IN NEW ZEALAND Journal of Professional Nursing
INSIDE THIS ISSUE... Cultural safety: A vital element for nursing ethics The journal Kai Tiaki’s role in developing research capability in New Zealand nursing, 1908-1959 Cigarette smoking and the frequency of colposcopy visits, treatments and re-referral
Volume 29. No. 1
March 2013
Praxis: “The action and reflection of people upon their world in order to transform it.” (FREIRE, 1972)
E D IT O RIAL BO ARD EDITOR-IN-CHIEF: Denise Wilson RN, PhD, FCNA (NZ) Norma Chick Willem Fourie Thomas Harding Dean Whitehead Stephen Neville Michelle Honey Jean Gilmour
RN, RN, RN, RN, RN, RN, RN,
RM, PhD PhD, FCNA (NZ) PhD PhD PhD, FCNA (NZ) PhD, FCNA (NZ) PhD
COVER: Crimson was deliberately chosen by the Editorial Group as the colour for this journal as it represents, for us, imagination, intuition, potentiality, struggle and transformation. KORU: Designed for this journal by artist, Sam Rolleston: The central Koru indicates growth, activity and action. The mirrored lateral Koru branches indicate reflection. Transformation is shown by the change of the initial plain Koru design to a more elaborate one.
PO Box 1984, Palmerston North 4440, New Zealand P/Fx (06) 358 6000 E admin@nursingpraxis.org W www.nursingpraxis.org ISSN 0112-7438 HANNAH & YOUNG PRINTERS
CO NTE NTS EDITORIAL .......................................................................................................................................... 2
ARTICLES: Cultural safety: A vital element for nursing ethics Thomas Harding .......................................................................................................................... 4 The journal Kai Tiaki’s Role in developing Rrsearch capability in New Zealand nursing, 1908-1959 Pamela J. Wood, Katherine Nelson ............................................................................................ 12 Cigarette smoking and the frequency of colposcopy visits, treatments and re-referral Jill Lamb, Shelagh Dawson, Mary Jo Gagan, David Peddie ........................................................ 24
NOTES FOR CONTRIBUTORS............................................................................................................. 34 NURSING PRAXIS WEBSITE .............................................................................................................. 37 SUBSCRIPTION INFORMATION.......................................................................................................... 37
Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Page 1
Nursing Praxis in New Zealand EDITORIAL As an academic, researcher and member of the
through past editions of Praxis and discovered
editorial board of Nursing Praxis in New Zealand
that editorials over the years have reinforced the
(Praxis) I am very aware both with respect to my
importance of publication, and a series of papers
own work and nursing research generally, that the
has appeared providing a stepwise approach to
research process is not complete until a report has
preparing a manuscript for publication. Certainly
been submitted for publication. Praxis is committed
the requirements associated with the Performance
to publishing New Zealand nursing research in order
Based Research Fund (PBRF) have highlighted the
to develop and disseminate research findings that
need for nurses working in education, (whether
will inform and support clinical practice. Although
they work in a University or Polytechnic) to publish.
the number of manuscripts submitted has increased
However this has not translated into a significant
over time this, in my view, is still not a true reflection
increase in the number of nurses submitting work
of the total number of completed studies. Too many
for publication.
remain unpublished, largely for the reason that researchers tend to omit this last step in the overall
An editorial piece written by Associate Professor
process.
Annette Huntington in 2003 took an encouraging stance by outlining that publication was an integral
For some years now tax payers of New Zealand
component of the research process. Huntington
have funded nurses to undertake postgraduate
states “... New Zealand generated research evidence
nursing education, initially through the Clinical
is vital to support decision-making in policy
Training Agency and now through Health Workforce
formation and practice� (p.3). I agree, but would
New Zealand. This has resulted in a proliferation,
add that the dissemination of research findings is
not only in the number of nurses participating in
also an ethical issue.
postgraduate education, but also in the number of educational institutions offering postgraduate
Gaining ethical approval is one of the first steps
programmes. Some of these institutions have
in the research process. The human ethics
compulsory research projects embedded in their
application form invariably asks how the results
programmes. Consequently, one could expect an
from the project will be shared with participants
increase in the volume of clinically focussed nursing
and disseminated in other forums, for example
research being published. Unfortunately this is not
quality assured publications and conferences. Also
the case. Many theses, dissertations and research
participants frequently consent to participating in
reports remain unpublished, languishing on library
research if they think it will improve health care
and/or office shelves. That situation - the non
practices. Consequently, I suggest it is unethical to
publication of nursing research - is the focus of this
complete research, and not present a report for
editorial.
publication. While I accept that many people choose to present findings at conferences which, although
In preparation for writing this editorial I browsed
Page 2
useful, is only one step in the dissemination process.
Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand Publication in a quality assured journal is the logical
Besides the earlier Praxis series on the subject, the
vehicle for the dissemination of information and as
editorial in the Journal of Nursing Scholarship (2012)
such should be the seen as the gold standard.
titled “Five Tips on Getting Research Published” provides useful guidelines to ensure success. I
The main barrier to publishing, as I hear from
conclude this editorial with a plea to all those
nurses, is that the review process is overly rigorous.
nurses who have undertaken, are in the process of
Unfortunately many authors take feedback from
undertaking or are planning to undertake research
reviewers personally. This all too often results in a
to accept that publication is integral to the research
loss of confidence and motivation to engage in the
process.
rewriting process. Consequently the manuscript languishes never to be resurrected and so remains
References
unpublished. The review process is integral to
Gennaro, S. (2012). Editorial: Five tips on getting published. Journal of Nursing Scholarship, 44(3), 203-204. doi:10.1111/j.1547-5069.2012.01461.x
developing a coherent and credible body of knowledge and is pivotal to maintaining quality. It is important to remember that feedback is not
Huntington, A. (2003). Editorial. Nursing Praxis in New Zealand, 19(1), 2-3.
personal; rather it focuses on the content and quality of the manuscript and is designed to assist
Dr Stephen Neville RN, PhD, FCNA(NZ)
with the publication process.
Postgraduate Programme Coordinator and Senior Lecturer
There is a multitude of resources available to assist
School of Health and Social Services
with preparation of manuscripts for publication.
Massey University
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Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
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Nursing Praxis in New Zealand CULTURAL SAFETY: A VITAL ELEMENT FOR NURSING ETHICS Thomas Harding, RN, PhD. Associate Professor, School of Nursing, Midwifery & Paramedicine (NSW & ACT), Australian Catholic University; Associate Professor, Department of Health Science, Buskerud University College, Norway.
Abstract This paper argues that the globalisation of nursing and the internationalisation of nursing education have lead to Western values being embedded into nursing curricula in nations where the cultural values and beliefs may be based in quite different philosophies. It argues for critical examination of assumptions underpinning ethics education in nursing and proposes that the principles of cultural safety need to be incorporated into ethics education to create a culturally safe ethic for both nurses and patients in a multicultural healthcare environment. Key words: ethics, cultural safety, nursing education, internationalisation
The internationalisation of nursing education A significant contemporary phenomenon is the
western culture, inclusive of theoretical and practice
globalisation of the nursing workforce and the
underpinnings from other first world English speaking
internationalisation of higher education in nursing
countries” (p. 2). Western cultural perspectives and
(Allen & Ogilvie 2004). Although the large number of
values, embedded in nursing education, practice
students studying out of their home countries may be a
and research have been exported to countries with
relatively recent phenomenon, the internationalisation
different cultural perspectives and practices. They
of nursing education is not. Nursing education has
have been transported by nurses from countries in the
been an ‘export industry’ since the inception of the
Anglo-US axis who have worked overseas, including
professional era in nursing following the Nightingale
teachers and researchers, and many nurse leaders
reforms in the Western world in the 1880s.
from non-Western nations have undertaken some of their education in English-speaking countries. As well,
In New Zealand, as in most nations, the origins of
English is the dominant international and professional
contemporary nursing practice and education lie in
language, consequently many nursing school libraries
the work of Nightingale’s lady-pupils: her disciples
have English language books and journals, most of
who propagated her methods throughout the
which derive from either the United States (US) or the
world dominated by the nineteenth century British
United Kingdom (UK) (Davis, 1999). These books and
Empire. Consequently, Western paradigms have been
journals reflect the value systems of the nations in
highly influential worldwide in the development
which they originate.
of nursing practice and education. In Australia, for example, Dickson, Lock and Carey (2007) note that nursing education and practice “is framed by the values, beliefs and expectations of a dominant Page 4
Harding, T. (2013). Cultural safety: A vital element for nursing ethics. Nursing Praxis in New Zealand, 29(1), 4-11.
Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand Nursing ethics and education
patients and students is when we consider the values which underpin the teaching and practice of ethics in
Kerridge, Lowe and Stewart (2009) point out that most
nursing.
health professions require their members to comply with an ethical code or code of conduct. Nursing is no
Whose values underpin nursing ethics?
exception and Todaro-Francheschi (2012) argues that the teaching and facilitation of social/moral roles and
According to Johnstone (2008), in order to understand
ethical behaviour is as important as the teaching of
the basis of ethical professional conduct nurses need
“nurse think”, i.e., practical reasoning skills, and skills
a working knowledge of the concepts and theories of
acquisition.
ethics, and the language which describes these. She traces the history of “ethics, as it is referred to and
Ethics is a branch of philosophy which concerns the
used today” (p. 12) to the works of the Ancient Greek
values underpinning motivations and actions: it is
philosophers: Socrates, Plato and Aristotle.
about both thinking and doing (Kirby & Slevin, 1995).
men laid a foundation for the Western approach to
It also encompasses the consequences that result from
ethics which emphasised moral decision-making,
these thoughts and behaviours.
questions about how we should live and act, based
Whereas nursing
ethics is described more specifically as a:
These
in unemotional, rational justification (Kerridge et al., 2009).
... domain of inquiry that focuses on the moral problems and challenges that nurses
Johnstone (2008) contends that ethics is culturally
face in the course of their work. It involves an
constructed and culture is the foundation for shared
exploration and analysis of the beliefs, values,
beliefs, customs and values. Yet, although the practise
attitudes, assumptions, arguments, emotions
of nursing is universal, it is rarely questioned whether
and relationships that underlie nursing ethical
nurses globally share the same values (Davis, 1999).
decisions. (Dooley & McCarthy 2005, p. xi)
In the US, for example, a dominant national theme is that of the pioneer, the ‘rugged individual’, and
If, as contended by Dooley and McCarthy, nursing
subsequently the notion of ‘self-reliance’ has become
ethics involves exploration and analysis of beliefs,
deeply engrained in the cultural psyche (Davis).
values and relationships then it follows that there is
Similarly, in Aotearoa New Zealand self-reliance is a
a social dimension which requires consideration of
prized attribute in Pākehā society. It is exemplified in
and respect for others (Kerridge et al., 2009). In terms
the almost legendary figures of Colin ‘Pinetree’ Meads,
of nursing practise, it means being able to practice
Barry Crump, Fred Dagg and Wal Footrot (Harding,
“patient-centred nursing that is congruent with
2006)1. A stereotypical image has been created of the
the personal values of patients, the institution and
New Zealand male which Phillips (1987) summarised
society” (Caldwell, Lu & Harding, 2010, p. 191). This
as:
is apparent in the increased emphasis on meeting the
A rugged practical bloke – fixes anything, strong
needs of a multicultural patient population, as well
and tough, keeps his emotions to himself,
as a culturally diverse nursing student body (Nairn,
usually scornful of women. Yet at heart a
Hardy, Harling, Parumal & Narayanasamy, 2011). It is
decent person, loyal to his mates, provides
questionable, however, how successful this increased
well for the wife and kids … (backcover)
interest in meeting the needs of culturally diverse Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Page 5
Nursing Praxis in New Zealand The idealised values of individualism and self-reliance
culture is subordinate to relationships with others
are embedded in our national psyche. Even though
(Bockover, 2003). Similarly, in Japan the word for self
these cultural constructs now verge on being an
(jibun) means part of a larger whole that consists of
almost mythical image of a vanished colonial past,
groups and relationships; therefore:
they remain influential. Davis (1999) contends that the ethical principle of autonomy and its application
individuals are not essentially apart from the
in ethico-legal practices such as informed consent and
society in which they exist. The individual
advance directives operationalise such values. The
or self attains and maintains form through
problem with such cultural constructs underpinning
relating to other in a variety of ways (Davis
our approach to ethics is that they are not universal
1999, p. 121).
values, but hegemonic constructs which, in Aotearoa New Zealand, reflect a world view of the European
In Aotearoa New Zealand, the cultural values of Tangata
coloniser.
Whenua have far more in common with those societies which can be termed ‘collectivist’ than they do with
World culture can be loosely divided into two different
the cultural values of the ‘individualist’ colonisers.
types: the individualist and the collectivist cultures. The
Māori identity is based in kinship relationships, but
former tends to characterise the hegemonic cultures
has been subject to processes of enculturation into
in Europe, North America and other English-speaking
the dominant Pākehā culture through covert and
countries such as Australia and New Zealand. In such
overt processes of assimilation (Williams, 2001). The
cultures the rights of the individual are predominant.
processes of colonisation have subordinated the
The majority of the world’s cultures, however,
cultural values of the Māori to those of the European
are more like those which can be categorised as
coloniser.
