1,720,963 research outputs found
Internationally Qualified Nurses’ Perceptions of How the New Zealand Registered Nurse Competency Assessment Programme Enabled Transition to Clinical and Culturally Safe Nursing Practice in Aotearoa New Zealand
No full textAotearoa New Zealand faces a workforce shortage of nurses nationally. One current approach to address the labour deficit is recruiting internationally qualified nurses (IQNs) into the workforce. Undertaking a competency assessment programme (CAP), entailing targeted study and clinical assessment, supports IQNs to meet Nursing Council of New Zealand requirements for nursing registration in Aotearoa. However, CAP providers offer the course with diverse approaches and there are no standardised curricula. Furthermore, to date, there is no empirical evidence on the utility of the CAP for IQNs regarding how well the programme meets its intended objectives from the perspective of the IQNs. This research aimed to identify the elements of the CAP that a specific cohort of IQNs found relevant and useful in their first two years of working as a registered nurse (RN) in Aotearoa. A secondary aim was to ascertain if, and how, the course was perceived to enhance their acculturation into the Aotearoa nursing profession.
A qualitative research method of focused ethnography framed the methodological approach. Semi-structured interviews occurred with purposive sampling of CAP graduated IQNs from the Philippines and India, representing the largest practising IQN groups nationally. Twelve participants—eight from the Philippines and four from India—with between 3 and 17 years working as RNs in Aotearoa, were recruited from the upper North Island of Aotearoa. Thematic analysis of the data resulted in two main themes describing the participants’ experiences on the CAP: 1. navigating new professional practice and 2. the need for language proficiency and positive social support. Sub-themes arising were unfamiliarity with new clinical areas and nursing roles, feeling deskilled, and misunderstanding the healthcare concepts of cultural safety and te Tiriti O Waitangi. In addition, communication barriers, with English not being a native language, Aotearoa accents and new professional terminology, significantly influenced their experiences. Finally, novel research findings were the participants’ new understandings of the symmetrical power balances between healthcare professionals in Aotearoa and recognition of the importance of the support gained from engaged and knowledgeable clinical preceptors.
This research found that the participants did not view their CAP experience as having a significant impact on learning new clinical skills, knowledge, or experience of their host country’s nursing workplace. Additionally, the curricula were not seen to have provided substantial educational and clinical experience benefits regarding the Aotearoa cultural context with the exception of specific cultural practices (Tikanga) and their application to nursing service provision for Māori. Recommendations from the research are for a comprehensive multiple stakeholder review of the current CAP curriculum, specifically regarding the clinical practice model used for recontextualising nursing practice and transitioning IQNs into the Aotearoa workforce, and the provision of targeted te Tiriti O Waitangi healthcare education: and the potential for new registration pathways in-keeping with recent global trends with a focus on key nursing knowledge examinations, and mandatory modules on Aotearoa cultural context. A further recommendation is – the inclusion of extended orientation periods and mandating a period of professional supervision for IQNs in post-registration employment period
An Exploration of Current Primary Care Practice Regarding Osteoporosis Assessment Following a Low Trauma Wrist Fracture in people aged 50 years and above in Wellington, New Zealand: A Quantitative Survey
No full textOsteoporosis remains a major health issue worldwide. The impact of the condition and the fractures that can occur, can have significant debilitating impact and also incur substantial financial costs to healthcare systems. The burden of osteoporosis and the rate of osteoporotic fractures in New Zealand is comparable to other countries such as Australia, the United States and Europe. There is global literature evidence dating back as far as 1960, indicating that a fracture sustained after a simple trip or fall can be an indicator of osteoporosis. There is a need to ensure that fracture patients with a potential osteoporosis diagnosis, receive follow up care for assessment to treat any underlying bone health issue to prevent future fragility fractures, particularly, hip fractures. Due to limited formal literature sources describing the associated New Zealand context, the aim of this research work was to explore current practice for osteoporosis assessment following a fragility wrist fracture in the general practitioner (GP) primary health care setting in Wellington, New Zealand.
