Zealand Nurses Research Articles

Teaching Cultural Safety in a New Zealand Nursing Education Program

Cultural safety education is a concept unique to nursing in New Zealand. It involves teaching nursing students to recognize and understand the dynamics of cultural, personal, and professional power and how these shape nursing and health care relationships. This article describes the findings of a research study on the experience of teaching cultural safety. As a teacher of cultural safety, the first author was interested in exploring the experience of teaching the topic with other cultural safety teachers. A qualitative approach situated in a critical theory paradigm was used for the study. The study was informed by the ideas of Foucault and feminist theory. Fourteen women between ages 20 and 60 were interviewed about their experience of teaching cultural safety. Five women were Maori (the indigenous people of New Zealand), and 9 were Pakeha (the Maori name for New Zealanders of European descent). Following data analysis, three major themes were identified: that the Treaty of Waitangi provides for an examination of power in cultural safety education; that the broad concept of difference influences the experience of teaching cultural safety; and that the experience of teaching cultural safety has personal, professional, and political dimensions. These dimensions are experienced differently by Maori and Pakeha teachers.

Anna Rogers, While you're away: New Zealand nurses at war 1899–1948, Auckland University Press, 2003, pp. x, 352, illus., NZ$39.99 (paperback 1-86940-301-0).

In 1899 Britain's army nursing service had fewer than eighty staff but when the Anglo-Boer War ended in 1902 there were around 1,700 British, Australian and New Zealand nurses in South Africa. New Zealand contributed approximately thirty nurses to this endeavour, a number small enough to permit Anna Rogers to profile each individual. This attention to detail is one of the strengths of While you're away. Following the outbreak of the First World War, the recently constituted Dominion sent six nurses to the former German colony of Samoa as a prelude to the formation of the New Zealand Army Nursing Service. In April 1915 the first dozen nurses sailed for Egypt; others served on hospital ships, at the Western Front and in New Zealand's war hospitals in England. Each of these spheres is allocated a separate chapter, as is the work of the 100 or so New Zealand girls who served the Red Cross or other British and French organizations. One recurring theme in the sections dealing with conflicts to 1918 is the struggle of the more relaxed and informal New Zealand and Australian nurses to come to terms with British class distinctions, anti-colonial prejudice, and “hide-bound British military tradition” (p. 151). This discomfort also affected the colonial soldier patients, many of whom were delighted to be under the care of their own countrywomen. Two chapters are devoted to the interwar years. The first explores the problems faced by these military nurses in the aftermath of the the First World War and the second summarizes the efforts of the handful of New Zealanders who nursed in the Spanish Civil War. The last seven chapters are devoted to New Zealand nurses during the Second World War, arranged according to the different spheres where New Zealand troops played a significant part—North Africa, Greece and Crete, Italy, the Pacific and Japan. There are also case studies of nursing aboard hospital ships, and of the voluntary aids who complemented the fully trained staff. ‘Faraway Places’ recounts the experiences of nurses and voluntary aids serving with British units, including some who had the misfortune to become prisoners of war. One of the strengths of this book is the liberal use of diaries, personal correspondence and interviews conducted by the author and others. These vividly illuminate the hopes and fears of three generations of military nurses, and the arduous conditions under which many of them worked. Some of these vignettes are poignant in the extreme while others reveal a rich vein of humour; I especially liked the account of the shrinking uniforms of the first group of voluntary aids sent overseas in 1941. Rogers is also to be commended for her use of primary sources when retelling relatively familiar events, such as the 1915 sinking of the Marquette in which ten New Zealand nurses perished. One disappointing feature is the failure at times to locate nursing in the wider historical context. Isobel Dodds, for example, who tended International Brigade members during the Spanish Civil War, is described as the daughter of a “politically active pacifist father who was a friend of Peter Fraser and knew Bob Semple and Paddy Webb” (p. 189). We are not told, however, that all three were MPs in New Zealand's first Labour government of 1935–49. By the same token, the text would have been enriched by a fuller explanation of the tantalizing references to the introduction of penicillin (pp. 222, 246, 306). Overall, however, this is a valuable addition to the story of New Zealand nursing, and to the historiography of the changing relationship between Mother England and its colonial offspring. As Rogers notes in her final paragraph, those New Zealanders who served overseas learned “what it meant not to be British”.

