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L P Journal of Professional Nursing M A IN NEW ZEALAND
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INSIDE THIS ISSUE... Building Relationships: The Key to Preceptoring Nursing Students Utilising the Hand Model to Promote a Culturally Safe Environment for International Nursing Students Understanding and Evaluating Historical Sources in Nursing History Research
Volume 27. No. 1
April 2011
Praxis: “The action and reflection of people upon their world in order to transform it.” (FREIRE, 1972)
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E DIT O RIAL BO ARD
EDITOR-IN-CHIEF: Denise Wilson RN, PhD, FCNA (NZ) Norma Chick Willem Fourie Thomas Harding Mary La Pine Dean Whitehead
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RN, RN, RN, RN, RN,
RM, PhD PhD, FCNA (NZ) PhD MN 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.
P.O. Box 1984, Palmerston North 4440, New Zealand P/Fx (06) 358 6000 E adminnursingpraxisnz.org.nz W www.nursingpraxisnz.org.nz ISSN 0112-7438 HANNAH & YOUNG PRINTERS
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EDITORIAL .......................................................................................................................................... 2
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ARTICLES:
Building Relationships: The Key to Preceptoring Nursing Students
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Jevada Haitana & Marian Bland.................................................................................................... 4 Utilising the Hand Model to Promote a Culturally Safe Environment for International Nursing Students
Bev Mackay, Thomas Harding, Lou Jurlina, Norma Scobie & Ruelle Khan................................... 13
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Understanding and Evaluating Historical Sources in Nursing History Research Pamela J Wood............................................................................................................................. 25 OUR STORY:
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Peter Harley: A Beacon of Humility and Professionalism
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Thomas Harding........................................................................................................................... 35 CONFERENCE REPORT: 3rd Philippine Nursing Research Society (PNRS) National Research Conference Thomas Harding........................................................................................................................... 38 BOOK REVIEW: Women’s Health in General Practice Ruth Davy..................................................................................................................................... 40 RESEARCH BRIEF: MELAA Report Summary Annette Mortensen...................................................................................................................... 41 NOTES FOR CONTRIBUTORS............................................................................................................. 42 Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
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Nursing Praxis in New Zealand EDITORIAL HOW READY ARE WE FOR DISASTERS? I want to begin this Editorial by acknowledging the
cultural considerations and how this impacted on
people of Christchurch and those in Japan, and to pay
saving people.
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my sincere sympathy to those who have lost loved ones, friends, acquaintances, colleagues and their
The recent events are a timely reminder for nurses to
homes and workplaces. I also want to acknowledge
reflect on how well prepared are they for a disaster
those nurses who lost their lives in the Christchurch
such as an earthquake or tsunami – real possibilities
earthquake. To those of you who are in the process of
for nurses practising in New Zealand. Fung, Lai and
rebuilding your lives; Kia maia, kia toa, kia manawanui
Loke (2009) state:
of the pain and heartache that goes with losing those
I D E E
we know, of having the treasures that are part of us
protecting others from health hazards; rests on
gone forever, of no longer having any certainty in life,
how they perceive disaster and its nature (p. 3167).
When disasters occur, nurses’ active role in caring
(be strong, be brave, be of good heart).
for the victims and those affected is crucial.
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For those of us watching from the outside we can only begin to imagine the terror of the initial earthquakes,
S S I X
Nurses’ effectiveness in responding to and handling disastrous happenings in relation to on-site triage, emergency care for the victims, supporting and
and the realisation that life will never be the same.
The recent events are a grim reminder that the power
The literature is full of studies about preparing nurses
of humankind is no match for the powerful forces of
for disasters, and the place of disaster preparedness
nature.
in nursing curricula. But how well are we prepared?
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Is this something all registered nurses need to revisit?
Nurses play important roles in disasters formally
Danna, Bernard, Schaubhut and Mathews (2010) share
and informally, immediately and during the ongoing
their insights as nurses who survived and worked
recovery people endure after such events. At a Western
through Hurricane Katrina, highlighting the role nurses
Pacific and South-East Asian Region Regulatory
play in disasters.
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meeting held in Wellington some time after the Boxing
Nurses are in leadership positions before, during
Day Tsunami of 2004 in the Indian Ocean, two nurses
and after any disaster. Nurses are called upon to
(one from Thailand and one from Bandi Achi) shared
report to duty, leaving their loved ones to care for
with us their experiences of living through the tsunami
themselves while the nurses care for the sick and
and disaster preparedness. Having watched the events
frail in unbelievably difficult situations (p. 9).
time after time on the television did not prepare me for what these nurses had to say. While they survived
Their experiences illustrate how the role for some
the disaster, the tsunami stripped away even pens and
nurses continued well after the initial emergency. They
paper – they had nothing to ‘work’ with. They also
also share preparation strategies. Their experiences
shared the tensions they lived with having to keep up
illustrate how the role for some nurses continued
their professional persona, all the while not knowing
well after the initial emergency, and highlight
if their family were even alive. They talked about
preparation strategies.
Page 2
We need to listen to the
Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand stories of our colleagues who have lived and worked
References
through the disasters of recent times, as it is through
Danna, D., Bernard, M., Schaubhut, R., & Mathews, P. (2010). Experiences of nurse leaders surviving Hurricane Katrina, New Orleans, Louisiana, USA. Nursing & Health Sciences, 12(1), 9-13. doi: 10.1111/j.1442-2018.2009.00497.x
their experiences and insights nurses can become better prepared for the unexpected events that have confronted communities here, and around the world. I want to finish by saying on behalf of the Nursing Praxis in New Zealand Editorial Board and staff our thoughts are with our nursing colleagues and the people of Christchurch and Japan in their journeys to
Fung, W. M., Lai, K. Y., & Loke, A. Y. (2009). Nurses’ perception of disaster: Implications for disaster nursing curriculum. Journal of Clinical Nursing, 18(22), 3165-3171. doi: 10.1016/j.dmr.2005.04.001
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rebuild their lives.