A quantitative cross-sectional descriptive survey of Wellington GPs was undertaken for this purpose. The reporting of study results were guided by the recommendations detailed within the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement on reporting observational studies (Vandenbroucke et al., 2014). 35 out of 297 GPs from 60 practices in the Wellington region responded to the survey. When describing the local context in Wellington, New Zealand, study results showed that almost three quarters of Wellington GP survey respondents follow up patients who have sustained a potential fragility wrist fracture. The discharge summary was also shown to be a vital part of the communication process between the tertiary and primary health care sectors, acting as a prompt to the GP for further investigation. The single biggest barrier inhibiting processes to enable timely osteoporosis treatment as perceived by GP survey respondents, was lack of public funding, in particular to support availability of diagnostic Dual Energy X-ray Absorptiometry (DEXA) scanning.
Other barriers were identified by the GP survey respondents, such as anti-osteoporosis medication side effects, patient compliance to treatment plans and a lack of time within the scheduled consultation to screen patients for osteoporosis. The main educational resources that a large percentage of GP survey respondents independently accessed on a regular basis, were those that were readily available. These included GP guidelines published by “Osteoporosis New Zealand” and possibly other, and online resources such as “Health Pathways” (a best-practice, condition-specific guideline and information resource for primary health care practitioners - https://3d.healthpathways.org.nz). The results also highlighted that most GP survey respondents preferred to take the lead role in the care for patients needing to undergo osteoporosis investigation and treatment. In addition, the GP survey respondents demonstrated a high level of knowledge regarding osteoporosis risk factors.
In summary, this study has identified features of practice with regards to osteoporosis assessment following a fragility wrist fracture in the Wellington region. In addition, this study has also enabled identification of specific areas that could be better supported and resourced to assist GP’s in the prevention of secondary fragility fractures. These include highly visible public health campaigns to raise public awareness of osteoporosis and education to GP’s regarding the available screening tools. A significant finding was also that the GP respondents in this study indicated they considered that an important part of their role was responsibility for osteoporosis prevention and treatment. The study results also highlight that despite funding issues, GP survey respondents view osteoporosis prevention and treatment as best placed in the care of the primary health care sector.
This is the first New Zealand study that has identified and described the local context around current practice for fragility wrist fracture care within the Wellington GP community, establishing important reference points which can be used to support further development and research
Anthroposophic Nursing in Aotearoa New Zealand: How Do Anthroposophically Educated Registered Nurses Use the Anthroposophic Paradigm to Inform Their Practice? An Interpretative Descriptive Approach
No full textThis study explores the way registered nurses who have completed further education in anthroposophic nursing apply this knowledge to patient care in Aotearoa New Zealand. Anthroposophic medicine and healthcare are based on anthroposophy, a spiritual philosophy of human existence first articulated by the Austrian philosopher Rudolf Steiner at the start of the 20th century. Healthcare extended with anthroposophic foundations focuses on a holistic, multidisciplinary and person-centred approach which considers the person’s physical, emotional, and spiritual needs. In Europe, anthroposophic healthcare and medicine are integrative health practices offered in hospital and community settings renowned for holistically supporting and benefiting patients with various health conditions.
A qualitative research design (interpretative description [ID]) was used to investigate the research question and aims. Eleven (11) semistructured interviews were conducted to gain insight into how registered nurses inform their practice with anthroposophic concepts and foundations. Eligible participants had completed an internationally accredited education pathway to anthroposophic nursing in Aotearoa New Zealand and held a current annual practising certificate (APC). Six (6) of the 11 participants had completed the requirements to become anthroposophic nurse specialists (ANS).
I analysed the data using the four steps of Morse’s (1994) cognitive processing framework. Three key themes were identified: “Our way of being,” expressions of anthroposophic nursing practice, and negotiating place: nursing with anthroposophic foundations in Aotearoa New Zealand.
The findings of this study contribute to a better understanding and awareness of anthroposophic nursing as a person-centred, holistic approach to care. With its emphasis on spiritually integrated caring interventions, participants articulated the anthroposophic paradigm as embodied knowledge that informed practice, nurtured patient/nurse relationships, and underpinned holistic person-centred nursing care. Anthroposophic concepts motivated inner development as part of the nurses’ self-reflection and spiritual growth and fostered embodied knowledge.