‘collectivist’: where, loyalty to a group may outweigh
powerful tool in this process, based on a Western
individual rights (Davis, 1999). For people acculturated
paradigm of learning with, in particular, an emphasis
in the values of societies characterised by collectivism,
on written language as the basis for rational thinking
autonomy may be inimical because the fundamental
(Jones & Hunter, 2004).
The education system has been a very
cultural value is that of group cohesion. For example, in China, ethics is deep rooted in general philosophy
In healthcare, an example of rational thinking is the
and culture, and the core of Chinese culture is in
use of normative ethics – principles, rules, theories
three different teachings: Confucianism, Taoism and
and guidelines – which may be used as a template
Chinese Buddhism (Qui, 2006). Arguably, the most
to guide our actions. This approach is fundamental
influential of these philosophical approaches has
to the four principles formulated by the US authors
been Confucianism, which emphasizes virtue, duty
Beauchamp and Childress (2001) in which autonomy,
and context (Caldwell et al.,2010). The ‘self’ in Chinese
beneficence, non-maleficence and justice provide a framework for ethical decision making in health care. A particularly influential development in the latter part
1
Colin Meads is arguably New Zealand’s most famous former All Black.
Barry Crump, author, characterised in his own life the New Zealand male stereotype. Fred Dagg was the comic alter ego of John. Clarke who satirised the rural New Zealand
of the twentieth century was the emergence of the field of bioethics which Reich (1995) defined as:
male and Wal Footrot was the eponymous hero of the popular comic strip Footrot Flats, which also drew upon the rural New Zealand male stereotype for humorous effect.
Page 6
Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand [t]he systematic study of the moral dimensions
group” (p. 3). Similarly, the pre-eminence of Western
– including moral vision, decisions, conduct
bioethics in ethics education in nursing provides a
and policies – of the life sciences and
‘one-dimensional perspective’, which fails to value
health care, employing a variety of ethical
the moral and ethical traditions of many recipients of
methodologies in an interdisciplinary setting.
health care and also those who provide that care.
(p. xxi) Bioethics represents an approach to ethical decision
Ethics in the nursing curriculum: Where is cultural safety?
making which Johnstone (2008) describes as primarily focused on medical concerns and which has been
In Aotearoa New Zealand, The Nursing Council of
instrumental in propagating “distinctively American
New Zealand (NCNZ) is the statutory authority that
concerns and offering distinctively American solutions
governs the practice of nursing in New Zealand and
and resolutions to the bioethical problems identified”
as such sets the standards for nursing registration
(p. 15). Kerridge et al., (2009) situate bioethics as
and education. Contained within the competencies
part of a family of applied ethical enquiry, practical
(and accompanying indicators) that are required for
ethics, which addresses ethical concerns within
admittance to the register of nurses is the explicit
specific contexts. They describe nursing ethics as
determination that the applicant “accept responsibility
being one part of bioethics, alongside ‘medical ethics’,
for ensuring that his/her nursing practice and conduct
‘psychological ethics’ and ‘environmental ethics’. Over
meets the standards of the professional, ethical and
the last two decades critical debate of bioethics has
relevant legislated requirements” (p. 4). Schools of
occurred, nevertheless the bioethical view has become
nursing are therefore required to ensure that students,
influential worldwide (Johnstone, 2008).
and future graduates, are able to practice within appropriate ethical frameworks.
The notion that nursing ethics is a subset of bioethics would not be a view held by all nurses and much has
Consequently, every nursing curriculum contains ethics
been written about efforts to develop a theory of
teaching, however, the amount of content, degree of
nursing ethics in which care – based on the values of
visibility, and assessment of practice application varies.
concern, compassion and empathy - is the ontological
Some programmes have dedicated ethics courses,
substance. Thus, a number of nurses have promoted
others may have it situated as part of another larger
an ethic of care based upon the notion that women
course, and others may incorporate it as theme which
are naturally predisposed to caring. Kuhse (1997)
runs through a number of courses. However, ethics is
noted the parallels between these developments
positioned within a particular curriculum and whether
and feminist endeavours with respect to formulating
or not the teaching draws upon principilism, bioethics
a woman-centred approach to ethics. Such a position
or an approach based on a feminist ethics the values
has been criticised by women of colour and lesbians.
that are being promoted are predominantly those of
For example, hooks (1984) was critical of white upper-
the Western, largely English-speaking, world. There is
class women for presenting a “one-dimensional
a hegemonic discourse inherent in nursing education
perspective on women’s reality … white women who
and the teaching of ethics and arguably in the
dominate feminist discourse today rarely question
practise of nursing that reflects Western philosophical
whether or not their perspective on women’s reality is
traditions.
true to their lived experiences of women as a collective Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Page 7
Nursing Praxis in New Zealand Since the late 1980s, nursing in New Zealand has
they are caring. This has the potential to place them in
accepted the need for a focus on cultural safety and
conflicting ethical situations (Caldwell, Lu & Harding,
an understanding of the impact of colonisation on the
2010). As Woods (2010) notes:
health of the Tangata Whenua. In the early stages of
theory development (1988-1991), cultural safety had
problems may arise when nurses attempt to
a strong bicultural focus. This arose from the view that
match notions of desirable ‘universal’ moral
student nurses needed to recognise the importance of
principles, such as autonomy and justice,
the Treaty of Waitangi and the impact of colonisation
with the largely relativistic ‘cultural norms’ of
on Māori. In the decade following, the concept was
different patients under the auspices of the
refined further and subjected to political and public
dominant culture of medicine (p.719).
scrutiny as it became embedded in education and practice (Ramsden, 2002). Following on from the
This is not to suggest that there has been a conscious
seminal work of Irihapiti Ramsden, the concept has
process of disregard for the needs of these students.
evolved from its initial bicultural focus to incorporate
However, as Woods (2005) notes, given that there
a wider multicultural focus (Richardson & Carryer,
are small numbers of nurse educators who have
2006). Yet, even in light of the paradigm shift heralded
postgraduate qualifications and with a multiplicity
by cultural safety education, it has been questioned
of possible and theoretical approaches to teaching
whether the danger remains that nursing education
nursing ethics, it may be that it is the lecturer’s
continues to perpetuate dominant ideologies (Spence,
background and preference that drives the choice of
1994). The question is as pertinent now as it was in the
ethical frameworks. As a corollary, it is likely that there
mid 1990s, as Woods (2010) comments:
will be an even smaller number of nurse educators who
are able to not only teach ethics but also authentically Yet for all of its apparent success in educating
incorporate a Māori perspective into this teaching.
and monitoring the practices of New Zealand nurses, the acceptance of the concept of cultural safety as an approach to guiding effective care, and especially as a guide to
Is it time to critically deconstruct nursing ethics?
ethical nursing practice, remains open to considerable debate (p. 716).
In the early 1990s writers from a diversity of academic disciplines began to question the hegemonic discourse
It is arguable that the teaching of cultural safety may
inherent in Western ethics. Over the last decade in
be perceived as somehow a course of study which
countries of the Pacific rim there has been questioning
stands apart from the teaching of ethics, taught by
of the largely unchallenged primacy of Western
its own groups of ‘experts’, therefore there has been
bioethics in medicine (For example: Qui 2006; Doring
little acknowledgement of the underlying Western
2003; Miyasaka et al., 1999; Fan 1998; Ip et al., 1998).
bias in the expected ethical knowledge and behaviour
Nie (2000), however, cautioned against assuming a
and their reflection of values derived from Western
homogeneous Chinese or American bioethics and
Judeo/Christian philosophies. Nurses and nursing
points out that there is no single approach and
students are, therefore, often required to operate
that both cultural and medical traditions manifest
within ethical frameworks which are either alien to
individualistic and communitarian values.
their cultural norms or those of the patients for whom Page 8
Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand Within nursing, this debate has been particularly
imperative inherent in this perspective. Conversely,
applied to bioethics. Myser (2003) cautions those
other nurse academics and researchers have explored
working in the field of bioethics to engage in stringent
the discrepancies and tensions between nursing ethics
self-reflection with respect to the construction of
based on Western moral philosophy and cultural
dominant mainstream theories and methods. She
norms with those from a variety of different Asian
emphasizes the apparent lack of critical examination
philosophical and cultural traditions, including Davis
of the “dominance and normativity of whiteness in
(1996), The Working Group for the Study of Ethical
the cultural construction of bioethics in the United
Issues in International Nursing Research (2003), Wros,
States” (p. 2). Myser suggests that in not recognising
Doutrich and Izumi (2004), Xu, Davidzhar and Giger
this privileged whiteness, and then to theorise from
(2005), and Cameron, Schaffer and Park (2001).
a non-reflective ethnocentric standpoint, is to risk perpetuation of cultural colonisation. A process in
In Aotearoa New Zealand, Māori researchers and
which nursing has engaged through the hegemony of
academics have begun developing a framework for
nursing education and practice from an Anglophone
Māori research ethics (Forster, 2003; Smith et al.,
perspective and the assumption that, even though
2009), which will reflect the values of a people for
nursing may be global, nurses share the same values
whom the collective is paramount in contrast to the
throughout the world. For example, in Korea, Han
dominant values expressed in the social, cultural
and Anh (2000) investigated how Korean student
and institutional environments which mainly reflect
nurses made ethical decisions in relation to the Korean
Western moral traditions and a focus on norms, rights
nurses’ code of ethics; however, there is no evidence
and principles. It is critical that nursing educators
that this code reflects Korean cultural values. Similarly,
reflect such developments in our approach to the
Park et al. (2003) replicated a US study, questioning
teaching of ethics otherwise we risk espousing an ethic
whether the study’s results, which explored the use
that may be unsafe for students, nurses and patients.
of five ethical decision-making models, would be relevant in Korea. What was not questioned, however,
Woods (2010) offers a way forward with his concept
was whether a research tool based in Anglo-American
of the socioethical nurse. He posits that cultural safety
values would be appropriate in this context.
contains key ethical elements which reflect “communal values, traditional practices, and co-operative virtues
Nurses are engaged in appraising, exploring and
within a multicultural society” (p. 719). He outlines
scrutinising what is taught and practised in the
the key features of such an ethic as: promoting social
distinctive field of nursing ethics; however, not all
justice and empowerment; maintaining individual/
nurse researchers/writers acknowledge the core of
collective cultural autonomy and identity; and, trust
ethnocentricity rooted in the still dominant Western
and respect. The challenge now lies with those of us
philosophical traditions that inform most nursing
who teach ethics in the nursing curriculum to challenge
ethics curricula and practice. In Europe, for example,
our own assumptions and explore ways in which the
nurse clinicians such as Allmark (2005) and Esterhuizen
principles of cultural safety can enhance our teaching.
(2006) have questioned the value of ethics and the use of professional codes in nursing practice. Despite the
Conclusion
globalisation of nursing and heavy nursing recruitment from non-Western countries neither of these two
The use of Western philosophical ethics, sifted
nurses critiques the dominant Western cultural
through a European cultural lens, has become the
Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Page 9
Nursing Praxis in New Zealand standard template for the teaching of nursing ethics
nurses have been global leaders with respect to cultural
worldwide. In doing so it enshrines the notion that all
safety and it is now time to extend that understanding
other cultures should have and use the same values
of cultural safety into the teaching of ethics. By
which predominant in those cultures which can be
doing so it may provide a way forward to facilitate
characterised as ‘individualistic’.
nurses developing understanding and competence to address ethical dilemmas in clinical practice across a
Critical examination of what and how we teach nursing
multiplicity of cultural perspectives, while at the same
ethics is required to ensure that the subject matter is
time the ethical values derived from their own culture
not perceived merely as a sub-category of bioethics
are respected and valued.
reflecting hegemonic European values. New Zealand
References Allen, M., & Ogilvie, L. (2004). Internationalization of higher education: Potentials and pitfalls for nursing education. International Nursing Review, 51(3), 73-80. doi:10.1111/j.1466-7657.2003.00226.x Allmark, P. (2005). Can the study of ethics enhance nursing practice? Journal of Advanced Nursing, 51(6), 618-624. doi: 10.1111/j.13652648.2005.03542.x Beauchamp, T., & Childress, J. (2001). Principles of biomedical ethics. Oxford , UK: Oxford University Press. Bockover, M.I. (2003) Confucian values and the internet: A potential conflict. Journal of Chinese Philosophy, 30, 270-273. doi: 10.1111/1540-6253.00112 Caldwell, E.S., Lu, H., & Harding T.S. (2010). Encompassing multiple moral paradigms: A challenge for nursing educators. Nursing Ethics, 17, 189-199. doi: 10.1177/0969733009355539 Cameron, M.E., Schaffer, M., & Park, H. (2001). Nursing students’ experience of ethical problems and use of ethical decision-making models. Nursing Ethics, 8, 432-445. doi: 10.1177/096973300100800507 Davis, A. J. (1999). Global influence of American nursing: Some ethical issues. Nursing Ethics, 6(2), 118-125. doi: 10.1177/096973309900600204 Dickson, C., Lock, L., & Carey, M. (2007). “In my country nurses don’t ...” Australian undergraduate nurse education and the international culturally and linguistically different student. Proceedings of the ISANA International Education Association - 18thInternational Conference, Gleneg, South Australia. Retrieved from http://proceedings.com.au/isana2007/papers/isana07final00009.pdf Doring, O. (2003). China’s struggle for practical regulations in medical ethics. National Review of Genetics, 4, 233-239. doi:10.1038/ nrg1022 Esterhuizen, P. (2006.) Is the professional code still the cornerstone of clinical nursing practice? Journal of Advanced Nursing 23, 2531. doi:10.1111/j.1365-2648.1996.tb03131.x Fan, R. (1998). Critical care ethics in Asia: Local or global. Journal of Medical Philosophy, 23, 549-562. doi:10.1076/jmep.23.6.547.2562 Forster, M. (2003). Te hoe nuku roa: A journey towards Māori centred research. Ethnobotany Research and Applications, 1, 43-46. Han, S., & Ahn, S.H. (2000). An analysis and evaluation of student nurses’ participation in ethical decision making. Nursing Ethics, 7, 113-23. doi: 10.1177/09697330000070020 Harding, T. S. (2006). Constructing the “other”: On being a man and a nurse. (Doctoral thesis, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand). Retrieved from https://researchspace.auckland.ac.nz/handle/2292/103 Hooks, B. (1984). Feminist theory from margin to center. Boston, MA: South End Press. Ip, M., Gilligan, T., Koenig, B., & Raffin, T.A. (1998.) Ethical decision-making in critical care in Hong Kong. Critical Care Medicine, 26, 447-451. doi:10.1177/096973300000700204 Johnstone, M.-J. (2008). Bioethics: A nursing perspective (5th ed.). Sydney, Australia: Churchill Livingstone.