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Associate Progessor Denise Wilson RN PhD FCNA(NZ) Editor-in-Chief/AUT University
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IN NEW ZEALAND
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Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
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Nursing Praxis in New Zealand BUILDING RELATIONSHIPS: THE KEY TO PRECEPTORING NURSING STUDENTS Jevada Haitana, RN, MN, Professional Nurse Advisor, Whanganui District Health Board, Whanganui Marian Bland, RN, PhD, Associate Professor Nursing, Universal College of Learning, Palmerston North
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Abstract
Preceptorship is a form of support offered to student nurses in the clinical setting by a registered nurse (preceptor)
I D E E
who offers guidance and acts as a role model to the student. Research suggests this can be a rewarding role for preceptors, but there are challenges which may impact on their ability to develop the role to its full potential. To better understand the experiences of being a preceptor and the factors that impact on the role, a qualitative descriptive study was undertaken in a small provincial hospital in New Zealand. A purposeful sample of five registered nurse preceptors
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completed semi-structured audio-taped interviews. Data analysis was completed using a step-by-step process informed by Burnard (1991).
The key finding of this research was the importance of the preceptor and student nurse establishing a professional working relationship. This then enables the preceptor to better assess, and assist promoting in the student’s level of
S S I X
knowledge and understand. At that point the preceptor can determine whether it is safe to allow the student more practice opportunities, or whether constant supervision is still required. Rostering students with one preceptor for the entire placement would better enable both parties to develop a cohesive working relationship, and result in a more positive, effective placement for both the student and preceptor.
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Key Words: Preceptorship experience, New Zealand, undergraduate nursing students, relationships.
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Introduction
context, especially in relation to hospitals outside of the main centres. This research therefore sought to
As a result of government directives, in 1988 nursing
answer the research question ‘What is the experience
education moved from hospital-based programmes
of being a preceptor in a small provincial hospital in
into the tertiary setting (Ryan-Nicholls, 2004). Instead
New Zealand?’
of student nurses learning primarily within hospital settings, they now acquire knowledge in both tertiary
Literature Review
education and clinical settings. Nursing students are placed with experienced registered nurses (preceptors)
A Broad Perspective.
who provide supervision and instruction within the
There is a significant body of international literature
clinical environment (McLeland & Williams, 2002).
related to preceptorship. The most positive aspects of
Despite the frequency with which preceptors work
being a preceptor have been identified as assisting the
with student nurses in New Zealand, there has been
Haitana, J., & Bland, M. (2011). Building relationships: The key to preceptoring nursing students. Nursing Praxis in New Zealand, 27(1), 4-12.
limited research here on preceptorship in the nursing
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Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand student to develop personally and achieve professional
Krause, & Sawin, 2006), and managing the emotional
goals within the placement, and being able to
stress associated with the preceptorship role (Hrobsky
share and increase their own knowledge (Hyrkas &
& Kersbergen, 2002; Mamchur & Myrick, 2003).
Shoemaker, 2007). Many preceptors believe it to be their professional duty to nurture and support nursing
New Zealand research regarding nursing preceptorship
students (Mannix, Wilkes, & Luck, 2009).
is limited. Kaviani and Stillwell (2000) evaluated the relationship between preceptor, preceptee and the
N O I T
Gassner, Wotton, Claire, Hofmeyer, and Buckman
manager within the clinical setting.
(1999), describe the need for “industry and academia”
focused on the experiences of the clinical nurse lecturer
to have a collegial relationship which includes
in the preceptor model. Three studies focused on the
“cooperation, shared planning and decision making,
experiences of preceptors in large public hospitals
shared power and non-hierarchical relationships”
(Macdiarmid, 2003; Orchard 1999; Rummel, 2001). To
(p. 21) to best assist student learning in clinical
date there has been no research into the experiences
placements. Mannix et al., (2009) agree and suggest
of preceptors in New Zealand hospitals outside of the
that educators and preceptors work together to
main centres. As preceptorship is such a significant
provide optimum experiences for students. Generally
component of clinical learning for student nurses, it is
preceptors valued the support they received from
important to further understanding of the experiences
the educational facility, colleagues and/or hospital
of preceptors in smaller provincial hospitals.
Dyson (1998)
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(Henderson et al., 2010; Ohrling & Hallberg, 2001). Unfortunately not all preceptors felt supported in the
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Methodology
role, citing a lack of availability and accessibility of
clinical lecturers and lack of support from colleagues
A qualitative descriptive design appropriate to
(Henderson, Fox, & Malko-Nyhan, 2006). Instances of
“examine a known phenomenon in a new population”
preceptors not having sufficient time to spend with the
(Wright, 1993, p. 117) was used to answer the research
students are frequently noted. Carlson, Pilhammar,
question.
and Wann-Hansson (2009) describe heavy workloads
qualitative descriptive designs seek to explore
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In order to generate new knowledge,
as one of the major factors that impact on preceptors’
participants’ “thoughts and feelings and/or attitudes
time to teach. These authors suggest that protected
towards an event” (Sandelowski, 2000, p. 337). The
time must be given to preceptors and students to
researcher then interprets the event in such a way that
facilitate learning.
it is clear and meaningful to the participant.