This study provides new insights into the challenges and opportunities faced by registered anthroposophic nurses working in healthcare structures unfamiliar with the foundations of this integrative approach. The findings will facilitate improved understanding of the relevance of practice guided by anthroposophic foundations and concepts related to the bicultural health context in Aotearoa New Zealand, and contribute to evolving recommendations for providing person-centred and holistic care which is inclusive of spirituality. These results augment the current literature, expanding knowledge of the ontological and epistemological significance of anthroposophic nursing as a caring culture in nonanthroposophic healthcare settings. Future empirical research to strengthen the development of anthroposophic nursing in Aotearoa New Zealand, should include investigating and validating the utilisation of the 12 Nursing Gestures model in various clinical settings
Understanding Recently Arrived Chinese Late-life Migrants' Experiences of Healthcare Access and Utilisation in Aotearoa New Zealand During and Beyond the Covid-19 Pandemic: A Mixed-Methods Study
No full textThis mixed-methods study investigated the experiences of recently arrived Chinese late-life migrants in accessing and utilising healthcare services in Aotearoa New Zealand (NZ), under both non-pandemic and COVID-19 pandemic conditions. The research objectives were to: 1) to explore the possible factors that inform recently arrived Chinese late-life migrants' healthcare access and utilisation in Aotearoa NZ, in the face of non-pandemic and COVID-19 pandemic environments; 2) to modify and pilot a nationally administered survey on the health service access and utilisation and patient experiences of recently arrived Chinese late-life migrants in Aotearoa NZ, in the non-pandemic and COVID-19 pandemic circumstances; and 3) to propose actionable recommendations for enhancing health service access and utilisation for Chinese late-life migrants and their families in the face of non-pandemic and future pandemic environments. The study followed an exploratory sequential approach, beginning with a qualitative study (phase one) and subsequently building a quantitative study (phase two) based on the qualitative results. The study population comprised Chinese late-life migrants aged 65 and over who had immigrated to Aotearoa NZ within the last ten years.
In phase one, a qualitative descriptive (QD) approach with purposive sampling was used to identify factors influencing participants' healthcare access and utilisation since arriving in Aotearoa NZ. Semi-structured in-depth interviews (n=12: 5 males, 7 females) were conducted. Four themes emerged from the data: 1) "It is the Little Things that Matter the Most," 2) Fractured Patient-Practitioner Relationship, 3) Cultural Beliefs and Attitudes Towards Healthcare Access and Utilisation, and 4) Desire for Healthcare Information. These themes highlight key factors affecting healthcare access and utilisation among Chinese late-life migrants.
Drawing from phase one's insights, phase two involved developing a cross-sectional survey based on the 2017/18 NZ Health Survey to collect quantitative data on healthcare access and utilisation among the target population. Network sampling recruited 63 survey participants (21 males, 42 females). Findings revealed that Chinese late-life participants commonly used primary healthcare over secondary/tertiary services, preferred public institutions, and visited emergency departments for after-hours care. Significant barriers included differences between the healthcare systems in Aotearoa NZ and China, and ineffective communication between migrants and healthcare practitioners. Additional factors such as costs, transportation, support networks, disease urgency, and previous healthcare experiences also influenced healthcare-seeking behaviours. Unlike existing literature, this survey found that having health/medical insurance did not significantly affect participants' likelihood of utilising healthcare services in Aotearoa NZ.
By integrating findings from both phases, three main factors affecting healthcare access and utilisation among recently arrived Chinese late-life migrants in face of the non-pandemic and the COVID-19 pandemic circumstances were identified. First, ineffective communication and cultural conflicts were major predisposing characteristics that fractured patient-practitioner relationships and negatively impacted attitudes towards healthcare. Second, limited enabling resources, such as inaccessible healthcare facilities, long waiting times, lack of public healthcare information, and insufficient family and social support, significantly disrupted healthcare access and utilisation. Third, although the study did not collect participants' health status, it found that their perspectives and experiences of healthcare access were consistently associated with their health conditions.
This study added an in-depth understanding of the factors impacting healthcare access and utilisation among recently arrived Chinese late-life migrants, in general and COVID-19 pandemic circumstances. It had important implications for developing the NZ healthcare system for migrant service delivery, especially during pandemics. The study also offers valuable insights for designing future studies on other late-life migrants' healthcare experiences during future pandemics, both in NZ and globally. Additionally, this study also offered the evaluation of the pilot survey using the Categorical Principal Components Analysis (CATPCA) method, which can identify potential deficiencies in the pilot survey and improve the design of a formal nationally administered survey in future studies
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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