Aoteaoroa/New Zealand nursing: from eugenics to cultural safety...

The concept of cultural safety offers a unique approach to nursing practice, based on recognition of the power differentials inherent in any interaction. It is from within the context of nursing in Aoteaoroa/New Zealand (A/NZ) that the concept developed and was subsequently integrated into nursing education. Cultural safety is based within a framework of biculturalism, and is congruent with the tenets of the nation's founding document, the Treaty of Waitangi. Clarification of the concept is offered, together with a review of the historical shift in nursing attitudes that has led to the emergence of "cultural safety" as a viable and valued component of nursing practice. The argument is made that cultural safety has allowed for a more reflective, critical understanding of the actions of nursing to develop. This includes recognition that nurses' attitudes and values have inevitably been influenced by social and political forces, and as such are in part reflective of those within the wider community. Comparison between the support given by nurses in the early 1900s to the theory of eugenics and the current acceptance of cultural safety is used to highlight this point. An examination of the literature identifies that ideological and conceptual changes have occurred in the approach of A/NZ nurses to issues with cultural implications for practice. A review of background factors relating to Maori health status and the Treaty of Waitangi is presented as a necessary context to the overall discussion. The discussion concludes with an acknowledgement that while the rhetoric of cultural safety is now part of nursing culture in New Zealand, there is no firm evidence to evaluate its impact in practice. Issues identified as impacting on the ability to assess/research a concept, such as cultural safety, are discussed. For cultural safety to become recognised as a credible (and indispensable) tool, it is necessary to further examine the "end-point" or "outcomes" of the process.

While You're Away: New Zealand Nurses at War 1899-1948

Captures the brave and moving story of the New Zealand women who nursed overseas in the South African War, World War I, the Spanish Civil War and the various theatres of World War II. They enlisted for much the same reasons as their male counterparts - duty, patriotism, adventure - and they endured many of the same dangers and discomforts. But their experience was very different from that of the men they nursed. Drawing on diaries, letters, interviews and a range of other sources, this book focuses on their personal experiences and memories, to give a picture of the courage, adaptability, practicality, humour and strength of these remarkable women.

Cross-Cultural Perspectives in Palliative Care

Patients with advanced, irreversible disease need palliative care in both developing and developed countries. The philosophy of palliative care is universal. Despite differences among individuals and cultural groups, basic needs, cares, and wants are common to humankind. For truly effective palliative care, cultural subtleties and nuances must be considered. Challenging assumptions based on one's own culture is essential to the development of knowledge and insight into others. Keeping open minds about what is new or different within different cultures where we provide care can extend and intensify quality of care. This paper reflects the author's experience as a New Zealand Nurse and of her visit to the Pain and Palliative Care Clinic in Calicut, India. This was a journey that crossed cultural boundaries and it illustrates the importance of building bridges to care.

Nursing people from cultures other than one's own: A perspective from New Zealand

ABSTRACTNursing a person from another culture is a dynamic, complex and tension-filled phenomenon. It is also always culturally and historically situated.This paper provides an overview of the evolving meaning of ‘culture’ in New Zealand nursing.Then, drawing upon the findings of research that used hermeneutic phenomenology to explore the experience of nursing people from cultures other than one's own, a description of the constituent parts is of this phenomenon is briefly outlined and followed by an exemplar that describes the coalescent and contradictory nature of the phenomenon as a whole. As New Zealand nurses negotiate the conflicts essential for ongoing development of their practice, interplay of the notions of prejudice, paradox and possibility is evident at intrapersonal and interpersonal levels as well as in relation to professional and other discourses.