The importance of orientating to the preceptorship
Research/ethics approval was gained from the Otago
role was highlighted (Hallin & Danielson, 2009; Zilembo
Polytechnic Ethics Committee and the Director of
& Monterosso, 2008). While some preceptors felt
Nursing, Maori Health Advisor and Clinical Governance
adequately prepared for the role (Hallin & Danielson),
Committee at the hospital where the study occurred.
others did not and perceived preceptorship as being
Participants in this research were all registered nurses
thrust upon them, resulting in failed relationships and
drawn from two acute inpatient wards in a small,
negative learning experiences for the student nurse
provincial New Zealand hospital which provides a
(Andrews & Wallis, 1999). A well-developed orientation
wide range of secondary services.
enhances preceptor knowledge of important factors
experience ranged from less than one year to over
such as student evaluation (Burns, Beauchesne, Ryan-
twenty years, and they were working full or part-time
Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Their practice
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Nursing Praxis in New Zealand rostered rotating shifts or on the casual pool. All had
The first author knew all participants personally prior
preceptored undergraduate nursing students at least
to the research commencing, as she was working
four times, but only one had completed a formal
as a clinical lecturer in the wards concerned. At the
preceptorship course.
beginning of each interview the first author clarified her research role with the participants, and reinforced
Posters describing the study were posted in the medical
her interest in their experiences as preceptors. They
and surgical wards. Five staff members contacted the
were also assured of confidentiality and anonymity
first author for further information on the study, and
in relation to their participation in the research, and
all subsequently consented in writing to participate
informed of the steps that would be taken by the
in the research. All participants were interviewed
researchers to ensure this.
N O I T
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individually by the first author at a location agreed by both parties. One participant was interviewed twice
Data Analysis.
to clarify information given during the first interview.
A modified framework based on Burnard (1991) and
The interviews, lasting between 45-60 minutes,
informed by Glaser and Strauss (1967) was used
were initially guided by a brief interview schedule.
as to guide data analysis. The process used in the
Only the authors, a second research supervisor
research is outlined in Table 1. This was appropriate
and a transcriber (who had signed a confidentiality
for qualitative research where data collection was
agreement) had access to the raw data during the
obtained using face to face interviews which had been
study. To help maintain the anonymity, privacy and
recorded and transcribed.
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confidentiality of participants, pseudonyms have been
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used in all publications and presentations arising from
Rigour.
the research, including this article.
In order to maintain rigour throughout the research
Table 1.
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Process of Data Analysis
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Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand Lincoln and Guba’s (1985) criteria to establish
due to the students usually working Monday to Friday
trustworthiness, and Tuckett’s (2005) operational
on either mornings or afternoons, and the preceptors
techniques were used. Credibility and triangulation
being on rostered rotating shifts.
were established and maintained by the first author
Part of the preceptoring is developing their trust
through self reflection and journaling, honest and open
and developing a relationship. You can’t do that if
disclosure to participants, and keeping a self reflective
you have only got the person for a day, you would
journal.
A fieldwork journal, having audio-taped
actually spend half of that shift getting to know
interviews which enhanced accuracy of the data, notes
that person, reassessing them, what can they do
made on the transcripts used for reflection, a record log
what can’t they do (Alex).
N O I T
throughout the research process and regular meetings
I D E E
with supervisors all contributed towards dependability.
Spending so little time with the student reduced
Confirmability is the final criterion in establishing
the preceptors’ ability to develop trust, which then
trustworthiness and this is achieved when research
impacted on their ability to evaluate the effectiveness
decisions and influences are described throughout the
of their teaching. This was extremely frustrating for
study and the research process is transparent (Koch,
the preceptors who valued their teaching role highly:
L P M A
2006; Lincoln & Guba). The process of this research
and decisions made were clearly documented in the final research report (Haitana, 2007).
Findings
S S I X
…cause you get a continuous flow-on effect, its…
you’ve already learnt the trust at the beginning, a therapeutic relationship, you’ve opened it up, you’ve settled it all at the beginning of the actual time-frame, you know what’s going to happen and you can actually build on that (Stacey).
There were eight themes generated from the data. The core theme that emerged from the preceptors’
Preceptors also valued the feedback they received
narratives centred on the significance of their
from the student, and working consistently with a
relationship with the student nurse.
student enhanced the development of this feedback:
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Within the
context of the preceptors’ responsibility for patient
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You know what I mean, I think that’s why having
safety, getting to know the student, and developing a
a single preceptor per placement and getting that
sense of trust, are essential pre-requisites for allowing
really good feedback is really good, and also good
the student some autonomy (letting go). The first step
for the preceptor ‘cos they feel like they’ve been
in building this fundamentally important professional
really useful (Bernie).
relationship begins with the preceptor getting to know the student nurse.
Spending limited time with a student, and/or working with them only intermittently, placed severe
Building a Relationship.
constraints on a preceptor’s teaching and coaching
Getting to know the student is an inherent part of the
role. Limited contact between preceptor and student
preceptor- preceptee relationship (Gillespie, 2002). All
nurse also makes it more difficult to establish a sense
the preceptors in this study stressed the importance
of trust.
of connecting with the student, and while it was potentially the most satisfying aspect of the role for
Trust. Feeling that they were unable to trust the
them, it was seldom achieved because they were only
student resulted in role dissatisfaction for the
intermittently rostered with the students. This was
preceptors. They could not then have the degree of
Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
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Nursing Praxis in New Zealand confidence required to allow the student some degree
them greater autonomy.
of autonomy within the clinical setting. Working with a
sense of responsibility for the preceptors, which
student over a longer period of time made it far easier
weighed heavily on each of them.
to establish some sense of trust.