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Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand Jones, M.E., & Hunter, J. (2004). Enshrining indigenous knowledge as a public good: Indigenous education and the Māori sense of place. Indilinga: African Journal of Indigenous Knowledge Systems, 3(2), 103-111. Kerridge I., Lowe, M., & Stewart, C. (2009.) Ethics and law for the health professionals. Sydney, Australia: Federation Press. Kirby, C., & Slevin, O. (1995). Theory and practice of nursing: An integrated approach to patient care. Edinburgh, UK: Campion Press. Kuhse, H. (1997). Caring: Nurses, women, and ethics. Oxford, UK: Blackwell. Miyasaka, M., Akabayashi, A., KaiI, I., & Ohi, G. (1999). An international survey of medical ethics curricula in Asia. Journal of Medical Ethics, 26, 514-521. Myser, C. (2003). Differences from somewhere: The normativity of whiteness in bioethics in the United States. American Journal of Bioethics, 3(2), 1-11. Nairn, S., Hardy, C., Harling, M., Parumal, L., & Narayanasamy, M. (2011). Diversity and ethnicity in nurse education: The perspective of nurse lecturers. Nurse Education Today, 32(3), 203-207. doi.org/10.1016/j.nedt.2011.02.012 Nie, J. B. (2000). The plurality of Chinese and American medical moralities: Towards an interpretive cross-cultural bioethics. Kennedy Institute of Ethics Journal, 10, 239-260. doi:10.1353/ken.2000.0020 Park, H., Cameron, M., Han, S., Ahn, S., Oh, H., & Kim, K. (2003). Korean nursing students’ ethical problems and ethical decision making. Nursing Ethics 10(6), 638-53. doi:10.1191/0969733003ne653oa Phillips, J . (1987). A man’s country? The image of the pakeha male. Auckland, New Zealand: Penguin. Qui, R. (2006). Bioethics: A search for moral diversity. East Mediterranean Health Journal, 12(S1), 21-29. Ramsden, I. (2002). Cultural safety in nursing education in Aotearoa and Te Waipounamu. (Doctoral dissertation, Victoria University of Wellington, New Zealand). Retrieved from http://publichealth.massey.ac.nz/kawawhakaruruhau/thesis.htm Reich, W. T. (1995). The encyclopaedia of bioethics (2nd ed.). New York, NY: McMillan. Smith, B., Russell, K., Reynolds, P., Palmer, S., Milne, M., & Hudson, M. (2009). Developing a framework for Māori Research Ethics. Proceedings of the Hui Whakapiripiri: Health Research Council Annual Hui (pp. 1-17), Auckland, New Zealand. Spence, D. G. (1994). The curriculum revolution: Can educational reform take place without a evolution in practice? Journal of Advanced Nursing, 19, 187-93. Todaro-Francheschi, V. (2012). Compassion fatigue and burnout in nursing: Enhancing professional quality of life. New York, NY: Springer Publishing. Williams D. (2001). Crown policy affecting affecting Māori knowledge systems and cultural practices: Report No. Wai 262. Wellington, New Zealand: Waitangi Tribunal. Working Group for the Study of Ethical Issues in International Nursing Research. (2003). Ethical considerations in international nursing research: A report from the International Centre for Nursing Ethics. Nursing Ethics, 10(2), 122-37. doi:10.1191/0969733003ne587oa Woods, M. (2005). Nursing ethics education: Are we really delivering the good(s)? Nursing Ethics 12(10), 5-17. doi:10.1191/0969733005ne754oa Woods, M. (2010). Cultural safety and the socioethical nurse. Nursing Ethics,17, 715-725. doi:10.1177/0969733010379296 Wros, P. L., Doutrich D., & Izumi, S. (2004). Ethical concerns: Comparison of values from two cultures. Nursing & Health Sciences. 6, 131-140. doi10.1111/j.1442-2018.2004.00184.x Xu, Y., Davidhizar, R. & Giger, G.N. (2005). What if your nursing student is from an Asian culture? Journal of Cultural Diversity, 12, 5-11. The Cancer Connect New Zealand (CCNZ) service
Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
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Nursing Praxis in New Zealand THE JOURNAL KAI TIAKI’S ROLE IN DEVELOPING RESEARCH CAPABILITY IN NEW ZEALAND NURSING, 1908-1959 Pamela J. Wood, PhD, RN. Associate Professor, School of Nursing & Midwifery. Monash University, Melbourne, Australia. Katherine Nelson, PhD, RN. Senior Lecturer, Graduate School of Nursing, Midwifery & Health. Victoria University of Wellington, NZ.
Abstract The development of research capability in New Zealand nursing can be seen particularly from the 1970s onwards. However, by analysing past issues of Kai Tiaki – the country’s longstanding nursing journal – over the five decades following its establishment in 1908, the present authors identified two precursors to this later stage. The journal fostered nurses’ awareness of research and consistently promoted nursing scholarship. Successive editors developed nurses’ capability in writing about their practice by publishing case studies, the winning essays in competitions run jointly with the professional association and nursing schools, and nurses’ articles on practice or professional issues. Although promotion of research awareness and nursing scholarship were not deliberate strategies to develop nursing research capability, they were necessary forerunners to it. Keywords: research capability, history of nursing, nursing journal, nursing scholarship, nursing research
The need for strategies and processes to develop
research in New Zealand focuses on the time period
research capability in nursing is receiving increasing
from the 1970s onwards. She explains the impact of
attention in nursing literature. Recently published
earlier overseas study opportunities, shifts in education,
studies suggest a shift in focus from building nursing
professional organisation support and individual nurses’
research capability in academic institutions, to
commitment and success in building the profession’s
developing it in clinical and non-academic settings.
2
research capacity.4 The establishment in New Zealand
Nevertheless, acceptance of the profession within
of post-registration university education for nurses in
academia has depended on nurses and others
the early 1970s, which enabled the formal academic
recognising nursing as a distinct discipline with its
development of nursing scholarship and research, has
own research and scholarship. One factor Australian
also been addressed.5
1
nurse scholars recently identified as facilitating the growth of nursing scholarship in that country was the
This present article examines historical precursors to
discipline’s “coming of age”. They were proud that in the
this development of research capability in New Zealand
relatively short period of 25 years Australian nursing had
nursing and places these within an international context.
matured to a point where ‘the discipline had emerged
In particular, it focuses on evidence in historical issues of
as legitimate in its own right’ and its scholarship had developed ‘a particularly Australian character’. 3 A similar trajectory could be traced in New Zealand. Litchfield’s history of the development of nursing Page 12
Wood, P. J., & Nelson, K., (2013). The journal Kai Tiaki’s role in developing research capability in New Zealand nursing, 19081959. Nursing Praxis in New Zealand, 29(1), 12-22. Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand Kai Tiaki, the country’s only professional nursing journal
among editors and was a member of the International
and avenue for fostering the publication of nursing
Council of Nurses (ICN) publication committee. The
scholarship or research in the time period before the
strong connection with the ICN continued over the
changes occurring in the 1970s. Through analysis of all
decades, with New Zealand nurse leaders attending its
issues over the five decades from the journal’s inception
congresses and holding positions within the council. In
in 1908, the research identifies mechanisms that
all these developments, New Zealand therefore either
developed nurses’ professional scholarship and sparked
led or was in line with international professional nursing
their awareness of research. In this article it is argued
developments.
that, although these strategies were not necessarily a deliberate strategy to build nurses’ research capability,
The international development of nursing research
they were a necessary forerunners to it.
capability, however, was distinctly different. American nurses led the way, well ahead of nurses in other
Background
countries. As early as the 1930s, the ICN made it clear that nurses needed to carry out research
Nursing in New Zealand had, by the early 1900s,
if they wanted to be regarded as belonging to a
achieved recognisable markers of a profession.
profession.6 By the 1950s, many American nurses were
New Zealand’s small population and great distance
confidently undertaking research into nursing education,
from other countries meant considerable effort and
organisation and practice and were completing higher
determination were needed if New Zealand nurses
degrees in universities. Their research had reached a
were to participate in international professional affairs.
critical mass that enabled the 1952 launch of the journal
These same factors also allowed the rapid establishment
Nursing Research.
of other initiatives affecting nursing. It was the first country to have a chief nurse with a national role in
Analysis in a separate, unpublished research project
a central government department, with Grace Neill
by one of the authors of this article (PW) found that
holding the first appointment as Assistant Inspector
three American journals particularly fostered nursing
of Hospitals from 1895. She attended international
research awareness and capability. The first issue of
congresses and drafted the world’s first specifically
Nursing Research carried a lengthy report of a doctoral
nursing legislation for state registration, the Nurses
study. 7 Besides reporting completed projects the
Registration Act 1901. This set up a process for nursing
journal’s three issues annually carried articles on other
registration and regulation, and a mandatory three-year
research matters, special sections summarising studies,
curriculum for all training hospitals. Neill’s successor
and reviews of books that would be helpful to nurses
from 1906, Hester Maclean, instituted two professional
wanting to understand more about research. Readers’
initiatives that were already in place in other countries,
requests for writers to include more information on
such as Australia. In 1908 she founded the journal, Kai
methodology indicated a growing research capacity and
Tiaki, and in 1909 encouraged the separate nursing
capability. The American Journal of Nursing published
associations in the four main cities to amalgamate
lists of research projects twice a year until this function
to form the New Zealand Trained Nurses Association
was taken over in 1954 by Nursing Research. The journal
(NZTNA). As chief nurse and first NZTNA president she
Nursing Outlook, established in 1953, also carried very
ensured the profession’s continuing active participation
brief (sometimes less than 50-word) summaries of
in international affairs. As journal editor she participated
research findings.
in the international exchange of articles and volumes Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Page 13
Nursing Praxis in New Zealand In other countries, the nursing profession had not reached
sources selected for this research were the issues of Kai
this level of research capability. If nurses were involved
Tiaki published between 1908 and 1959. Besides this
in research, it was usually in large surveys of workforce
familiar and commonly used title within the profession,
issues or studies addressing problems with nursing
from 1908 to 1929 the journal was also known as the
education, often led by non-nurse researchers. The ICN’s
Journal of the Nurses of New Zealand and from 1930
statement that nurses needed to undertake research
as the New Zealand Nursing Journal. The journal had
to be considered a profession had not translated into
errors in the numbering of volumes so only the year and
the deliberate development of research capacity and
month are used here to designate volumes and issues.
capability. Nevertheless, the measures that can now
On Maclean’s retirement in 1923, the NZTNA purchased
be identified as its precursors were underway. These
Kai Tiaki but Maclean remained its editor until her death
were encouraging nurses to write about their practice
in 1932. The journal was initially published quarterly until
and raising nurses’ awareness of research that affected
1930, when it began appearing every second month.
nursing. Editors’ concerted efforts to encourage nurses to
From mid-1938 to1947 it was published monthly, then
write were more than simply a ploy to ensure sufficient
two-monthly until 1959. Although successive editors
material for each issue. They constituted a serious
bemoaned low subscription numbers, the journal was
attempt to promote nursing scholarship. This present
widely read and appreciated in the profession. The journal
research therefore examined the New Zealand journal,
therefore played a key role in the lead-up to the deliberate
Kai Tiaki, to identify its approaches to fostering research
development of research capacity and capability in New
awareness and nursing scholarship.
Zealand nursing.