Win-win-win: Collaboration advances critical care practice

Against a background of increasing interest in education post registration, New Zealand nurses are working to advance their professional practice. Because the acquisition of highly developed clinical capabilities requires a combination of nursing experience and education, collaboration between clinicians and nurse educators is essential. However, the accessibility of relevant educational opportunities has been an ongoing issue for nurses outside the country’s main centres.Within the framework of a Master of Health Science, the postgraduate certificate (critical care nursing) developed between Auckland University of Technology and two regional health providers is one such example. Students enrol in science and knowledge papers concurrently then, in the second half of the course, are supported within their practice environment to acquire advanced clinical skills and to analyse, critique and develop practice within their specialty.This paper provides an overview of the structure and processes of an eighteen month, distance education course focused on developing advanced practice in the context of critical care nursing.

Advanced nursing practice - evolution or revolution?

This article has been written to challenge the seemingly unquestioning acceptance of changing roles in New Zealand nursing. It is evident in nursing history that a number of issues, such as community versus hospital services and generalist versus specialist practice, tend to resurface in a cyclic manner. Characteristics that are currently associated with 'advanced' nursing roles can be recognised when the origins and development of nursing in New Zealand are traced. This gives rise to speculation that changes to nursing scope of practice are not so much revolutionary as evolutionary, and can perhaps be viewed as a reclaiming rather than a redefining of nursing roles.

Burnout: Results of an empirical study of New Zealand nurses

Burnout is conceptualised as a syndrome consisting of three components-emotional exhaustion, reduced personal accomplishment and depersonalisation of clients or patients that occurs in individuals who work in the human service professions, particularly nursing. It has been observed that nurses are at a high risk of burnout and burnout has been described as the ‘professional cancer’ of nursing. This is the first New Zealand study to use the Maslach Burnout Inventory (MBI) and the Phase Model of Burnout to determine the extent and severity of burnout in a population of 1134 nurses. Results revealed an overall ‘low to average’ level of burnout, suggesting that New Zealand nurses, apart from those in the 41—45 age group, are doing better than expected insofar as they are managing to avoid or not progress to the advanced phases of burnout. Possible explanations and directions for future research are presented.

On the brink of change? Implications of the review of undergraduate education in New Zealand for mental health nursing.

A New Zealand Nursing Council review of undergraduate education provides an ideal opportunity to make much needed changes to the system of preparation for mental health nurses. This article critiques comprehensive nursing education through an examination of its history in New Zealand, recent mental health reports and a projected estimate of workforce needs. Historical analysis reveals a process of marginalization and invisibilization of psychiatric/mental health nursing within comprehensive programmes with a consequent reduction of skills and a weakening of the profession. The author concludes that psychiatric/mental health nursing is a distinct scope of practice which requires specialty undergraduate preparation.

Practice nursing in New Zealand

The New Zealand Nurses Organisation (NZNO) represents 60% of nurses in New Zealand and one third of general practice nurses are members (Docherty, personal communication). The NZNO has a Practice Nurse Section which has a similar role to that of the RCNs Practice Nurse Association. Marion Guy has recently been re-elected as Chair of the Practice Nurse Section and, with her Executive Committee, represents the interests of practice nursing at a national level within New Zealand.

Nurses face the same problems worldwide.

I have recently returned from a visit to New Zealand. It was interesting that the problems facing New Zealand nurses are strikingly similar to those of nurses in Britain. For example, they are concerned about pay, staff shortages, workloads and skill mix. They are also increasingly having to rely on the support of unregulated caregivers. Although all their nurse training is at graduate level, continuing specialist nurse training is difficult to access, and nurses are expected to pay for postregistration education themselves. There is also no formal postregistration training to prepare nurses for the role of district nurse.

Increasing patient numbers: The implications for New Zealand emergency departments

Within the New Zealand (NZ) health care system, a number of changes have affected the way health care is accessed and delivered. Emergency Departments (EDs) are noticing increased attendance of patients with minor or non-urgent conditions. This increase in patient volume, together with on-going fiscal constraints and restructuring, has placed an added strain on the functioning of EDs. New Zealand nurses need to question the role currently given to EDs and identify the issues surrounding the increased use of these departments for primary health care. Is this move feasible in the NZ environment, and what are the implications for emergency nurses?