This engendered a huge
I ask you to do observations and there is a change,
The last student I had was a student in her third
I want to know why; if you can compare it to others
year and she was really, really good. She was great
and what’s happening, because I want to know,
and you could trust her. She knew what she was
because I need to trust that you understand what’s
on about, she followed instructions well. You’d talk
happening. Because I said at the time if I’m going
to her about what you wanted from her and what
to let you have a patient load I need to know that
she wanted from me and she was honest. I could
you are going to make sense otherwise I am not
delegate and know that she would come back to
I D E E
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going to let you have any of my patients. And they
me with her information (Kim).
sort of look at me and I say, no it’s as black and white as that because at the end of the day it is my
These are things we need. I need for you to understand that I find it difficult to let a student go.
responsibility and if you want to take some of my
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It is about your professionalism, I think it is about
you being able to, because you are responsible for
patients and care for them then you have to prove to me that you can actually do it (Stacey).
those patients, it’s about you knowing in your heart
This internal conflict about when to let the student
that you have to trust that student but in order to
manage the patient was clear during the interviews.
trust them you need to keep them on a leash for a
Prior to letting the student go the preceptors had
period of time (Alex).
to determine whether the student was adequately
S S I X
prepared. It was difficult to make this judgement
All the participants thought they needed to work
when so little time had been spent with the student.
with the student for a minimum of three to four days
You have to make a judgement on every student you
to complete their evaluation of the student, and
see. You have to make a quick judgement about
assess whether or not it was safe to allow him/her
how capable you think they are, and how confident
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increasing autonomy. Not only did working with the
or how likely they are to come to you (Alex).
student consistently over a period of days help with building the relationship between the two parties,
And then, I wondered what the hell she was doing,
but it was likely to lead to the student being offered
I went down there and she was on her third person
more opportunities within the clinical setting. A one-
and she hadn’t bought me any obs. I discussed
to-one relationship provided continuity and increasing
with her the parameters beforehand of what
satisfaction levels for both parties. It also enabled
was normal, but I just wanted to go through with
the preceptor to establish the confidence to let the
her again and have a look at them to see if she
student have more autonomy in practice, the process
had done them and if they were normal for that
of “letting go”.
person because sometimes it’s different to what is considered. This girl was just standing there she
Letting go.
At some stage in the relationship,
didn’t understand, I don’t know, I felt like I was
preceptors needed to decide when it was safe to
explaining it well, and she just didn’t understand.
manage the nursing student from a distance, to allow
She would just say yes and that was hard for me
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Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand because she was so keen and so eager and she was
Another key consideration for preceptors that made
like ‘Oh I have a patient today’ and I had to keep
it difficult to allow the student more autonomy was
saying ‘no’ because we aren’t doing so well (Kim).
the feeling that they were ultimately responsible for patient safety, and if anything did go wrong there could
They will have worked with a nurse for three or four
be repercussions, such as the loss of their nursing
days, built up so that the nurse was quite confident
registration.
and then let them do a bit more advanced stuff
Two reasons, one is because I have seen what
and then they’d get a new nurse who doesn’t know
mistakes can happen and because the work
them and then makes them do nothing more than
environment is so regulated by legislation and
temperature. They get a bit of momentum, get a
consequences you feel very much under pressure
bit more confidence and then all of a sudden they’re
I D E E
N O I T
every day, that you can’t do, wouldn’t want to do
back to square one again (Bernie).
anything wrong (Alex).
Bernie highlights the frustration that arises for both preceptor and student when they work together for
I’m sitting there thinking, ‘Oh my goodness! Can I
L P M A
only a short period of time. The student works with
a preceptor for a few days, is given some autonomy, gains confidence, and then the preceptor changes so
trust this particular person, is this person capable?’ You don’t know what you’re thinking, you don’t know how they learn, and the whole rules changed and it was kinda like fear, and then all of a sudden
the student is then directed back to doing the basics
I looked at responsibility, my responsibility and
such as taking vital signs. Preceptors valued their
the key thing was my badge, and I thought, ‘No,
relationship with the patient and as a result felt the
this is what I’ve done all my training for, now you
need to protect the patient and not allow the students
have to prove to me exactly what you can do’, and
autonomy until they were confident of their practice:
yeah, it changed the whole initial way I thought
S S I X
Not, yeah partly but the other thing I am thinking
A R
about it (Stacey).
of is the relationship you develop with the patient and their families and our work ethic is extremely
P
All participants stated they would prefer to have the
sometimes intimate in a sense, extremely intense
student for a longer period of time. Firstly, this would
and involved and this can happen in a very short
assist in the essential task of relationship building, and
time, you know you develop an intense relationship
the development of a sense of trust that would lead to
in a very short time. That is sometimes students,
the student having greater autonomy. A one-to-one
it takes some time to develop, some students you
relationship would also provide continuity for both
know they have just got it and some students just
parties during the clinical experience, and result in a
stand well back and I have to stand back and let
more satisfying experience for each.
them do it, I find that hard, I find that really hard (Alex).
Discussion
I mean I always have as the bottom line whether
This study sought to understand the experiences of
I’m being the nurse or the preceptor ‘would I want
preceptors working in a small hospital in a provincial
this person nursing me?’ (Stacey).
city in New Zealand. The findings identified were not unique and have been previously discussed in the
Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
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Nursing Praxis in New Zealand literature. Findings such as the contribution of the
Research also supports the belief that it is beneficial to
preceptor, workload and support issues associated
have one preceptor per placement for a variety of other
with the preceptorship role and legal responsibilities of
reasons. These include; continuity of the preceptorship
the preceptor mirror those from studies of preceptors
experience (Kaviani & Stillwell, 2000), teaching and
working in larger, urban hospitals (Calman, Watson,
socialisation of the preceptee (Myrick & Barrett, 1994),
Norman, Redfern, & Murrells, 2002; Carlson et al.,
a better understanding of students’ learning needs
2009; Gassner et al., 1999; Henderson et al., 2010;
and expectations (Schroyen & Finlayson, 2004) and an
Hrobsky & Kersbergen, 2002; Hyrkas & Shoemaker,
ability to develop trust and mutual confidence, which
2007; Kaviani & Stillwell, 2000; Macdiarmid, 2003;
is fundamental in establishing a successful partnership
Ohrling & Hallberg, 2001; Orchard, 1999; Rummel,
between the preceptor and the student (Ohrling &
2001; Yonge, Krahn, Tojan, Reid, & Haase, 2002). It
Hallberg, 2001). Furthermore, trust can only develop
appears therefore that the location and size of the
over a period of time (Hupcey, Penrod, Morse, &
hospital is not a major factor in the experiences of
Mitcham, 2001); therefore it would be beneficial for
preceptors. Nevertheless, the key contribution of this
students and preceptors to be rostered together.
