Nursing Dissertations and Theses

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    Dialysis nurses discussing advance care planning and death and dying with patients
    (2017) Hay, Sandra; Eastern Institute of Technology
    BACKGROUND Dialysis nurses in New Zealand look after dialysis patients dealing with a chronic life-limiting illness: end stage kidney disease. The nurses often develop close relationships with their patients and become involved in discussions about death and dying with them and their families. These discussions are often awkward and nurses may not think they are the right people to have the discussions. Previous overseas studies have shown that dialysis patients and their families want to have the opportunity to talk about their prognosis and expected length of life on dialysis. AIM The aim of this study was to investigate the experiences of dialysis nurses when discussing advance care planning (ACP), and death and dying with their patients. More specifically, the study sought to understand the factors which impact on nurses’ ability to have such conversations. METHOD A qualitative descriptive approach underpinned the study. Using purposive sampling, seven dialysis nurses from four New Zealand District Health Boards were recruited as participants. They were interviewed by telephone using a semi-structured interview guide, and the transcribed audiotaped data was then subject to thematic analysis. The interview asked questions about the nurses’ experiences with ACP and death and dying conversations, and about their feelings when discussing such topics. FINDINGS The findings revealed an overarching theme about what was necessary to get the discussion about ACP, and death and dying right for patients. There were four associate sub-themes: the right time; the right place; the right person; and, the right resources. CONCLUSION Discussing ACP and death and dying with patients can be uncomfortable for dialysis nurses. The nurses struggled to find the right time and most appropriate place to embark on the conversations. They spoke of how the doctors are often the health care professionals that initiate the conversation about ACP with dialysis patients, but that it is not necessarily done at the right time for the patient in order for them to absorb the information. Having the right resources to support the discussions is important for the success of ACP, as is accurate documentation that ACP conversations have taken place. The nurses and other renal healthcare disciplines require initial and on-going education on ACP to ensure it is offered to all dialysis patients at the most appropriate time in the patients’ illness trajectory. The nurses require support from employers and managers to carry out the discussions to ensure it is successful for the patients. A renal specific framework on ACP would provide structure to the ACP process, and guide renal health care professionals to understanding ACP, and undertaking ACP discussions.
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    What makes a good preceptor? Perspectives of recent new graduate Registered Nurses in New Zealand.
    (2017) Krawczyk, Michell; Eastern Institute of Technology
    BACKGROUND In the first year of a Registered Nurse’s career, there is a need for support to provide the opportunity for these Registered Nurses to develop relationships, increase confidence and competence, and build on their knowledge base. A preceptor plays an important role to ensure the successful outcome of this phase. Preceptors need to give the required support to ensure new nurses can develop from a graduate (advanced beginner) Registered Nurse to a competent Registered Nurse. With a current shortage of Registered Nurses and over fifty percent of the current Registered Nurse work force predicted to retire by 2035, it is important to retain these new Registered Nurses to overcome this deficit. RESEARCH QUESTION AND OBJECTIVE The research undertaken for this thesis sought to answer the question “What makes a good preceptor?” The primary objective for this research was to determine from recent New Graduate Registered Nurses (NG-RN) what attributes make a good preceptor. These attributes may lead District Health Boards and other healthcare providers to look more closely into whom they choose to be preceptors. METHOD The research undertaken was of a quantitative design, with the option of free text answers, which provided some qualitative data. An electronic questionnaire encompassing 14 questions was designed using SurveyMonkey®. The weblink to this questionnaire was sent via email to 120 recent NG-RNs in three District Health Boards, who had completed the Nurse Entry to Practice programme between 2013 and 2016 and were still employed by the District Health Board. RESULTS The response rate from the 120 questionnaires sent out was 25% (n=30). The quantitative results have shown four main characteristics required of a preceptor: support from the preceptor and a supportive working environment, knowledge sharing, teaching of new skills and feedback. Other characteristics that rated highly were guidance, approachability and patience. The quantitative data also showed that the level of confidence post preceptorship, compared to pre-preceptorship, was rated by the participants as good or better, but that the participant preceptorship experience had no impact on 50% of the respondents’ intention to remain in nursing employment. Those that stated the preceptorship experience had an impact on their decision to remain in nursing employment, said they stayed mostly due to having a supportive preceptor and working environment. Four key themes emerged from the qualitative responses relating to beneficial attributes of a good preceptor: support, which involved both feeling supported and receiving this support; knowledge, which involved both being knowledgeable and sharing of this knowledge; feedback, including the type and how it was given; and teaching, which involved the teaching of new skills and at an appropriate level, with support being the most common theme throughout the study. These were similar to the quantitative results. CONCLUSION The study identified many characteristics which make a good preceptor, with support, knowledge, feedback and teaching being the four main characteristics. The respondents were, in general, well supported in their first year of nursing. A supportive preceptorship increased confidence and influenced the NG-RN to stay in their nursing employment. Providers who run preceptor programmes need to continue to ensure they are selecting appropriate preceptors and ensure more regular time for preceptors and NG-RNs to spend together.