Mentoring relationships of New Zealand nurses: results of an empirical study (part 2)

The first national study of mentoring relationships of New Zealand nurses used three issues from the descriptive literature as its conceptual framework. The results and discussion of the study are reported in part two. Results demonstrated that moderate levels of mentoring according to Kram's (1985) typology occurred amongst nurses and that they had many supportive relationships, mainly with women who were peers. The characteristics of nurses' mentoring relationships did not differ significantly from mainstream empirical data when factors such as gender, organisational status, age differences and duration of relationships were considered. Concerns about the future direction of mentoring research and in particular about recent international literature calling for the development of a separate mentoring theory for women conclude the article.

Mentoring relationships of New Zealand nurses: an empirical study (part 1)

A national, random, postal survey (n = 298) of mentoring behaviour among New Zealand nurses was undertaken. The initial research problem was to seek an explanation for the apparent lack of mentoring in New Zealand nursing. However, as the study evolved the lack of agreement concerning the definition of mentoring became a major research obstacle. A new conceptual framework of mentoring grounded in the work of Kathy Kram (1985) was devised. A quantitative global measure of mentoring behaviour (the TMS score) was used to measure levels of mentoring behaviour. This score was used as the dependent variable in subsequent statistical tests of: the definitional hypothesis-the study's validity check; the peer mentoring hypothesis which explored selected dynamics of mentor protégé relationships, and four allied research questions. The conceptual framework and approach are discussed in part one.

Holistic nursing in New Zealand.

New Zealand nurses are active and dynamic emerging holistic practitioners. Despite an economic recession and dramatic changes in their health care delivery systems, the country's holistic nurses have mobilized to develop and begin a holistic nurses' association. Holistic nurses from both islands have begun independent practices using complementary therapies and modalities. Although New Zealand is distant from North America geographically, there have been increasing numbers of exchange visits and subsequent influence on international holistic nursing practice. New Zealand, being a lush, green, clean, semitropical country in the South Pacific, is a wonderful place for North American nurses to experience cross-cultural nursing while still being in an English-speaking country.

Health Sector Collective Bargaining and the Employment Contracts Act: A Case Study of Nurses

This case study describes and analyses the negotiation of a collective employment contract between an area health board management and regional representatives of the New Zealand Nurses Association during the first set of negotiations conducted under the Employment Contracts Act 1991. The study found that, contrary to claims by the Act's proponents, the Act does not lead to improved co-operation and communication between employers and employees. However, a high level of communication and co-operation was evident in the employee-union relationship, and it was found that certain provisions of the Employment Contracts Act afford employees greater power to determine their conditions of employment.

Investigating the frequency of nursing stressors: A comparison across wards

Intensive care unit stress has become an area of expanding enquiry. However the research evidence suggests that certain kinds of stressors are commonly encountered by all nurses irrespective of their nursing speciality. The frequency with which a range of stressors occured in different wards was examined by using a nation-wide sample of 2500 New Zealand nurses. The results indicated that while intensive care-critical care wards were on average more likely to experience “ difficulties involved in nursing the critically ill” than other wards, medical, continuing care and orthopaedic wards experienced in comparison more stressors more frequently. These results were discussed in terms of their implications for intervention and training.

Identifying the causes of nurses' stress: A survey of New Zealand nurses

Abstract A nationwide survey of 2500 general and obstetric nurses identified five potential sources of stress. These included work overload, difficulties relating to other staff, the difficulties involved in nursing the critically ill, concerns over the treatment of patients, and dealing with difficulty or helplessly ill patients. These findings support earlier work which suggested that a number of stressful situations are commonly encountered by all nurses. In terms of intervention strategies these results point to a number of important issues which are discussed in this paper. They include the difficulties and conflicts inherent in the nurses' role, the multidimensional nature of the different stressors, aspects of the work environment which give rise to different stressors and the relationship between stressors.

Variables important in the selection of New Zealand nurses: implementation and evaluation of a multivariate selection technique

Variables important in the selection of New Zealand nurses: implementation and evaluation of a multivariate selection technique