research is a confirmation of the importance of the
N O I T
I D E E
L P M A
relationship the preceptor has with the student, and
The difficulty for preceptors allowing students more
how this relationship impacts not only on preceptor
autonomy has also been identified (Ohrling & Hallberg,
satisfaction, but also on student learning and
2001; Rummel, 2001). Participants in this research
development.
were reluctant to allow the students more autonomy
S S I X
if they had not been working with them for a number
Hyrkas and Shoemaker (2007) suggest that one of the
of shifts. This was in part due to the Nursing Council
intrinsic rewards associated with preceptorship is the
of New Zealand statement that Registered Nurses are
sense of achievement associated with the teaching
accountable for “directing, monitoring and evaluating
component. This contributes to preceptor satisfaction
care that is provided by nurse assistants, enrolled
and ongoing commitment to the role. One of the
nurses and others” (2005, p. 3). The preceptors could
main factors to impact on the sense of achievement
not allow students to provide care if they were not
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is the ability of the preceptor to spend an adequate
confident the student’s practice was safe.
amount of time with the student. Gillespie (2002) describes how being connected in the preceptor-
Limitations
preceptee relationship allows the student “to feel at ease, feeling valued and respected, and experiencing
This descriptive study focused on the experiences
positive self regard” and experience “the connected
of five preceptors working in one small provincial
student-teacher relationship as a safe environment
hospital in New Zealand. One cannot assume that the
that affirmed them as people, learners and nurses
experiences of these preceptors will be the same as
and supported their learning experience” (p. 569).
for other preceptors working in the same hospital, or
Connection also provides the preceptor and preceptee
any other hospital. A further limitation was that due
with some understanding of each person’s role in the
to the small sample size, the experiences of preceptors
relationship; the academic and clinical work that needs
across all areas of the hospital were not explored.
to be completed by the student; and the opportunity to negotiate how each party will fulfil their obligations during the clinical placement. Page 10
Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand Implications for Nursing Practice
make to undergraduate nursing education. The most significant finding arising from this research relates
The benefits arising from the preceptor and student
to the need for student nurses to work with their
working
one-on-one
preceptor on rostered rotating shifts. The complexities
relationship were clearly evident in this study. While
associated with such an arrangement mean that further
there may be some difficulty in regard to planning
research into its feasibility, benefits and disadvantages
and implementation of a one-on-one partnership
is indicated, especially in relation to other provincial
throughout the whole of the student’s placement,
hospitals in New Zealand.
together
in
an
ongoing
N O I T
this research indicates it would be a valuable strategy
The preceptor-student nurse relationship is one
within the New Zealand context.
I D E E
support system that must be nurtured if it is to achieve
Conclusion
its full potential. Increasing support for preceptors must come from within the clinical agencies, and the
The aim of the research was to gain an understanding
respective Schools of Nursing. Only then can the
of the experience of being a preceptor in a small
preceptor and student nurse develop the partnership
provincial hospital in New Zealand. The participants’
necessary to develop and maintain quality nursing
stories capture the day-to-day realities of this
care, now and in the future.
L P M A
important role and the valuable contribution they
References
S S I X
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A R
Burns, C., Beauchesne, M., Ryan-Krause, P., & Sawin, K. (2006). Mastering the preceptor role: Challenges of clinical teaching. Journal of Pediatric Health Care, 20(3), 172-183. doi: 10.1016/j.pedhc.2005.10.012 Calman, L., Watson, R., Norman, I., Redfern, S., & Murrells, T. (2002). Assessing practice of student nurses: Methods, preparation of assessors and student views. Journal of Advanced Nursing, 38, 516-523. doi: 10.1046/j.1365.2648.2002.02213.x
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Carlson, E., Pilhammar, E., & Wann-Hansson, C. (2009). Time to precept: Supportive and limiting conditions for preceptoring nurses. Journal of Advanced Nursing, 66, 432-441. doi: 10.1111/j.1365-2648.2009.05174.x Dyson, L. (1998). The role of the lecturer in the preceptor model (Unpublished master’s thesis). Massey University, Wellington, New Zealand. Gassner, L., Wotton, K., Clare, J., Hofmeyer, A., & Buckman, J. (1999). Theory meets practice. Evaluation of a model of collaboration: Academic and clinical partnership in the development and implementation of undergraduate teaching. Collegian: Journal of the Royal College of Nursing Australia, 6(3), 14-21, 28. doi: 10.1016/51322-7696(08)60337-6 Gillespie, M. (2002). Student-teacher connection in clinical nursing education. Journal of Advanced Nursing, 37(6), 566-576. doi: 10.1046/j.1365-2648.2002.02131.x Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory. New York: Aldine. Haitana, J. (2007). Building relationships: A qualitative descriptive study reflective of the day-to-day experiences of one group of preceptors in a provincial hospital in New Zealand (Unpublished master’s thesis). Otago Polytechnic, Dunedin, New Zealand. Hallin, K., & Danielson, E. (2009). Being a personal preceptor for nursing students: Registered nurses’ experiences before and after introduction of a preceptor model. Journal of Advanced Nursing, 65(1),161-174. doi:10.1111/j.1365-2648.04855.x Henderson, A., Fox, R., & Malko-Nyhan, K. (2006). An evaluation of preceptors’ perceptions of educational preparation and organisational support. Journal of Continuing Education in Nursing, 37(3), 130-136. Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
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Nursing Praxis in New Zealand Henderson, A., Twentyman, M., Eaton, E., Creedy, D., Stapleton, P., & Lloyd, B. (2010). Creating supportive clinical learning environments: An intervention study. Journal of Clinical Nursing, 19(1-2), 177-182. doi: 10.1111/j.1365-2702.2009.02841.x Hrobsky, P.E., & Kersbergen, L. (2002). Preceptors’ perceptions of clinical performance failure. Journal of Nursing Education, 41, 550-553. Hupcey, J. E., Penrod, J., Morse, J. M., & Mitcham, C. (2001). An exploration and advancement of the concept of trust. Journal of Advanced Nursing, 36, 282-293. doi: 10.1046/j.1365-2648.2001.01970.x Hyrkas, K., & Shoemaker, M. (2007). Changes in the preceptor role: Revisiting preceptors’ perceptions of benefits, rewards, support and commitment to the role. Journal of Advanced Nursing, 60, 513-524. doi: 10.1111/j.1365-2648.2007.04441.x Kaviani, N., & Stillwell, Y. (2000). An evaluative study of clinical preceptorship. Nurse Education Today, 20(3), 218-226. doi: 10.1054/ nedt.1999.0386
N O I T
Koch, T. (2006). Establishing rigour in qualitative research: The decision trail. Journal of Advanced Nursing, 53, 91-100. doi: 10.1111/j.1365-2648.2006.03681.x Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. London: Sage.