Research design
For this project hard copies of these issues were searched for all material relating to research and nursing
Historical inquiry is the analysis and contextualised
scholarship. Although digitised volumes are available
interpretation of historical material to explain continuity
for 1908-1929, all issues were browsed in hard copy to
and change through time. Nurse-historian Siobhan Nelson
capture all relevant material and avoid missing smaller
reminds us that history is ‘the interplay between historical
pieces that did not warrant inclusion in an index or could
8
data and the fusion of narrative and analytical writing’.
be missed by keyword searches of digitised volumes. The
She justifiably challenged the way nurse-writers have tried
search period ended in 1959 as by then the journal’s focus
to legitimate, regularise, format and constrain historical
had shifted significantly away from nursing practice to
scholarship within the profession’s understanding and
industrial issues. This was also the time when some New
lexicon of qualitative research. Historical inquiry in
Zealand nurses were beginning to study at universities
nursing needs to follow the methodological conventions
overseas. The end of the period therefore marks a
observed by researchers in the discipline of history. The
transition to a different level of research awareness.
9
explanation of the design of this research is therefore limited to a description of the historical primary sources
In all, 325 past issues of the journal were examined and
and analytical approach.
148 items selected. Two groups of items were selected for analysis: articles, editorials, notices and position
Historical research requires careful selection of primary
advertisements addressing the topic of research or
sources – those created in the time period being studied –
nursing scholarship, and articles reporting nurses’
that will yield relevant and reliable information to address
scholarship and research. Items in the first group were
the aim of the research. The main historical primary
analysed to identify the issues considered important
10
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Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand at the time along with the ideas and strategies for
nurses’ understanding of their work but encouraged
developing scholarship and research awareness and
nurses to similarly contribute. This was a call repeated
capability that were evident. Analysis of the second
by successive editors. In 1938, for example, nurses were
group focused on identifying research and scholarship
told the editorial committee looked forward to the time
topics, style and authorship, and any changes in these
when every nurse not only subscribed but took an active
through time. Analysis of historical primary sources needs
part in maintaining the journal’s position amongst nursing
to interpret the material within its social and cultural
journals of the world.16 Editors referred back to Maclean’s
context. This was addressed by considering the changes
initial request in their own call for nurses’ contributions,
in nursing, its place within the healthcare system and
even in the late 1950s.17 Their success in fostering nursing
professional leadership in this time period.
scholarship overall will be considered in more depth later in this article. Two specific mechanisms for encouraging
Relevant material from major nursing journals in four
nurses to write about practice and professional issues
other countries (Britain, Canada, the Unites States of
will be considered first. These were essay competitions
America and Australia), which had been searched for
and nursing case studies, promoted jointly by the journal,
allied research projects, is also included to provide an
professional association and nurse educators.
international context for this study. In particular, it is used to explain the international growth in nursing research,
Essay competitions
and international alignment of mechanisms within New Zealand to develop research awareness and nursing
In Britain, the Nursing Record began running an essay
scholarship.
competition as early as 1888. The first question to be addressed was ‘What constitutes an efficient nurse?’18
Developing nursing scholarship
Questions became more complex and often focused on hospital management. When the journal became
In her first editorial in Kai Tiaki, Maclean exhorted nurses
the British Journal of Nursing, topics turned to a more
to contribute material. This became a standard, regular
clinical focus.
11
call. It was common practice internationally for editors to chide and cajole nurses into contributing articles.12
In New Zealand, from 1938 the nursing association ran
Editors drew on ideas from other journals in their
an essay competition for students in hospital schools of
efforts. The editor of the Sydney-based Australasian
nursing. The initial topic was how nursing technique was
Nurses’ Journal, established in 1903, challenged nurses
a link in the prevention of disease, and the first, second
by referring to American nurses’ successful scholarship,
and third prize winners’ essays were published.19 The
hoping to provoke Australian nurses to write.13 The 1925
association’s Nursing Education Committee declared
ICN congress in Finland paid considerable attention to
that 70 per cent of the essays had been of a very high
it, and the Canadian Nurse reprinted an article from
standard.20 The following year the committee decided
the American Journal of Nursing giving practical advice
the competition would continue as an annual event. It
on how to write.
would set the questions, each hospital would select its
14
15
best essay and an independent judge would decide the Although Maclean welcomed any material, including
prize winner who would receive a book and a trophy for
news and social items, she particularly wanted nurses
her school. The question that year kept the preventive
to write about their practice. Most issues carried articles
focus, asking candidates to write about personal hygiene
from doctors. Maclean valued these for deepening
and its importance in a nurse’s life.21
Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Page 15
Nursing Praxis in New Zealand In ensuing years nurses wrote, for example, about
Qualified nurses and students in New Zealand published
nursing patients with tuberculosis or those having a
case studies related to patients with a range of
hysterectomy, the importance of early treatment in
conditions, including rat bite fever, Addison’s anaemia,
cancer and the part parent visiting should play in a
actinomycosis and a child with tetanus; and on different
hospitalised child’s routine. Psychiatric nurses were
forms of treatment such as the Miller-Abbott tube used
asked, for example, about the value of occupational
for paralytic ileus.30 Four cases of typhoid fever from one
therapy and how a nurse could assist a family adjusting
family were the subject of a New Zealand backblocks
to their young child being admitted to a psychiatric
hospital nurse’s account in 1912.31 Nurses sometimes
hospital.23 Maternity nurses had the chance to write
published together,32 but articles often carried no author
about establishing breastfeeding.24 In 1947, reflecting
name.33
22
the post-war context, they were asked to explain the early labour care of an English bride newly arrived in
Internationally, after its introduction by an American
New Zealand. Occasionally nurses were set more
nurse , the profession gradually incorporated into
general topics, such as Grace Neill’s professional
clinical nursing education a particularly nursing form
contribution, or the principle of doing no harm.
26
of the case study.34 Canadian nurse educators also
They were also notified of a 1958 ICN competition on
acknowledged the method’s antecedents, both in
incorporating ethics into all nursing subjects taught.
Florence Nightingale’s encouragement of nurses’ written
25
reflection on patient care and in the use of case studies At times the Education Committee was disappointed
in various avenues of education outside of nursing. They
with entries, either in number or quality. This was
valued case studies for focusing students on the patient,
particularly so in its first case study competition in
developing students’ observation skills and ability to
1943, the focus of which was an obstetric topic.
learn independently, and for combining theoretical
27
Nevertheless, case studies were another significant
learning and experience.35
means of encouraging nurses to write about their practice.
New Zealand nurses became aware of the case study as an educational method through a paper presented at
Case studies
the 1927 ICN congress in Geneva by Gertrude Hodgman from Yale University. Her paper was published in various
The concept of describing a “case” was familiar in
nursing journals.36 New Zealand nurses’ international
medicine in the nineteenth century. Nurses would
visits in the 1930s also stimulated its acceptance.37
have understood the idea in the Nursing Record’s 1890
Finally, after an article drawing on a Canadian survey of
essay competition requiring them to describe at least
nursing education and Canadian and American literature
four cases they had personally nursed.28 Nurses in
explained the case study’s process and benefits, the
different countries occasionally followed the medical
approach became firmly established in New Zealand.38
profession’s example in writing accounts of “interesting
The significant point on this final article was that it
cases” where the course of illness had been in some
explained the emphasis on nursing, rather than the
way unusual. In 1907, for example, an Australian nurse
previous convention of focusing on a case’s medical
wrote about a case of typhoid fever with numerous
details. The writer noted that it could therefore be
complications.29
called a nursing study. This was an indicator that the profession was beginning to recognise its distinct area of scholarship, a form of “coming of age”.
Page 16
Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand Students’ nursing case studies were sometimes
included the awareness of psychological factors affecting
published in Kai Tiaki. They commonly addressed
nursing,44 and specific accounts of practice.45 Nurses also
care of patients with medical conditions, such as
wrote about work in different practice settings.46 They
agranulocytosis, pyelitis and acute nephritis, or patients
addressed nursing related to (sometimes new) forms
receiving new treatments such as sulphathiazole for
of medical or surgical treatment.47 One nurse wrote
staphylococcal septicaemia. 39 Sometimes student
with a doctor on intravenous practice, another with a
authors were unnamed. Students’ case studies often
hospital pharmacist on drug administration.48 In 1944,
ended with a reflection on the assignment’s value for
two nurses wrote together, describing a situation where
their learning, perhaps as a gesture towards the tutor
the new drug, penicillin, had been successfully used.49
40
or maybe in hope of a better mark. Nurse B.G. Weir of Auckland Hospital declared the case study had helped
Fourteen of the 22 New Zealand nursing articles
her discover the valuable part a nurse played and the
published in the 1930s carried no author’s name. Of
tremendous responsibility placed upon her. Nurse
these, six gave a descriptor such as “a registered nurse”
N.M. Buckland of New Plymouth Hospital found it had
or “a probationer nurse”, three gave their initials at the
been ‘a great help’. With her tutor’s assistance she
end, and five carried no identifier at all. (Case studies in
had learned which of the various nursing measures to
the 1930s showed similar proportions, with half of the
stress and their order of importance. At the end of this
sixteen studies carrying no author name.) In contrast
study the editor explained that nursing studies could
medical authors in the journal were always named.
be in an essay form that made it more interesting and
The proportion of named and unnamed nursing articles
personal, or in tabulated form that assisted the nurse
was reversed in the 1940-1955 period when only four
to collect her material, learn in an orderly manner, and
of the sixteen New Zealand articles were without an
prepare for examinations.
author name. (Only one author of the ten case studies
41
42
in this period was unnamed). Either editorial policy had Whether written by registered nurses or students, case
changed with respect to identifying nurse authors, or
studies varied in style from short, pithy accounts, to
individual nurses themselves were now willing to add
chatty descriptions and to a more serious discursive
their names. Whatever its impetus, the change suggests
style. They therefore differed in their ability to develop
the profession’s greater confidence that nurses had
nurses’ writing but all contributed to the growth of
something worthwhile to say and should therefore be
nursing scholarship, a forerunner to research capability.
identified. This was another indicator of the profession’s “coming of age” in its field of scholarship.
Developing New Zealand nursing scholarship Articles varied in style from discussion papers and Nurses made a substantial contribution to the journal.
essays, to information neatly compressed under
Between 1930 and 1955, for example, besides the
headings or presented as briefly jotted points,
competition essays and case studies, it published
depending on whether nurses wanted to raise issues,
38 articles written by registered nurses and two by
recount personal experiences or instruct. While articles
student nurses, and reprinted six nursing articles that
came mostly from hospital nurses, other contributors
had been published in overseas journals. The pieces by
were those in public health, rural and city district
New Zealand nurses offered opinions on professional
nursing, specialist clinics, mental health, postgraduate
issues or addressed matters affecting nursing, health
study, nursing education and leadership roles. In the
education and nursing education. More clinical topics
late 1950s, however, a significant change occurred in
43
Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Page 17
Nursing Praxis in New Zealand editorial policy. The journal gave far more emphasis
an eye-opener.55 Few avenues existed in New Zealand,
to industrial and professional issues and very little to
however, for actively developing research skills. A post-
nursing practice. In doing this, the journal’s role in
registration course had been available to nurses since
fostering scholarship was beginning to change.
1928, but its curriculum did not specifically include research, although it promoted nursing scholarship.
Developing research awareness and skills There is very little evidence to indicate that New The New Zealand journal kept nurses well abreast with
Zealand nurses were directly engaged in research in
international research developments. It frequently
these decades. From 1932 the Association’s Education
carried small items notifying nurses of medical
Committee published its annual surveys of nursing
research, particularly relating to cancer. It also carried
procedures, but these were more an effort to standardise
international nursing research. In 1938, for example, the
practice throughout the country by combining the best
editor translated to the local situation the findings of an
aspects of procedures used in the teaching hospitals. In
experiment by two nurses studying at Teachers College,
the 1930s and 1940s, however, the journal was able to
Columbia University in New York, who had investigated
publish two forms of research by local nurses. In 1933
the most effective lubricant for rubber catheters.
it reported a trial undertaken by four nurses. A school
50
51
nurse (Cox), a nurse inspector (North) and two nurses Travel scholarships to other countries in the 1930s
caring for Maori in the rural district (Uniacke and Hill)
and visits of American nurses to New Zealand also
had investigated the best home treatment for scabies,
enhanced awareness of research. Professor Hudson
impetigo and pediculosis. Their study included 333
from Columbia University, for example, travelled to New
cases and compared two treatments for scabies, two
Zealand in 1938 and local nurses acknowledged there
for impetigo and four for pediculosis. The nurses noted
was a great deal to learn from New York, a city unafraid
the number of treatments needed and the number of
to experiment and one that had established the first
days taken to effect a cure. Comparative costs were also
nursing professorship in the world.
calculated. The district’s medical officer of health, Dr
52
H.B. Turbott, wrote the article, apparently to support The need for nurses to have research skills was
the nurses and ensure their research was published
internationally recognised, though development of such
and therefore available to others practising in similar
was limited. An ICN nursing service survey in 1949, with
settings. He named the nurses, made it clear that it was
detailed information from sixteen countries, commented
a district nursing study and noted his admiration of the
that the nurse’s place in the health team was difficult
nurses’ skill in carrying it out in difficult conditions.56
to define and nurses were presently ill-equipped to do the further research necessary. If however, they
The second report in 1944 was on the nursing care of
were trained in research, the status of the profession
the chronically ill patient. In this the unnamed author
would be improved. In 1955 the ICN issued specific
had gathered observations from matrons in charge of
advice on the method for surveying a nursing school
hospitals for the “chronic sick” and from nurses who had
and this was published in the New Zealand journal.