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    The effect of a long-term condition management programme on hospital presentations: A retrospective three group study.
    (2017) Mason, Sara; Eastern Institute of Technology
    BACKGROUND The Trajectory of Long Term Care Model (TLC) provides a framework for directing appropriate care to patients depending on where they are in the trajectory of their illness. It recognises that patients with long-term conditions (LTC) frequently move between different levels of healthcare services and escalates care depending on need. The Pulmonary Long-term Management (PLTM) Community Nursing Service developed a service based on the TLC model. The aim of this study was to ascertain if any reductions could be seen in emergency presentations or hospital admissions for patients who had participated in the PLTM service. METHODS This study applied a quasi-experimental, retrospective design using a total of 287 participants. Presentations and admissions to hospital were analysed for both respiratory disease and overall LTC. To explore the differences between the groups (one-hour intervention, ten-week intervention, and non-participation group) general linear models were generated for emergency presentations and hospital admissions within LTC or respiratory disease. If a significant difference between the groups were detected, then pairwise comparisons were performed using Bonferroni corrections. RESULTS When examining LTCs the ten-week intervention showed 75.7% less emergency room presentations compared to the non-participation group (p=0.006) and a 58.9% less hospital admissions compared to the non-participant group (p=0.008). Interestingly, no significant differences were found between the one-hour intervention group and the ten-week intervention group for emergency room presentations (p=0.677), admissions to hospital with LTCs (p=1.0), emergency presentations with respiratory disease (p=1.0) or admissions to hospital with respiratory disease (p=1.0). CONCLUSIONS Statistically significant reductions in hospital utilisation were seen when examining LTCs but not respiratory disease. This is noteworthy given that this study also found an average of three LTC per participant. This study could have significant implications for LTC management strategies especially given the difficulties seen in enrolment, participation and retention in LTC management programmes. Continuing inequities in health provide an argument for improved access to alternative choices in LTC management.
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    The perceived benefits of structured simulation sessions on the development of critical thinking for nursing students.
    (2017) Nichols, Rebecca; Eastern Institute of Technology
    BACKGROUND The education of New Zealand (NZ) nurses has changed rapidly over the last four decades to address the changing role of the New Zealand registered nurse (RN). One of the most significant changes in nursing education is the use of high fidelity simulation in clinical education Structured simulation is an innovative, interactive teaching methodology that can be used as a clinical adjunct to support critical thinking and confidence in nursing students and new graduates. This study was undertaken to investigate whether structured simulation sessions support the development and application of critical thinking skills from the perspective of year two undergraduate nursing students. METHOD A quantitative descriptive study was undertaken for this research. Twenty-five year two students completed an online questionnaire following participation in structured simulation sessions and a three-week clinical placement. Data were analysed thematically using the survey questionnaire tool SurveyMonkey™ and using Thomas’s (2006) inductive reasoning approach. RESULTS The students perceived structured simulation sessions were beneficial in the development of critical thinking; simulation improved their confidence levels and enabled them to apply these skills in the clinical environment. Students need to learn in a safe, supportive, non-judgemental environment. The simulation environment and level of realism is key to reducing student anxiety and maximising the level of engagement and learning for the student. The debriefing component was the most valued aspect of simulation where much of the consolidation of learning, critical thinking and confidence development occurred. CONCLUSION This study supports the role that simulation has in developing critical thinking skills and improving confidence in undergraduate nursing students and provides evidence that simulation is a valuable tool for students to practise nursing skills and apply nursing theory into clinical practice. It is recommended that simulation be embedded into undergraduate nursing programmes to support the development of critical thinking and the application of theory to practise. The structure and delivery of the simulation is crucial to optimise student engagement and learning.
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    How can we best support registered nurses transitioning into emergency nursing?
    (2017) Richmond, Victoria; Eastern Institute of Technology
    One in four New Zealanders attend the emergency department, in New Zealand, each year. The emergency department is a dynamic and challenging environment, which requires nurses to have advanced assessment skills and clinical-reasoning. There is no universal approach in New Zealand to supporting registered nurses transitioning into emergency nursing. There is limited available literature, which explores this group of nurse’s experiences. This research project aimed to explore what registered nurses transitioning into emergency nursing found supportive in their transition and to identify the current supports that were available in their place of work. A qualitative method with a descriptive exploratory design was utilised to gain an understanding of participant experience and provided rich data for the study. Thematic analysis has been used to keep the data true to participant experience, this has also allowed the data to be organised and arranged into themes and sub themes. Findings from this research suggest that supporting nurses transitioning into ED requires an individualised approach. Participants have identified that the transition to emergency nursing is influenced by support from peers within the department and hospital and is influenced by prior professional and personal experiences. The dominant themes identified in this research are quality preceptorship, continuing education, and safety in practice. A recommendation for developing a New Zealand specific programme to support registered nurses transitioning to emergency nursing has been suggested, alongside a framework for transition to specialty practice that has been developed in Australia. This research adds to the paucity of knowledge surrounding registered nurse transition to emergency nursing and provides information for those who support nurses in emergency departments.