I D E E
Macdiarmid, R. (2003). Teaching on the run: An ethnographic study of RNs teaching other students (Unpublished master’s thesis). University of Auckland, Auckland, New Zealand. Mamchur, C., & Myrick, K. (2003). Preceptorship and interpersonal conflict: A multidisciplinary study. Journal of Advanced Nursing, 43, 188-196. doi: 10.1046/J.1365-2648.2003.02693.x Mannix, J., Wilkes, L., & Luck, L. (2009). Key stakeholders in clinical learning and teaching in bachelor of nursing programs: A discussion paper. Contemporary Nurse, 32(1-2), 59-68.
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McLeland, A. & Williams, A. (2002). An emancipatory praxis study of nursing students on clinical practicum in New Zealand: Pushed to the peripheries. Contemporary Nurse, 12(2), 185-193. Myrick, F., & Barrett, C. (1994). Selecting clinical preceptors for basic baccalaureate nursing students: A critical issue in clinical teaching. Journal of Advanced Nursing, 19, 194-198. doi: 10.1111/j.1365-2648-1994.tb01068.x Nursing Council of New Zealand. (2005). Competencies for the registered nurse scope of practice. Retrieved from http:// wwwnursingcouncil.org.nz/competenciesm.pdf
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Ohrling, K., & Hallberg, I. R. (2001). The meaning of preceptorship: Nurses lived experience of being a preceptor. Journal of Advanced Nursing, 33, 530-540. doi: 10.1064/j.1365-2648.2001.01681.x Orchard, S. H. (1999). Characteristics of the clinical education role as perceived by registered nurses working in the practice setting (Unpublished master’s thesis). Massey University, Wellington, New Zealand.
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Rummel, L. G. (2001). Safeguarding the practices of nursing: The lived experience of being-as preceptor to undergraduate student nurses in acute care settings (Unpublished master’s thesis). Massey University, Albany, New Zealand.
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Ryan-Nicholls, K. (2004). Preceptor recruitment and retention: The preceptor partnership is the most effective means of ensuring that students integrate professional theory with clinical practice, but a growing lack of nurse preceptors may threaten the process. Canadian Nurse, 100(6), 18-22. Sandelowski, M. (2000). Whatever happened to qualitative description? Research in Nursing and Health, 23, 334-340. doi: 10.1002/ 1098-240X(200008)23:4<334::AINUR9>3.0.CO;2-4 Schroyen, B., & Finlayson, M. (2004). Clinical teaching and learning: An action research study. Nursing Praxis in New Zealand, 20(2), 36-45. Tuckett, A. G. (2005). Rigour in qualitative research: Complexities and solutions. Nurse Researcher, 13(1), 29-42. Wright, P. S. (1993). How will I collect data? Methods for exploratory studies. Journal of Pediatric Oncology Nursing, 10(3), 115-116. doi: 10.1177/104345429301000308 Yonge, O., Krahn, L., Trojan, L., Reid, D., & Haase, M. (2002). Supporting preceptors. Journal for Nurses in Staff Development, 18(2), 73-79. Zilembo, M., & Monterosso, L. (2008). Towards a conceptual framework for preceptorship in the clinical education of undergraduate nursing students. Contemporary Nurse, 30(1), 89-94.
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Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand UTILISING THE HAND MODEL TO PROMOTE A CULTURALLY SAFE ENVIRONMENT FOR INTERNATIONAL NURSING STUDENTS Bev Mackay, RN, DN, Principal Lecturer, Department of Nursing and Health, NorthTec, Whangarei Thomas Harding, RN, PhD, Associate Professor, Deputy Head, School of Nursing (NSW & ACT) Faculty of Health Sciences, Australian Catholic University, North Sydney Campus (MacKillop), Australia
N O I T
Lou Jurlina, RN, Advanced Diploma in Child and Family Health, Nurse Consultant
I D E E
Norma Scobie, RN, MN, Principal Lecturer, Department of Nursing and Health, NorthTec, Whangarei Ruelle Khan, RN, BHSc, Principal Lecturer, Department of Nursing and Health, NorthTec, Whangarei
Abstract
L P M A
The rising number of international students studying outside their own country poses challenges for nursing education. Numbers are predicted to grow and economic factors are placing increasing pressure on tertiary institutions to accept these students. In adapting to a foreign learning environment international students must not only adapt to the
S S I X
academic culture but also to the socio-cultural context. The most significant acculturation issues for students are English as a second language, differences in education pedagogy and social integration and connectedness. Students studying in New Zealand need to work with Māori, the indigenous people, and assimilate and practice the unique aspects of cultural safety, which has evolved in nursing as part of the response to the principles underpinning the Treaty of Waitangi. The Hand Model offers the potential to support international students in a culturally safe manner across all aspects of
A R
acculturation including those aspects of cultural safety unique to New Zealand. The model was originally developed by Lou Jurlina, a nursing teacher, to assist her to teach cultural safety and support her students in practising cultural
P
safety in nursing. The thumb, represents ‘awareness’, with the other four digits signifying ‘connection’, ‘communication’, ‘negotiation’ and ‘advocacy’ respectively. Each digit is connected to the palm where the ultimate evaluation of the Hand Model in promoting cultural safety culminates in the clasping and shaking of hands: the moment of shared meaning. It promotes a sense of self worth and identity in students and a safe environment in which they can learn. Key Words: Cultural safety, nursing, education, international students, hand model.