54
themselves been patients.57 Although only two nursing
New Zealand’s nursing association had previously in
research projects were reported in this period, they are
1930 reported a survey on the amount of time student
nonetheless significant forerunners of the development
nurses spent on domestic and non-professional work in
of New Zealand nursing research capability.
53
each year of their training. The result was considered Page 18
Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand Precursors to developing nurses’ research capability
busy professional lives and they were glad of the help in this final stage of reporting the results. Although the shift to naming authors was starting at the time of the
Research capability in the profession was built on
second study’s publication, the author did not identify
a foundation of nursing scholarship and research
herself. As only the one nursing research article had
awareness. Since the 1920s American nurses had
previously been published, and then with a doctor as
advocated research-mindedness as a vital element in
author, perhaps she felt reluctant to claim the new role
advancing the profession. By 1953 the Nursing Research
as an independent nurse researcher.
editor felt able to say that the ‘spread of the research attitude’ seemed ‘highly significant and promising for
Besides raising research awareness, the journal actively
the future’.58 Elsewhere at this time, however, little had
fostered various forms of nursing scholarship. It was not
happened in developing research capability since the
alone in this venture. Nursing schools adopted the case
ICN’s clear message twenty years earlier. Only a few
study as a method for expressing nursing practice,60 and
nurses outside of the United States of America were
the journal published many from students and registered
joining research teams. Opportunities for employment
nurses. The professional association sponsored an essay
in research were sporadically advertised in nursing
competition, nursing schools encouraged students to
journals. At the international level, applicants in 1950
enter, and the journal published winning entries. This
for the position of the Florence Nightingale International
represented a concerted, joint effort by three major
Foundation’s director were expected, however, to have
sources of influence over the capability and future
not only good nursing qualifications and wide nursing
direction of the nursing profession in New Zealand. It
experience but also experience in research methods.59
needs to be acknowledged that Kai Tiaki would have been expected to publish the essays as it was the
Although by the 1950s there were only a few examples
official journal of the association at this time. At the
of nursing research in New Zealand, the trajectory
same time, editors would have been pleased to receive
of building research capability can be traced from its
this material for its issues. Nevertheless, the journal
two precursors, the growth of nursing scholarship
played a deliberate part in fostering nursing scholarship.
and research awareness. The nursing journal played
Editors encouraged nurses to write about their practice
a significant part in this process. The intent of Hester
and nurses responded to the call. A wealth of articles
Maclean and her successors in publishing reprints or
explained aspects of nursing care, different nursing
excerpts of overseas articles relating to research was
practice settings and professional issues.
to raise nurses’ awareness of research rather than encourage them to engage directly in it. The country’s
Despite New Zealand’s great distance from other
lack of professional education for research until the
countries, small size and population, the editors ensured
1970s meant nurses had little opportunity to acquire
it was in line with international trends in fostering
research skills. It is therefore significant that two
nursing scholarship. Maclean’s involvement with the
accounts of nursing research by New Zealand nurses
ICN publication committee, and later nurse leaders’
were published in the 1930s and 1940s. The fact that
engagement in ICN and international conferences,
the first was written by a doctor on behalf of nurses
meant that the vigorous international push to get
suggests the nurses lacked confidence in their ability
nurses to write for their own professional journals was
in this new area. Or perhaps carrying out the research
incorporated into professional activities in New Zealand.
had taken all the time and energy they had in their Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Page 19
Nursing Praxis in New Zealand In this review two forms of the profession’s “coming
writers now felt confident adding their name to their
of age” in relation to research have been identified.
submitted work. Either way, it suggests a change in
By the end of the 1930s, nurses had adapted the case
how the profession regarded itself. It signifies growing
study to focus on nursing practice, differentiating it
confidence that nurses had worthwhile opinions and
from the medical case study and therefore identifying
useful perspectives to offer on practice and should
they had their own sphere of professional knowledge
therefore be named. It therefore shows an increasing
and scholarship, or at least their own way of expressing
esteem for nurses’ scholarship. The development of
patient care. In the 1940s and 1950s the proportion of
the nursing case study and the growth in confidence
named authors steadily increased. Instead of up to half
seen through named authorship were earlier forms of
of all nursing articles carrying no author identification,
the “coming of age” that recent nurse scholars have
as in previous decades, only a quarter of articles now
also identified as crucial to the development of nursing
had no author named. It is unclear whether this was
research capability.61
a shift in editorial policy or whether individual nurse
Endnote References 1 B. Green, J. Segrott, H. Priest, A. Rout, M. McIvor, J. Douglas, Y. Flood, S. Morris & C. Rushton, ‘Research capacity for everyone? A case study of two academic nursing schools’ capacity building strategies’, Journal of Research in Nursing, 12, 3 (2007), pp.247-65. 2 P.A. Jamerson, A.F. Fish & G. Frandsen, ‘Nursing Student Research Assistant program: A strategy to enhance nursing research capacity building in a Magnet status pediatric hospital’, Applied Nursing Research, 24 (2011), pp.110-13; L. O’Byrne & S. Smith, ‘Models to enhance research capacity and capability in clinical nurses: a narrative view’, Journal of Clinical Nursing, 20 (2010), pp.1365-71; L. Travis & M.K. Anthony, ‘Energizing the research enterprise at non-academic health center schools of nursing’, Journal of Professional Nursing, 27, 4 (2011), pp.215-20. 3 L. Stockhausen & S. Turale, ‘An explorative study of Australian nursing scholars and contemporary scholarship’, Journal of Nursing Scholarship, 43, 1 (2011), pp.89-96, quotation on p.93. 4
M. Litchfield, To Advance Health Care: The Origins of Nursing Research in New Zealand, New Zealand Nurses Organisation, Wellington, 2009.
5
N. Chick & N. Kinross, Chalk and Cheese. Trail-blazing in New Zealand: A Story told through Memoir, N. Chick & N. Kinross, Christchurch, 2006; P. Wood & S. Knight, Achieving University Education for New Zealand Registered Nurses: The Role of the C.L. Bailey Nursing Education Trust, Graduate School of Nursing, Midwifery & Health, Victoria University of Wellington, Wellington, 2010.
6
‘A revision of nursing technique’, Kai Tiaki (KT), March (1933), pp.7-9.
7
M.J. Mack, ‘The personal adjustment of chronically ill old people under home case’, Nursing Research, 1, 1 (1952), pp.9-30.
8
S. Nelson, ‘A history of small things’, in J. Latimer, ed, Advanced Qualitative Research for Nursing, Blackwell Science, Oxford, 2003, pp.211-29, quotation on p.216.
9
J. Tosh, with S. Lang, The Pursuit of History: Aims, Methods and New Directions in the Study of Modern History, 5th ed., Pearson Longman, Harlow, UK, 2012.
10
P.J. Wood, ‘Understanding and evaluating historical sources in nursing history research’, Nursing Praxis in New Zealand, 27, 1 (2011), pp.25-33.
11 ‘The purposes of the journal’, KT, January (1908), p.1. 12 See for example ‘The new journal’, editorial, Australasian Nurses’ Journal, 3, 3 (1908), pp.81-82; ‘The responsibilities of a nurse to her nursing journal’, Australasian Nurses’ Journal, 17, 12 (1919), p.406. 13 ‘The new journal’; ‘The responsibilities of a nurse to her nursing journal’; ‘Our “journal”’, editorial, Australasian Nurses’ Journal, 8, 2 (1910), p.38; Australasian Nurses’ Journal, 17, 12 (1919), p.406.
Page 20
Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand 14 M. Breay, ‘The aims of a professional journal’, Canadian Nurse, 21, 12 (1925), pp.631-2; M. Roberts, ‘How to make a journal useful and attractive’, Canadian Nurse, 22, 1 (1926), pp.8-13. 15 M. Goodnow, ‘Writing – a duty’, Canadian Nurse, 20, 1 (1924), pp.804-06. 16 ‘Editorial. New Zealand Nursing Journal (Kai Tiaki)’, KT, July (1938), pp.171-2. 17 ‘Message from Director, Division of Nursing, Department of Health. The purposes of the “Journal”’, KT, January (1958), p.4. 18 ‘Competitive prize essay’, Nursing Record, 1, 4 (1888), p.46. 19 ‘Nursing as a link in the prevention of disease’, KT, October (1938), p.279 & pp.282-3. 20 ‘The hospital essay competition’, KT, September (1938), pp.245-50. 21 ‘Branch notes. Wellington’, KT, August (1939), pp.294-5. 22 J. Wilson, ‘A nursing study of a case of pulmonary tuberculosis’, KT, February (1949), pp.9-12; E. Lindsay, ‘The pre-operative and post-operative case of a case of hysterectomy’, KT, February (1950), pp.7-10; M. de Latour, ‘What steps are being taken to bring before people of this country the importance of early treatment of cancer? Why is early diagnosis of this disease valuable and how can you as a nurse contribute?’, KT, June (1953), pp.90-93; J. Allen, ‘Discuss the psychological effect on a young child of a stay in hospital and the part parents’ visiting should play in his routine’, KT, April (1955), pp.37-39. 23 G. Cock, ‘The value of occupational therapy in the treatment of mental disorders, and the part played by the nurse,’ KT, December (1953), pp.177-80; R. Maniapoto, ‘A young child is admitted to a psychiatric hospital, What are the family reactions likely to be and how can the psychiatric nurse assist the family to adjust to this situation?’, KT, December (1954), pp.209-10. 24 J.O.M. Pipe, ‘The importance and establishment of breastfeeding’, KT, April (1945), pp.99-101. 25 S. Hickman, ‘The general care of an English bride, newly arrived in New Zealand, who arrives in hospital in the early stages of labour’, KT, March (1947), pp.39-41. 26 H. Campbell, ‘Mrs Grace Neill. Her life and work and her contribution to nursing in New Zealand’, KT, June (1945), pp.146-9; M. Karl, ‘It may seem a strange principle to enunciate as the first requirement of a hospital that it should do the sick no harm. (Florence Nightingale.) What special significance has this statement for the nurse who is responsible for the complete welfare of her patient?’, KT, February (1956), pp.6-8. 27 ‘Obstetrical Case Study Competition, 1943. Criticism of Entries’, KT, January (1944), p.21. 28 ‘Competitive prize essay. Seventeenth competition’, British Journal of Nursing, 4, 114 (1890), p.271. 29 ‘A case of typhoid fever with numerous complications, including perforation-operation-recovery’, Australasian Nurses’ Journal, 5 (1907), p.308. 30 M.E. Burke, ‘Rat bite fever’, KT, September (1938), pp.241-2; N. Knight, ‘Nursing treatment of Addison’s Anaemia’, KT, July (1930), pp.187-8; P. Floyd, ‘A case study: Actinomycosis’, KT, October (1946), pp.274-6; M.B. Mulligan, ‘Case history of a child aged eleven years who had contracted tetanus’, KT, November (1944), pp.258-9; K.F. Dalls, ‘The Miller-Abbott Tube in the treatment of paralytic ileus’, KT, November (1939), pp.393-4. 31 ‘Cases of typhoid fever’, KT, April (1912), p.29. 32 B. Jones & R. Watson, ‘A case of actinomycosis infection of the lung treated with penicillin’, KT, May (1944), pp.112-14. 33 See for example ‘A case of agranulocytosis’, KT, March (1937), pp.67-68; ‘An interesting case of scarlet fever (Haemorrhagic)’, KT, May (1930), pp.159-60; ‘Pyloric stenosis in twins’, KT, July (1936), pp.143-4. 34 M. Domitilla, ‘An experiment suggesting a teaching method for the Head Nurse’, American Journal of Nursing, 24, 7 (1924), pp.537-41. 35
O. Lilly, ‘Case study as a means of teaching nurses to teach themselves’, Canadian Nurse, 23, 4 (1927), pp.193-5; A. McLeod, ‘The student nurses’ monthly case report’, Canadian Nurse, 21, 5 (1925), pp.252-4; E.M. Stuart, ‘The case study method of ward teaching’, Canadian Nurse, 28, 1 (1932), pp.26-28.
36
See for example ‘The case study method,’ British Journal of Nursing, 75, 1910 (1927), pp.210-02.
37 ‘Items of interest from Miss Barnett’, KT, July (1932), p.157; I. Martin, ‘Nursing education’, KT, January (1939), pp.5-6. 38 ‘The nursing study’, KT, July (1939), pp.237-40. 39
I. Wills, ‘A case of agranulocytosis’, KT, October (1939), pp.384-5; E. Warner, ‘Nursing study of a case of pyelitis’, KT, March (1930), p.62; P. Williams, ‘Case study – acute nephritis’, KT, November (1945), pp.295-7; M. Gough, ‘A case of staphylococcal septicaemia successfully treated with sulphathiazole’, KT, June (1942), pp.183-4.
Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Page 21
Nursing Praxis in New Zealand 40
See for example ‘Nursing study’, KT, May (1939), pp.174-8; ‘Intracranial tumours’, KT, June (1939), pp.12-14.
