringing
Authors:   , Lally Elsa June 
Published: November 2021

<p>Action research is a critical reflective process that involves spirals of cycles if of planning, acting, reflecting/evaluating and replanning the next cycle. This action research inquiry explores communication and nursing practice in an effort to improve practice and enhance patient care. Implications of this study indicate that action research is a method that works, and it is a satisfying way of challenging and changing nursing practice. Using ear syringing as a procedure, in the general practice setting and at two separate surgeries, another Practice Nurse and I co-researched this study during working hours. 12 people consented to participate in the research that involved the audiotaping of each ear syringing interaction. Following each transcription of the recording, my co-researcher and I read our own and then each other's transcripts, and listened to the recordings. We then met to discuss and reflect on our findings and to plan the next cycle. Throughout the process, my co researcher and I found a number of areas of practice we could change or enhance. Changes included the use of technical language such as "contraindications" and "auditory meatus", the side effects of syringing, improvements in communicating situations where ear syringing is not recommended and the options available, and post procedure information. These changes became a significant challenge and areas for improvement when both my co-researcher and I forgot the changes, thus repeating previous errors and omissions. This factor highlighted the need to practise any changes prior to interactions, and to have a cue card on hand to facilitate recollection and to cement improvements into practice. Although time constraints limited this inquiry to three cycles, at the final meeting we agreed to continue the reflective process we had begun to explore our practice.</p>