Introduction A new challenge for nursing education is the globalisation of the nursing workforce and the concurrent internationalisation of higher education (Allen & Ogilvie, 2004). According to the New Zealand Ministry of Education (NZMoE, 2001), international experience for tertiary students in formal education Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
outside their own country is now common with worldwide figures possibly reaching 5 million over the next 20 years. Mackay, B., Harding, T., Jurlina, L., Scobie, N., & Khan, R. (2011). Utilising the hand model to promote a culturally safe environment for international nursing students. Nursing Praxis in New Zealand, 27(1), 13-24. Page 13
Nursing Praxis in New Zealand An international student is a foreign student who
education’, ‘international students’, ‘cultural safety’,
does not meet domestic student requirements of
‘acculturation’ and the concepts associated with the
residency, New Zealand citizenship or exemption
Hand Model (awareness, connection, communication,
criteria (Education Act of 1989). They do not affect
negotiation and advocacy). The papers retrieved were
the Government cap on student numbers at each
scrutinised for recurring themes.
institution and must usually pay full fees.
The
recruitment of such students has become an important
International Nursing Student Experience
N O I T
component of the strategic planning of many tertiary institutions. International students already contribute
Although, to date, there has been little research
significantly to the New Zealand economy (NZMoE,
conducted in New Zealand into the experience of
2008) and in Australia the reduction of government
international nursing students, there is a wealth of
funding for tertiary education institutions has
international literature describing the challenges
prompted Australian nursing schools to actively
for students studying in a foreign culture.
recruit international students (Kilstoff & Baker, 2006).
significant themes that emerge are: difficulties with
In light of the possible decrease in funding signalled
English language for non-English speaking background
by the Tertiary Education Commission, there is every
(NESB) students; differences in education style; and
likelihood that there will be pressure on Schools of
social integration and connectedness.
I D E E
Three
L P M A
Nursing to increase the numbers of international
For NESB students the most salient challenge is English
students.
S S I X
fluency. Poor fluency creates problems academically
If international students are to succeed then
with a direct link between poor English acculturation
the learning environment must facilitate their
and poor academic performance (Salamonson,
acculturation into both the New Zealand academic
Everett, Koch, Andrew, & Davidson, 2008). In the
and social cultural milieu. A “Hand Model” of cultural
social context, poor fluency creates communication
safety was developed by a nurse teacher to assist her
difficulties (Seibold, Rolls, & Campbell, 2007; Xu &
in teaching cultural safety and her students to practice
Davidhizar, 2005) and feelings of social isolation
A R
P
cultural safety in nursing (Jurlina, 1995). In this paper
(Sanner, Wilson, & Samson, 2002). It impacts on the
we explore the potential of this model in providing a
student nurse’s clinical experience (Rogan, San Miguel,
framework for creating a culturally safe environment
Brown, & Kilstoff, 2006) and accented English creates
for international students. The most significant issues
communication problems between students and
for international nursing students studying in a foreign
Registered Nurses (Shakya & Horsfall, 2000).
culture are briefly outlined, cultural safety in the New Zealand nursing context is explored and linked
There are significant cultural differences in Eastern
to its relevance for international students. Following
and Western pedagogy. For students acculturated
discussion of the application of the Hand Model,
in Confucian philosophy, the Western education
implications for education and practice are considered.
system can negatively influence student engagement (Seibold et al, 2007; Wang, Singh, Bird, & Ives, 2008;
The literature for this paper was generated from a
Xu, Davidhizar, & Giger, 2005). Confucian pedagogy
variety of electronic databases including CINAHL and
values a strong work ethic, respect for the teacher
EBSCO and an internet search using Google Scholar.
and a practical focus in learning. Western pedagogy,
A variety of related search terms were used: ‘nurse
on the other hand, promotes a climate of inquiry in
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Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand the attainment of new knowledge and ways of thinking
for Asian students who have a highly developed need
(Tweed & Lehman, 2002). Although there are differences
for interdependence and close connections, as the
between Asian groups there are shared characteristics
emphasis on independence in the majority of Western
which can facilitate Western teachers’ understanding
cultures was a foreign concept to them.
from a cultural context (Xu & Davidhizar, 2005). Xu and Davidhizar reviewed the research literature on cultural variability and intercultural communication in nursing
Cultural Safety in New Zealand Nursing Education
N O I T
education finding that personal and cultural factors influenced communication between Asian students
In New Zealand there is a strong focus on cultural
and American teachers. Communication was hindered
safety in education and practice. It is required as
by the need to ‘save face’, indirect communication
a Registered Nurse competency and in the nursing
styles and wanting to avoid conflict, with some teacher
education curriculum (Nursing Council of New
bias against Asian students also being an issue. For
Zealand, [NCNZ] 2009). In the early stages of theory
Asian students personal factors such as poor English
development (1988-1991), cultural safety had a strong
ability are exacerbated by anxiety brought on by lack
bicultural focus. This arose from the view that student
of confidence (Xu & Davidhizar; Yeh & Inose, 2003).
nurses needed to recognise the importance of Te Tiriti
Study pressure, a drive for perfection and highly
o Waitangi/the Treaty of Waitangi, and the impact
developed self-consciousness and sensitivity were
of colonisation on Māori to be able to practise in a
also issues influencing effective communication with
culturally safe manner with Māori. The Treaty was
teachers (Xu & Davidhizar).
signed between the Crown and Māori, the Indigenous
I D E E
L P M A
S S I X
people of New Zealand, in 1840.