41 B.G. Weir, ‘A case of removal of senile cataract’, KT, January (1941), pp.9-12. 42
N.M. Buckland, ‘A nursing study. Lobar pneumonia’, KT, May (1940), pp.139-42, quotation on p.142.
43
E.R. Bridges, ‘Hospital social service. The hospital almoner’, KT, September (1937), pp.200-06; F.J. Cameron, ‘Acceptable standards of paediatric nursing service’, KT, October (1953), pp.146-50; E. Paora, ‘Public health and other problems of a Maori Health District and suggestions for improvement’, KT, September (1940), pp.295-6; ‘Lecture to lay audience and farmers’ wives on “hydatids”’, KT, January (1930), p.135; ‘Communicable disease nursing. How to instruct the pupil nurses’, KT, September (1930), pp.257-8.
44 ‘Family forces affect the individual’, KT, December (1954), pp.222-3; ‘Psychology and nursing’, KT, January (1930), pp.16-18; ‘Nursing deals with not only diseases but personalities’, KT, February (1939), pp.50-53. 45 ‘Aseptic technique in limb amputations’, KT, July (1939), p.258; P. Beaumont-Orr, ‘Nursing care of lobectomy’, KT, November (1946), pp.307-08; ‘Cod liver oil treatment of wounds’, KT, January (1938), p.20; E.A. Gell, ‘Nursing cases of congenital dislocation of the hips following manipulations’, KT, December (1941), pp.406-08; ‘The nursing care of patients after intensive X-ray treatment’, KT, August (1938), pp.203-04; ‘The nursing care of the chronic patient’, KT, June (1944), pp.127-30; H. Wallis, ‘Pathological fracture due to parathyroid tumour’, KT, October (1950), pp.174-5. 46 F.J. Cameron, ‘A day in the country with the district health nurse’, KT, January (1946), pp.6-9; M. Corkhill, ‘Bedside care in the home’, KT, March (1946), pp.53-58; C. McKenny, ‘The V.D. clinic’, KT, November (1934), p.199; ‘One wet day in the life of a Plunket Nurse’, KT, January (1930), pp.22-24; ‘Outpatients department’, KT, May (1930), p.136 & p.138; K. Rutherford, ‘My work as the rural district nurse’, KT, December (1953), pp.174-6; ‘The district health nurse at work in the city’, KT, April (1946), pp.77-81; ‘Venereal disease clinic’, KT, May (1930), pp.118-20. 47 D. Barron, ‘Sunlight treatment or actinotherapy’, KT, March (1935), pp.14-16; P.E. Borlase, ‘Treatment for arthroplasty of the hip with vitallium moulds’, KT, June (1950), pp.110-13; C. Braethwaite, ‘Nursing treatment. Trans-urethral resection’, KT, September (1936), pp.182-3; A.M. Brown, ‘The treatment of peripheral vascular disease by venous occlusion’, KT, December (1940), pp.39092; E.M. Irving, ‘Nursing treatment in the oxygen tent’, KT, August (1939), p.276; E. Kellahan, ‘Nursing treatment of schizophrenia by hypoglycaemic shock’, KT, November (1939), pp.390-92; M. Sheehan, ‘The story of sulphanilamide’, KT, February (1939), pp.64-65. 48 H. McCombie & J.S. Aitken, ‘Wellington Hospital intravenous practice and technique’, KT, October (1942), pp.249-53; E.M. Summers & J.S. Peel, ‘Drugs and the nurse’, KT, December (1948), pp.254-5. 49 B. Jones & R. Watson, ‘A case of actinomycosis infection of the lung treated with penicillin’, KT, May (1944), pp.112-14. 50 See for example ‘Cancer research fund’, KT, November (1930), p.319; ‘War on cancer’, KT, March (1930), p.62. 51 ‘Lubricants for rubber catheters’, KT, July (1938), pp.175-7. 52 ‘Visit of Miss Hudson to Wellington’, KT, July (1938), p.195. 53 ‘International Council of Nurses’, KT, August (1949), pp.76-77. 54 ‘How to survey a school of nursing’, KT, February (1955), p.20. 55 ‘Editorial’, KT, March (1930), pp.51-52. 56 H.B. Turbott, ‘Treatment of scabies, impetigo and pediculosis’, KT, January (1933), p.316, p.318 & p.320. 57 ‘The nursing care of the chronic patient’, KT, June (1944), pp.127-30. 58 M. Bridgman, ‘The research attitude’, Nursing Research, 2, 2 (1952), p.51. 59 ‘International Council of Nurses’, British Journal of Nursing, 98, 2182 (1950), p.64. 60 ‘Items of interest from Miss Barnett’; Martin; ‘The nursing study’. 61 Stockhausen & Turale.
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Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand
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Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Page 23
Nursing Praxis in New Zealand CIGARETTE SMOKING AND THE FREQUENCY OF COLPOSCOPY VISITS, TREATMENTS AND RE-REFERRAL. Lamb, J. RN, BN, MHSc, Clinical Nurse Specialist, Colposcopy Department, Christchurch Women’s Hospital, Christchurch, NZ. Dawson, S.I. RN, BSC (Hons), MSc and Public Health Research, PhD, Senior Manager, Population Health Manager, BAML, Perth, Australia. Gagan, M.J. PhD, PHCNP, FAANP, CEO, Nurse Practitioners First Ltd. Christchurch, NZ. Peddie, D. FRANZCOG, MRCOG, Consultant Gynaecologist & Obstetrician, Christchurch Women’s Hospital, Christchurch, NZ.
Abstract Current research has confirmed that cigarette smoking is a risk factor for cervical cancer. Although more recently, there has been a slight decline in smoking rates, the relationship between tobacco use and cervical cancer remains clear. The development of research-based knowledge with which to inform the profession will assist practitioners to promote smoke-free practices for women and their families. The aim of this study was to identify whether female smokers referred to the colposcopy department at a city hospital required more follow-up visits, treatments and re-referrals than did nonsmokers. This retrospective descriptive study observed new patients (n= 494) who attended a city hospital colposcopy department in 2001 over the following six years. When compared to non-smokers women who smoked were found to be three times more likely to need a third follow-up visit, and twice more likely to need further treatments to remove abnormalities. This study also identified that 71% of Māori women attending the clinic were smokers compared to 44% of non-Māori women. It was also found that Māori women were less likely to attend the colposcopy clinic than were nonMāori. This study highlights to health professionals and to the women who undergo colposcopy, that treatment is more likely to be successful for patients who cease smoking. The results have also supported the importance and relevance of smoke-free education to women. This allows the link to cervical abnormalities and smoking to be explained and smoking cessation assistance offered. This information also highlights the need for Māori women, who are more likely to smoke and have higher rates of non-attendance for appointments, to have services provided that will encourage attendance and smoke-free behaviour. Keywords: Cervical cancer, colposcopy, cigarette smoking, ethnicity, cervical intraepithelial neoplasia Many women attending a city hospital for colposcopy
undertaken as a retrospective descriptive study that
visits are current smokers, so this can be a useful time to
compared the persistence and recurrence rates of cervical
highlight the link between cigarette smoking and cervical
intraepithelial neoplasia (CIN) with individual smoking
abnormalities. Identification of a woman as a current
status in women who attended the colposcopy clinic.
smoker presents an opportunity to offer assistance for
Ethnicity was also examined to discover whether Māori
her to become smoke-free. The aim of this study was to
women and other ethnic groups were disproportionately
demonstrate the impact cigarette smoking can have on
represented at the colposcopy department.
the cervix and the need for cigarette smokers to have more follow-up visits, treatments and re-referrals for colposcopy visits than non-smokers. This research was
Page 24
Lamb, J., Dawson, S.I., Gagan, M.J., & Peddie, D. (2012). Cigarette smoking and the frequency of colposcopy visits, treatments and re-referral. Nursing Praxis in New Zealand, 29(1), 24-33. Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand Background
once a woman becomes smoke-free, how long it takes before the risk declines is unclear (Dresler, Leon, Straif,
Cervical cancer is the second most common form of
Baan, & Secretan, 2006; ICESCC et al., 2006).
cancer in women, worldwide (Bosch, Lorincz, Munoz,
The incidence of cervical cancer in New Zealand women
Meijer, & Shah, 2002; Sankaranarayanan & Ferlay, 2006)
was recorded at 6.9 per 100,000 in 2002 (Ministry of
and the eighth most common cancer affecting women
Health, 2006b). This rate was the same as in Australia,
in New Zealand (Ministry of Health, 2007a). Cigarette
and lower than the United Kingdom (8.3 per 100,000).
smoking is associated with many cancers, including
The highest incidence of cervical cancer recorded is
cervical cancer, and the likelihood of developing cervical
in Latin America, with an incidence rate of 33.5 per
cancer is lower in non-smokers and former smokers
100,000. Some of the lowest incidence rates have been
(Munoz, Castellsague, de Gonzalez, & Gissmann, 2006).
recorded in China with a rate of 2.7 per 100,000 (Parkin,
While the risk of developing cervical cancer decreases
2006) (see Table 1).
Table 1 . Incidence of Cervical Cancer in 2002 Country
Rate per 100,000
China 2.7 New Zealand
6.9
Australia 6.9 Canada 7.7 United States
7.7
Sweden 8.2 United Kingdom
8.3
Latin America
33.5
Note: Sourced from Munoz et al. (2006); New Zealand Ministry of Health (2006b); Wain, (2006).
Cervical cancer impacts significantly on younger women
cancer is the third most common form of cancer in Māori
and is recognised as a serious cause of years of life lost
women in New Zealand, and the fourth leading cause
for women in developing countries. For example, in
of death for Māori women (Ministry of Health, 2007a).
countries such as those of Latin America and Eastern Europe cervical cancer causes more years of life
Tobacco smoking in New Zealand and ethnicity
lost than tuberculosis, acquired immune deficiency syndrome (AIDS) and maternal circumstances. Globally
Tobacco smoking is recognised as the chief cause of
it is estimated that cervical cancer is responsible for
preventable death in New Zealand. It is estimated that,
2.7 million years of lost life (age-weighted) (Yang, Bray,
on average, 4,700 men and women die each year from
Parkin, Sellors, & Zhang, 2004). In New Zealand, 200
smoking-related illnesses (Health Sponsorship Council,
women are diagnosed annually with invasive cancer of
2007). At all ages Māori have the higher rate (47%) of
the cervix, and approximately 60 women die each year
smoking, with Māori women having the highest rate
from the disease (Ministry of Health, 2006b). Cervical
of 50% (Ministry of Health, 2007b). While 27.5% of 15
Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Page 25
Nursing Praxis in New Zealand to 19 year olds were reported to smoke, Māori girls
their inclusion essential to achieve representativeness.
have a 60% smoking prevalence, almost double that of young Māori men (32%). However, this picture is
Participants
reversed for Pacific teenagers – young Pacific girls’
This study examined records from patients who
smoking prevalence is 28% compared to young Pacific
attended for the first time at the colposcopy clinic
men (46%) (Ministry of Health, 2006c).
between 1 January 2001 and 31 December 2001. Of 1100 women seen in 2001, 500 met the inclusion
Research Design
criteria, and 494 participants were followed-up until 31 December 2006. Patients were included in the study if
This was a quantitative descriptive study, using a
they met the criteria and excluded if they had any of
stratified random sample. That approach was used as
the conditions outlined in Table 2.
some of the variables in the population were known and Table 2. Inclusion and Exclusion Criteria Inclusion Criteria
Exclusion Criteria
•
New patient
•
Under 20 years of age or over 70 years of age
•
No previous colposcopy
•
Previous presentation to the clinic for colposcopy
•
Presented at the colposcopy department in 2001
prior to referral during 2001. •
Previous colposcopy
•
Age 20 years of age to 69 inclusive
•
Treatment to occur at a different facility
•
Had low grade intraepithelial lesions (LSIL) or
•
Glandular abnormality
high grade intraepithelial lesions (HSIL) on
•
Vulval abnormalities that may or may not
their cervix.
include the cervix
Method Data regarding how often clients had attended for
not attend’ (DNA) status.
treatment were collected from treatment registers. All other data were obtained from clients’ clinical records.
Ethical approval from the University of Otago Board
Data available from assessment forms included age,
of Studies was granted. Consultation with a Māori
ethnicity, smoking behaviour, LSIL/HSIL diagnosis,
Research Office representative took place prior to
combined oral contraceptive pill (COCP) usage, parity,
commencement of the study, and a Māori Research
gravida, biopsy, treatment type, number of treatments,
Manager requested that the findings related to Māori
treatment type at each follow-up appointment, cancer,
women be disseminated appropriately to Māori
genital warts, re-referral, weight and height, and ‘did
researchers, health providers and health professionals.
Page 26
Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand Data analysis
being 29.83 years (SD. 8.87 years). The participants were
Data were entered onto an Excel spreadsheet by the
84.6% European, 5.7% MÄ ori, and 0.8% Pacific Island,
researcher, and then checked for errors. The checked
which reflected the ethnic distribution of the population
data was imported into the Statistical Package for Social
for the city hospital region.
