There were 13 Master of Nursing graduates at the recent 2014 graduation. Congratulations, one and all!
Brief abstracts of their theses follow.
How adults with Type 2 diabetes and a chronic lower extremity wound understand the link between their wound and their diabetes management
Type 2 diabetes and its associated complications are increasing in New Zealand, as in many countries. This research focused on identifying participants’ understanding of the link between diabetes and wound healing, as well as foot care, and impact of diabetes on quality of life. Findings identified that most participants were not aware of how diabetes management could affect the healing of wounds, thus indicating the relevance of education to assist patients in their self-care.
Workplace health promotion: Employee and employer perspectives.
This research explored employee and employer experience of a 10-week workplace health promotion programme. Findings included the identification of barriers and enablers related to the workplace health promotion programme in relation to participation, communication and information; tailoring and targeting issues; and health behaviour change and modification.
Compassion fatigue and cancer nurses – A national survey of cancer nursing in New Zealand Nurses who work with cancer patients are at risk of what is termed “compassion
fatigue” by the nature of the close relationships they have with family/whanau.
This research sought to identify the experiences of nurses who provide care for such patients. Findings indicated nurses were satisfied with their work and shared a belief that they could make a difference to cancer patients, although some cancer nurses had difficulty separating work and personal life, and others suffered insomnia. A major finding was the lack of education on managing the stressors of caring for cancer patients.
Management of patients on chemotherapeutic treatment for advanced cancer with acute conditions in the Emergency Department
This research explored the experiences of nurses from emergency departments of clinically high risk cancer patients who were on chemotherapy. Findings indicate that care delivered within the ED is urgency-driven and chemotherapy itself may have little influence on the interventions provided. Challenges arise through patient complexity, and lack of oncology specialist availability in the ED. Care may be more influenced by local hospice teams due to established relationships with the ED.
Discharge planning at a regional New Zealand hospital emergency department:
Screening elderly patients for early multidisciplinary team referral using the elder’s risk assessment index Emergency department use among elderly patients is increasing and early riskscreening of the elderly can help predict the need for multi-disciplinary-team input. This research investigated the potential for the Elder’s Risk Assessment Index score to predict multi-disciplinary-team (MDT) referrals of the elderly who are discharged home from the emergency department. Data analysed from 1376 patients identified that 175 patients were referred to the MDT, but inconsistencies among elderly patients selected for MDT referral were also found. This confirms the necessity for a standardised referral process, which would be supported by a valid risk-screening tool.
Factors influencing outpatient cardiac rehabilitation attendance
This research explored whether the delivery and content of inpatient cardiac rehabilitation meets patient expectations, and if inpatient cardiac education influenced a patient’s decision to attend outpatient cardiac rehabilitation programme. Findings showed 50% of people would have liked more information in hospital. Only 37% attended outpatient cardiac rehabilitation on discharge; some of the reasons given for not attending were lack of referral and that people understood only some or none of the information given to them while in hospital. The findings also highlighted the cardiac rehabilitation nurse was the health professional who consistently recommended outpatient cardiac rehabilitation.
What are the barriers and enablers to emergency department nurses’ management of patients’ pain?
Pain is the most common reason for presentation to the emergency department. An anonymous online survey examined factors perceived by nurses as barriers or enablers to managing a patient’s pain. Barriers identified were the responsibility of caring for other acutely ill patients, lack of time, workload, reluctance of clinicians to prescribe analgesia and the lack of nursing knowledge regarding opioid administration. Enablers identified were the provision of nurse-initiated analgesic protocols and pain management champions. It is envisioned that by implementing these enablers, nurses, by virtue of their role, are in a unique position to be leaders in pain assessment and pain management in emergency departments.
Annatjie was awarded the Hawke’s Bay District Health Board Director of Nursing Award for Excellence in Postgraduate Nursing Study
What are the information needs of patients receiving procedural sedation in the emergency department?
A descriptive exploratory study. This research interviewed patients who had recent experience of receiving sedation in a regional New Zealand Emergency Department (ED), as well as nurses and medical staff with direct experience of monitoring and providing procedural sedation in the same ED. Patient trust resulted from consistent and repeated verbal
information from multiple members of a cohesive team, without the requirement for additional written information. Information needs identified by all participants
as contributing to feelings of safety and trust were: explanations of progress, delays, procedures and environment; repetition and clarification of information using a
whole team approach and medico-legal and risk versus benefit information.
What are the barriers and enablers of using the focus charting format in the hospital setting?
Nursing documentation is important in providing safe and effective healthcare to patients. This research sought to identify the barriers and enablers to using a focus
charting format in one hospital setting. Fifty one per cent of participants believed they had adequate education to successfully use focus charting, however a barrier
to its successful use was insufficient education and on-going support. Sixty six per cent of participants believed using the focus format improved the quality of nursing
documentation. More positive responses were received from nurses with less than 5 years experience, compared to those with more than 10 years experience in terms
of education, quality of documentation and retrieving information.
New Zealand nursing students’ experiences of ethical issues in clinical practice:
A descriptive study. This research aimed to identify the most frequently experienced ethical issues, and the level of distress that nursing students feel when faced with these issues.
A questionnaire incorporating ethical issues related to patient rights and patient care was distributed to members of the New Zealand Nurses Organisation National Student Unit. Unsafe working conditions proved to be the most commonly occurring and one of the most distressing ethical issues facing nursing students.
Other issues included breaches of ethical principles such as confidentiality, privacy, dignity and respect. The most distressing issues were those that compromised patient safety. Themes that emerged from participants’ responses included lack of support and supervision, bullying, and end of life issues. Developing ethics education around concerns that students have in clinical practice may enhance students’ understanding of the issues and their ability to respond appropriately.
Stories of yesterday. Reflections on collegiality: Capturing the essence of nurses working with nurses
This research involved gathering “long serving” nurses’ stories about their experiences of practising nursing and, in particular, their experiences of collegiality,
within the context of hospital nursing in New Zealand in the 1970s and 1980s. These stories provided a richness of personal experience, and were indicative of fun, humour, shared experiences and camaraderie, in an environment that was busy, demanding and often challenging. The narratives provide a valuable collection of real life experiences from a different era in nursing and will add to our understanding of nursing history in New Zealand.
The impact on the family of living with a child with Type 1 diabetes
This research explored parents’ experience of living with a child with Type 1 diabetes. Interviews with nine parents/caregivers of a child who had been diagnosed with Type 1 diabetes within the previous 12 months indicated a number of issues. These were disruption to family life; impact on family relationships; the psychosocial effects of living with Type 1 diabetes and adaptation to a ‘new normal’. Findings also revealed the considerable level of understanding and support required to competently foster optimal diabetes care for children.
Nurse perceptions of the challenges of providing self-management education in primary health care to people with newly diagnosed Type 2 diabetes
Nurses’ perceptions of challenges in providing self-management education to patients newly diagnosed with Type 2 Diabetes were the focus of this work. Practice Nurses with a special interest in diabetes were interviewed regarding their knowledge base, training backgrounds, the content of patient education, and the usefulness of current guidelines.
Findings identified many nurses’ practice had evolved to encompass more complex aspects of diabetes education and care, differing from past diabetes primary care nursing roles. Patient education needs depended on what nurses perceived to be necessary. National diabetes management guidelines were considered useful as a guide for providing