Sciences (SPSS) version 13. All data variables of interest were found to be normally distributed. Data analysis in
Smoking behaviour
this study utilised descriptive and inferential statistics
The smoking status of women attending the colposcopy
to describe and characterise demographic data. This
clinic was routinely collected at each clinic appointment
information is reported as percentages, frequencies,
in order to complete the medical history. Smoking status
mean, risk ratio, and odds ratio.
at the time of first clinic visit was therefore known for all 494 women and showed that 44.9% (n=222) women
Results
were smoking at the time of data collection. The number of cigarettes smoked per day was identified for 130
Five hundred women were eligible for inclusion in
women, with 64 smoking less than 10 cigarettes per
the study, however, six did not attend and were then
day. For 92 women, this information was not stated
removed from the study. The remaining 494 women
(see Figure 1).
were aged between 20-69 years, with the mean age
Figure 1. Smoking Status
Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Page 27
Nursing Praxis in New Zealand Ethnicity, cervical intraepithelial neoplasia (CIN), and
clinic (two participants took up private care), women
attendance rates
who reported smoking, when compared to women who
While non-Māori women had a 1.28 greater odds ratio
did not smoke were significantly more than twice as
of having CIN, this was not statistically significant (p =
likely to need a further treatment as were non-smokers
0.65). One of the seven women in the study recorded
(RR 2.10, CI 1.37 to 3.21, p = 0.001) (see Table 3). In
as having squamous cervical cancer identified as Māori.
relation to those who reported smoking, 78.4% (n=174
Māori women were found to be significantly more likely
out of 222) had CIN compared to73.9% (n=201 out of
not to attend (DNA) the clinic for colposcopy when
272) of non-smokers. Therefore, smokers were 1.28
compared to non-Māori (OR 3.05, CI 1.41 to 6.63, p =
times more likely to have CIN. However this difference
0.0006).
was not statistically significant (p = 0.29).
Smoking and ethnicity
Treatments to remove abnormalities from the cervix
It was found that women with a non-European ethnicity
were recorded as LLETZ biopsy, cone biopsy, laser
were 1.25 (CI 0.70 to 2.25) times more likely to smoke
treatment, hysterectomy, ablation, private follow-up and
than European women, although this difference was
no treatment. Among the 494 study participants, 74.1%
not statistically significant (p = 0.46). Twenty (71.4%)
(n=366) first treatments were carried out, with a LLETZ
of the 28 (5.7%) Māori women in the study, reported
procedure being the most common and accounting
smoking. Māori women were significantly more than
for 43.3% (n=214) of the procedures. Hysterectomies
three times likely to report smoking when compared to
accounted for only 0.2% (n=1) of the procedures, while
all other women in the study (OR 3.27, CI 1.41 to 7.57,
0.4% (n=2) of the women had private follow-up. Women
p = 0.005), although the numbers of Māori women
who reported smoking were nearly twice as likely to
attending the colposcopy clinic were low.
need a second treatment as non-smokers (RR 1.90, CI 0.84 to 4.31). However, the number of study participants
First treatment at colposcopy clinic and smoking status
needing a second treatment was very low (n = 25), and
Of the 364 (73.7%) women treated at the colposcopy
not statistically significant (p = 0.15).
Table 3. Smoking Status and Number of Follow-up Appointments
Smokers (n=222) (Rate %)
Non-smokers (n=272) (Rate %)
RR
CI
p
Follow-up 1
100%
100%
-
-
-
Follow-up 2
92%
83%
1.61
1.11 to 2.34
0.014
Follow-up 3
58%
27%
3.21
1.95 to 5.28
<0.001
Follow-up 4
37%
15%
3.43
1.83 to 6.43
<0.001
Follow-up 5
19%
9%
2.74
1.21 to 6.17
0.018
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Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand Follow-up visits and smoking status, ethnicity, age,
The study identified that within the study period 454
gravida, parity and COCP
of the women required one referral to the colposcopy
The cohort of 494 was observed in relation to the
department. In relation to second referral, 40 (7.3%)
number of follow-up visits each participant needed and
required a second referral. For women in this second
their smoking status. Women who smoked compared
referral group, it was found that smokers were more
to those who did not smoke, were 1.61 times more
than twice as likely to have a second referral as were
likely to need a second follow-up appointment, more
non-smokers (RR 2.12, CI 1.12 to 4.23). This difference
than three times more likely to need a third and fourth
was statistically significant (p = 0.03). In relation to
follow-up appointment, and almost three times more
women requiring three referrals, four such women
likely to need a fifth follow-up appointment than
were seen, with two of this group smoking and two
non-smokers. These differences were all statistically
not smoking. No analysis was performed on this group
significant. Ethnicity, age, gravida, parity and COCP
as it was too small for the results to be meaningful.
use were not statistically significantly associated with
Age, ethnicity, gravida, parity and OCP use were not
number of follow-ups.
statistically significantly associated with needing more than one referral.
Number of re-referrals Of the 494 study participants, 91.9% (n=454) required
The results demonstrated that for all second, third,
only one referral, although 8.1% (n=40) required a
fourth and fifth follow-up visits, the women who
second referral after being previously discharged
attended were more likely to be smokers than non-
from the colposcopy clinic. Within the study period,
smokers (see Table 3). At the first follow-up there were
the maximum number of re-referrals for any woman
found to be a 60% (CI 1.11 to 2.34; p = 0.014) likelihood
was three, with only four women requiring a third re-
of the woman having been reported as a smoker when
referral. Of the 40 women requiring second referral,
she presented as a new patient in 2001. At the third and
25 reported smoking. Smokers were significantly more
fourth visits, women who smoked were over three times
than twice as likely to need a second referral (RR 2.12, CI
more likely to attend than women who did not smoke.
1.12 to 4.23, p = 0.03). Although the numbers were too
At follow-up five, the numbers of women needing a
low to carry out any meaningful analysis, two women
colposcopy were 28, with 19/28 of this group reported
needing a third referral reported smoking and two did
as smoking (OR 2.74, CI 1.21 to 6.17; p = 0.018). Unlike
not. Age, ethnicity, gravida, parity and COCP use were
smoking, other variables such as ethnicity, age, gravida,
not significantly associated with the need for more than
parity and COCP use were not statistically significantly
one referral.
associated with number of follow-ups.
The 8.1% (n= 40) of women requiring a second treatment would be considered an acceptable figure
Limitations
(Ministry of Health, 2005; Sellors & Sankaranarayanan, 2003). For this group of women, it was found that while
During the course of this research, a number of
they were nearly twice as likely to be smokers as non-
limitations that may have impacted on the outcomes
smokers (RR 1.90, CI 0.84 to 4.31), this difference was
were identified. The most significant of these related to
not statistically significant. However, as numbers were
the number of years spent smoking and the number of
low caution is advised when interpreting these results.
cigarettes smoked. While the smoking status of women
Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Page 29
Nursing Praxis in New Zealand was identified in all of the records used in the study,
information to women and health professionals could
information relating to the length of time smoking
improve the smoking cessation rate and thereby reduce
and the number of cigarettes smoked could have been
the number of colposcopy interventions required. It also
helpful when interpreting the results. It would be useful
has the benefits for the colposcopy service in terms of
in a future study to have a prospective design and ask
reduction of numbers of repeat visits for women.
further questions related to the intensity and duration of the participant’s cigarette smoking habit. In addition,
Māori women in New Zealand are shown to have the
caution needs to be taken with respect to analyses
highest rate of mortality from cervical cancer, followed
where small numbers were observed, particularly
closely by Pacific women (Sadler et al., 2004). Māori
with regard to Maori and Pacific women. During the
and Pacific Island women were identified as being three
timeframe of the study, inaccuracies in the recording of
times more likely to not attend appointments than
ethnicity have been noted therefore the numbers may
non-Māori women. This highlights the need to consider
well be under-counted. Some patients had an initial
alternative means of improving ongoing attendance for
colposcopy examination but failed to attend follow-up
colposcopy. This is an area requiring further research.
appointments. As a result, the data related to on-going visits in relation to persistence and recurrence of cervical
Previous research has identified that many women,
abnormalities is incomplete. It is noted that there is
regardless of their smoking status, may come into
a clear link between socioeconomic status, smoking
contact with the Human Papillioma Virus (HPV), but at
and cervical abnormalities (Ministry of Health, 2005);
some point in the disease process cigarette smoking
however, because of the retrospective design of the
either encourages acquisition of the HPV or assists in the
study data relating to socioeconomic status was unable
disease progressing to CIN (International Collaboration
to be obtained.
of Epidemiological Studies of Cervical Cancer et al., 2006; 2005; Munoz et al., 2006). In studies undertaken
Discussion
throughout 22 countries HPV DNA has been found in 99.7% of all cervical cancers (Clifford, Franceschi, Diaz,
This study has shown that smoking cigarettes can
Munoz, & Villa, 2006). The current study provides further
adversely affect the health of the cervix. Women who
support for this trend. However, although women who
smoke are at greater risk of requiring more referrals
presented with CIN were 1.28 times more likely to smoke
to colposcopy, more follow-up visits and treatments
when compared to non-smokers, this difference was not
to their cervix than women who do not smoke. The
statistically significant. (p = 0.29). McIntyre-Seltman,
risk of cervical abnormalities for women who become
Castle, Guido, Schiffman, and Wheeler’s (2005) study
smoke-free is less than for women who continue to
of 5,060 women found the development of HPV was
smoke; therefore, smoking cessation is potentially
only weakly associated with cigarette smoking; but that
beneficial to reduce the need for women to have on-
the progression of HPV to CIN III was greater in women
going follow-up, treatments and referrals, and to reduce
who smoked compared to women who did not smoke
the risk of cervical cancer (International Collaboration of
(OR 1.7; 95%; CI 1.4 to 2.1).
Epidemiological Studies of Cervical Cancer et al., 2006; Richardson et al., 2005). While it is widely known in the
Although smoking is associated with an increased
medical profession that cigarette smoking is a risk factor
risk of squamous cell carcinoma (Koushik & Franco,
for squamous cell carcinoma, this link is not so widely
2006; Richardson et al., 2005; Vaccarella et al., 2008)
known in the general population. Dissemination of this
it is still unclear whether smoking increases the risk
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Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand of developing, or the persistence of, HPV. Two recent
at a greater risk of developing CIN III or SCC than are
studies further support the present study. In these it
non-smoking women (Gunnell et al., 2006; International
was found that women who smoked had an increased
Collaboration of Epidemiological Studies of Cervical
incidence of HPV, and women with a greater smoking
Cancer et al., 2006; McIntyre-Seltman et al., 2005).
intensity were more likely to have HPV (Richardson et
While the Ministry of Health (2006a) found that in 2001
al., 2005; Vaccarella et al., 2008). The two large studies
approximately 23% of the Canterbury female population
previously identified, where women who develop CIN
was smoking, in the present study for the population of
and cervical cancer were found to be more likely to be
women attending the colposcopy clinic that figure was
smokers (International Collaboration of Epidemiological
about doubled (44.9%).
Studies of Cervical Cancer et al., 2006; McIntyre-Seltman et al., 2005; Munoz et al., 2006), also support the
Conclusion
findings of this research. The results show conclusively that cigarette smoking While women who have had a treatment for CIN
increases the likelihood of women requiring further
have been identified as being at an increased risk of
colposcopy visits, treatments and re-referrals. The
developing further CIN (Cestero, 2006; Kalliala, Anttila,
results identified that when compared to non-smokers,
Pukkala, & Nieminen, 2005), the risk that women who
women who smoked were three times more likely to
smoke will require a second treatment is greater than
need a third follow-up visit, and twice as likely to need
that for women who do not smoke (Acladious et al.,
further treatments to remove abnormalities. Women
2002). This study found that women who smoked were
who smoked were also twice more likely to require a
more than twice as likely to need further treatment
second referral than women who did not smoke. The
when compared to women who did not smoke. In a
link between smoking and the frequency of colposcopy
United Kingdom study, the risk of treatment failure was
visits, treatment and re-referrals supports the need for
found to be 3.17 times higher for women who smoked
intervention to encourage smoking cessation. This need
than that for non-smokers. (Acladious et al., 2002).
is particularly the case for MÄ ori and Pacific women
This same study also took account of the intensity and
as they are more likely to smoke than those of other
duration of smoking and confirmed that the greater the
ethnic identities.
number of cigarettes smoked, the greater the tendency for treatment failure (Acladious et al., 2002).
Both the research results and the literature indicate the importance of linking colposcopy interventions
The two studies previously discussed (Acladious et
and promotion of smoke-free behaviour. The literature
al., 2002; Vaccarella et al., 2008) support the research
has also indicated that the link between smoking and
reported here in that they demonstrated that women
CIN needs wider and stronger dissemination to health
who smoke are more likely to have persistence and
professionals, women, and their families. Girls reaching
recurrence of HPV, LSIL and HSIL. It is expected that
puberty should also be targeted with the information
women who experience persistent and recurrent
that cigarette smoking is associated with damage to
HPV and CIN will require more interventions, which
the cervix, and that the risk of HSIL and cervical cancer
may include additional examinations, diagnosis,
is greater for those starting smoking at a young age
and treatments to remove cervical abnormalities. A
(International Collaboration of Epidemiological Studies
number of the other studies examined also support
of Cervical Cancer et al., 2006; Tolstrup et al., 2006).
these findings, showing that women who smoke are Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Page 31
Nursing Praxis in New Zealand References Acladious, N. N., Sutton, C., Mandal, D., Hopkins, R., Zaklama, M., & Kitchener, H. (2002). Persistent human papillomavirus infection and smoking increase risk of failure of treatment of Cervical Intraepithelial Neoplasia (CIN). International Journal of Cancer, 98(3), 435-439. doi: 10.1002/ijc.10080 Bosch, F. X., Lorincz, A., Munoz, N., Meijer, C. J., & Shah, K. V. (2002). The causal relation between human papillomavirus and cervical cancer [Electronic Version]. Journal of Clinical Pathology, 55, 244-265. Retrieved from http://jcp.bmj.com/cgi/content/abstract/55/4/244 Cestero, R. M. (2006). Risk of high-grade cervical intraepithelial neoplasia (CIN 2/3) or cancer during follow-up of human papillomavirus (HPV) infection or CIN 1. American Journal of Obstetrics and Gynecology, 195, 1196-1197. doi:10.1016/j.ajog.2006.08.005 Dresler, C. M., Leon, M. E., Straif, K., Baan, R., & Secretan, B. (2006). Reversal of risk upon quitting smoking. The Lancet, 368, 348-349. doi:10.1016/S0140-6736(06)69086-7 Gunnell, A. S., Tran, T. N., Torrang, A., Dickman, P. W., Sparen, P., Palmgren, J., & Ylitalo, N. (2006). Synergy between cigarette smoking and human papillomavirus type 16 in cervical cancer in situ development. Cancer Epidemiology, Biomarkers & Prevention, 15, 2141-2147. doi:10.1158/1055-9965.EPI-06-0399 Health Sponsorship Council. (2007). Tobacco Control. Retrieved from http://www.hsc.org.nz/index.html International Collaboration of Epidemiological Studies of Cervical Cancer (ICESCC). (2006). Carcinoma of the cervix and tobacco smoking: Collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies. International Journal of Cancer, 118, 1481-1495. doi: 10.1002/ijc.21493 Kalliala, I., Anttila, A., Pukkala, E., & Nieminen, P. (2005). Risk of cervical and other cancers after treatment of cervical intraepithelial neoplasia: Retrospective cohort study. BMJ, 331, 1183-1185. doi:10.1136/bmj.38663.459039.7C Koushik, A., & Franco, E. L. (2006). Epidemiology and the role of human papillomaviruses. In J. S. Jordan, (Ed.), The cervix (2nd ed., pp. 259-276). Malden, MA: Blackwell. McIntyre-Seltman, K., Castle, P. E., Guido, R., Schiffman, M., & Wheeler, C. M. (2005). Smoking is a risk factor for cervical intraepithelial neoplasia grade 3 among oncogenic human papillomavirus DNA-positive women with equivocal or mildly abnormal cytology. Cancer Epidemiology, Biomarkers & Prevention, 14, 1165-1170. doi:10.1158/1055-9965.EPI-04-0918 Munoz, N., Castellsague, X., de Gonzalez, A. B., & Gissmann, L. (2006). HPV in the etiology of human cancer. Vaccine, 24(S3), S1-S10. doi:10.1016/j.vaccine.2006.05.115 Ministry of Health. (2005). Cervical screening in New Zealand: A brief statistical review of the first decade. Wellington, New Zealand: National Cervical Screening Programme. Retrieved from http://www.nsu.govt.nz/files/NCSP/NCSP_statistical_review.pdf Ministry of Health. (2006a). Cancer deaths and registrations. Retrieved from http://www.moh.govt.nz/moh.nsf/pagesns/32/$File/Ca ncer+Deaths+and+New+Registrations+2005.doc Ministry of Health. (2006b). Mortality and demographic data. Wellington, New Zealand: Author. Retrieved from http://www.health. govt.nz/publication/mortality-and-demographic-data-2006 Ministry of Health. (2006c). Tobacco trends 2006: Monitoring tobacco use in New Zealand. Wellington, New Zealand: Author. Retrieved from http://www.moh.govt.nz/notebook/nbbooks.nsf/0/2CA43F6104C0C581CC25709300029F0C/$file/tobacco-trends-2006.pdf Ministry of Health. (2007a). Cancer new registration and deaths 2004. Wellington, New Zealand: Author. Retrieved from http://www.nzhis. govt.nz/moh.nsf/pagesns/500/$File/Cancer04.pdf Ministry of Health. (2007b). New Zealand smoking cessation guidelines. Wellington, New Zealand: Author. Retrieved from http://www. health.govt.nz/publication/new-zealand-smoking-cessation-guidelines Parkin, D. M. (2006). The global health burden of infection-associated cancers in the year 2000. International Journal of Cancer, 118, 3030-3044. doi:10.1002/ijc.21731 Richardson, H., Abrahamowicz, M. L., Tellier, P., Kelsall, G., du Berger, R., Ferenczy, A., . . . Franco, E. L. (2005). Modifiable risk factors associated with clearance of type-specific cervical human papillomavirus infections in a cohort of university students. Cancer Epidemiology, Biomarkers & Prevention, 14, 1149-1156. doi:10.1158/1055-9965.EPI-04-0230 Sadler, L., Priest, P., Crengle, S., & Jackson, R. (2004). The New Zealand cervical cancer audit whakamatau mate pukupuku tatiawa o Aotearoa: Screening of women with cervical cancer 2000-2002. Wellington, New Zealand: Ministry of Health. Sankaranarayanan, R., & Ferlay, J. (2006). Worldwide burden of gynaecological cancer: The size of the problem. Best Practice & Research Clinical Obstetrics & Gynaecology, 20(2), 207-225. doi:10.1016/j.bpobgyn.2005.10.007
Page 32
Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand Sellors, J. W., & Sankaranarayanan, R. (2003). Colposcopy and treatment of cervical intraepithelial neoplasia: A beginnersâ&#x20AC;&#x2122; manual. France: International Agency for Research on Cancer. Vaccarella, S., Herrero, R., Snijders, P., Dai, M., Thomas, J., Hieu, N., . . . Franceschi, S. (2008). Smoking and human papillomavirus infection: Pooled analysis of the International Agency for Research on Cancer HPV Prevalence Surveys. International Journal of Epidemiology, 37, 536-546. doi:10.1093/ije/dyn033 Wain, G. V. (2006). Cervical cancer prevention: The saga goes on, but so much has changed! Medical Journal of Australia, 185(9), 476477. Retrieved from www.mja.com.au/journal/ Yang, B. H., Bray, F. I., Parkin, D. M., Sellors, J. W., & Zhang, Z. F. (2004). Cervical cancer as a priority for prevention in different world regions: An evaluation using years of life lost. International Journal of Cancer, 109, 418-424. doi:10.1002/ijc.11719
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Nursing Praxis in New Zealand NOTES FOR CONTRIBUTORS The initial and continuing vision for Nursing Praxis in New Zealand is that, within the overall aim of fostering publication as a medium for the development of research and scholarship, the Journal should: • Inform and stimulate New Zealand nurses. • Encourage them to reflect critically upon their practice, and engage in debate and dialogue on issues important to their profession. Nursing Praxis in New Zealand publishes material that is relevant to all aspects of nursing practice in New Zealand and internationally. The Journal has a particular interest in research-based practice oriented articles. Articles are usually required to have a nurse or midwife as the sole or principal author. There is no monetary payment to contributors, but the author will receive a complimentary copy of the Journal on publication. The ideas and opinions expressed in the Journal do not necessarily reflect those of the Editorial Board. Nursing Praxis in New Zealand original research, discursive (including conceptual, position papers and critical reviews that do not contain empirical data), methodological manuscripts, commentaries, research briefs, book reviews, and practice issues and innovations. Contributions are also accepted for Our Stories, which are short pieces profiling historical and contemporary stories, which reveal the contributions of individual nurses to our profession
Guidelines for Manuscripts While we encourage authors to be creative in the way they present their information, the following requirements must be met: •
Manuscripts should be word processed, formatted for A4 size paper, with double line spacing, page numbers on the bottom right side of the page and the manuscript title in the header of each page.
•
Use a plain font (Arial, Calibri, or Times New Roman).
•
The title must be no longer than 12 words.
•
Include an abstract of no more than 300 words, summarising the article. For research articles the abstract must include information about the research design, participants, and data collection and analysis methods.
•
Include a maximum of six (6) keywords.
•
Generally manuscripts will not exceed 3,500 words, however longer articles will be considered as long as they are focused and concise.
•
If the article is a research report then details of ethical processes followed must be included in the body of the manuscript.
•
Tables and figures each need to be presented on a separate page at the end of the manuscript. Insert into Manuscript <INSERT TABLE NO. / FIGURE NO. ABOUT HERE> where the table or figure should be inserted. Generally these should be inserted AFTER the pece of text where they are first referred to.
Further details are available on the Nursing Praxis in New Zealand website - www.nursingpraxis.org The Editorial Board reserves the right to modify the style and length of any article submitted, so that it conforms to the Journal format. Major changes to an article will be referred to the nominated author for approval prior to publication.
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Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand
Manuscript Submissions • Please supply manuscripts as a Word Document by e-mail to admin@nursingpraxisnz.org.nz • Manuscripts must be word processed, with double spacing, the title in the header and page numbers in the lower right of the footer. on each page. • All tables and figures must be included at the end of the document each on a seperate page. • Check you have used a plain font (Calibri, Arial or Times Roman). • No details of the author are to be displayed on the manuscript, please include this as a separate document (see below). A separate submission sheet must accompany the manuscript, detailing: • The full name, academic and professional qualifications of all authors, and current employment details. • An address to which all correspondence should be sent, contact phone numbers and e-mail addresses. • A statement that the work has not been previously published and giving written consent for publications; this must be signed by all contributing authors. • Where a manuscript is co-authored, each author must declare how they have actively participated in the development and writing of the manuscript.
Referencing It is the author’s responsibility to ensure that all references and citations are accurate and that all referencing follows 2010 APA (6th edition) conventions (see the Nursing Praxis website for examples). This includes all electronic references, which must include doi number for journal articles. References in the text should cite the author’s name(s), followed by the date of publication. Where direct quotations are used, page numbers must be given. References at the end of a manuscript should be listed alphabetically on a separate sheet formatted with a hanging indent and italicised, not underlined. E.g: American Psychological Association (APA). (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author. Smythe, L., & Giddings, L. S. (2007). From experience to definition: Addressing the question ‘What is qualitative research?’ Nursing Praxis in New Zealand, 23(1), 37-57. In the case of historical research, referencing compliant with the New Zealand Journal of History is acceptable.
Review Process All manuscripts will be blind critiqued by at least two reviewers prior to a decision being made by the Editorial Board. Subsequently the author will be notified of acceptance (along with any recommended changes) or rejection of the manuscript. Regular features are not peer reviewed. The review process takes, on average, three months.
Copyright Authors are responsible for the accuracy of their articles. After publication the article and its illustrations become the property of the Nursing Praxis in New Zealand journal.
Letters to the Editor Should not exceed 200 words. A nom de plume is acceptable provided full name and address are supplied. Please e-mail as a Word document.
Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
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Nursing Praxis in New Zealand Commentaries Nursing Praxis welcomes commentaries on papers published in its pages. These should be approximately 1000 words in length and should offer a critical but constructive perspective on the published paper. Original authors will be given the opportunity to respond to published commentaries.
Research Briefs Generally should not exceed 1500 words. Content must include a statement of the topic and purpose of the research; participants and the mode of recruitment; what was done (method and procedure for data collection and analysis); and a brief indication of the findings and their implications for nursing. As the material will be read by a broad cross-section of nurses, abstracts from theses are often not suitable in their original form and so require reworking.
Our Stories Nursing Praxis in New Zealand welcomes submissions to ‘Our Stories’. We are interested in publishing short articles that focus on nursing experiences over time. Our Stories will profile historical and contemporary stories, which reveal the contributions of individual nurses to our profession. Short articles, not exceeding 1500 words, are welcomed which provide insight to the contribution that a New Zealand nurse has made to the profession either locally, nationally, internationally. Such articles could include the stories behind the research, interviews with key nurses or the stories of those who have inspired and influenced their colleagues through their passion and commitment to the profession.
Book Reviews Book reviews should not exceed 500 words. Content must include a statement about the book’s topic and purpose, key points of interest in the book, a critique of the contents, and an indication of the implications or relevance for nursing or health practice.
Practice Issues and Innovations Articles are welcomed which highlight practice issues and innovations. Such articles might constructively discuss current nursing policy, practice or describe new approaches to nursing practice. This should be prepared as outlined for manuscripts above.
Send all Submissions via: E-mail – as a Word document together with scanned original copy of signed author information to: admin@nursingpraxis.org OR Post – One hardcopy of all documents together with a copy on a disk as a Word document to: Nursing Praxis in New Zealand P O Box 1984 Palmerston North 4440 New Zealand
Indexes Nursing Praxis in New Zealand is indexed in: • CINAHL (Cumulative Index of Nursing and Allied Health Literature), and • ProQuest.
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Vol. 29 No. 1 2013 - Nursing Praxis in New Zealand
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PO Box 1984, Palmerston North 4440, New Zealand P/Fx (06) 358 6000 E admin@nursingpraxis.org W www.nursingpraxis.org