Social integration and connectedness are also significant problems for international students.
In the decade following its initial development the
Relocation to a foreign environment requires learning
concept of cultural safety was further refined and
about the local culture(s) and functioning within that
subjected to political and public scrutiny as it became
society. Alongside understanding the cultural norms,
embedded in education and practice (Ramsden,
A R
P
expectations, beliefs and communication styles, the
2002). Following on from the seminal work of Irihapiti
hitherto taken-for-granted everyday aspects of life such
Ramsden, the concept has evolved from its initial
as food, shopping and transport may be considerably
bicultural focus (Māori and Non-Māori) to incorporate
different.
Thus, the international student has to
a wider multicultural focus (Richardson & Carryer,
develop competency in everyday living requirements
2005), which is reflected in the current Nursing Council
(Poyrazli & Grahame, 2007).
of New Zealand definition: The effective nursing practice of a person or family
The ability to develop social connectedness within the
from another culture, and is determined by that
dominant culture was an issue that appeared in many
person or family. Culture includes, but is not
studies about international students (Evans & Stevenson,
restricted to, age or generation; gender; sexual
2006; Poyrazli & Grahame, 2007; Sanner et al. 2002).
orientation; occupation and socio-economic status;
Yeh and Inose (2003) examined predictors of stress
ethnic origin or migrant experience; religious or
in acculturation, including social support satisfaction
spiritual belief; and disability (NCNZ, 2009, p. 4).
and social connectedness. Both were found to be significant in predicting acculturation distress, especially Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
The outcome of cultural safety is to enable “safe Page 15
Nursing Praxis in New Zealand service to be defined by those who receive the
(Rogan et al., 2006) or to develop competence in
service” (NCNZ, 2009, p. 5); however, it is the nurse
colloquial English and pronunciation (Seibold et al,
who has become the focus of cultural safety, not the
2007). The need for academic and cultural support is
client (Ramsden, 2002). According to the Nursing
also widely acknowledged with a range of strategies
Council of New Zealand (2009) the achievement of
outlined, including the use of student support systems
being culturally safe first requires movement through
(Ryan, Markowski, Ura, & Chong-Yeu, 1998; Seibold et
the steps of cultural awareness and cultural sensitivity.
al; Shakya & Horsfall, 2000), a dialogic tutor-student
A significant part of this process is self-awareness,
relationship (Koskinen & Tossavainen, 2002), academic
understanding one’s own culture and acceptance of
staff developing awareness of cultural differences and
differences between that and other cultures, including
adapting teaching strategies (Amaro, Abriam-Yago, &
the political status and historical circumstances of
Yoder, 2006; Gardner, 2005; Xu et al. 2005; Ryan et
different groups in society, and recognising and
al.), and supporting students to maintain their cultural
minimizing power imbalances between service
identity (Xu et al.).
N O I T
I D E E
providers and service recipients.
The strategies described in the international literature
L P M A
It is arguable that nursing education, even given its
to support international students offer a valuable
commitment to the principles of the Treaty of Waitangi
perspective.
and to the teaching of cultural safety, has been able to
the context of an indigenous model has the potential
create an environment that supports Māori students
to enhance acculturation and safety in the setting of
adequately.
Māori students with poor cultural
Aotearoa New Zealand. We suggest that the Hand
identity struggle to succeed in tertiary education
Model currently used to teach cultural safety in an
(Bennett, 2002) and many are disadvantaged if the
undergraduate nursing programme may provide a tool
education system is not congruent with Māori cultural
to promote this, given that the desired outcome is
values (Simon, 2006). Therefore the question arises
shared meaning regardless of the culture of the people
whether international students, especially those from
engaged with the model or existing power imbalances.
non-European backgrounds, are placed at cultural risk
According to Ramsden (2000) the essence of cultural
A R
P
S S I X
Incorporating these strategies within
in New Zealand nursing programmes. There is not the
safety is the trust moment and the shared meaning of
same historical imperative to address this issue as with
power and vulnerability through which differences can
Māori nursing students. However, notwithstanding
be explored, negotiated and legitimised.
moral considerations, there is a mandated duty as outlined in the Code of Practice for the pastoral care
The Hand Model
of international students to provide “assistance to students facing difficulties adapting to a new cultural
In 1995 there was great demand for Māori nurse
environment” (NZMoE, 2003, p. 7).
educators who were well-grounded in their kaupapa and tikanga (Ramsden, 2002). However cultural safety
It is timely to consider how international students can be
teachers often felt unprepared to teach the concept
better supported; the international literature reflects
and nursing students can struggle with it (Wepa,
our concern and a range of approaches are suggested.
2005). The Hand Model was developed by Lou Jurlina,
A major focus is on improving English language
a nursing teacher, to support the teaching of cultural
skills, for example, through the use of language
safety from the perspective of the educator and the
programmes to enhance oral clinical communication
student. As a new teacher, she felt unprepared to
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Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand teach cultural safety. She had also been involved
is in your hands”. Nurses care for people using
with other Māori nurses, including Irihapeti Ramsden,
their hands so it seemed obvious that I could use
in preparatory work for the initial development of
this model. The hand is also an important symbol
Nursing Council guidelines for cultural safety nursing
for me as Māori, I began to write what each digit
in New Zealand. These experiences influenced her
represented (Jurlina, L. personal communication,
personal journey towards development of the Hand
February 2, 2009).
Model. Other authors have also explored the hand as
N O I T
an approach to articulating a Māori cultural context
The thumb represents ‘awareness’, with the other
in nursing practice (Barton & Wilson, 2008). The key
four digits signifying ‘connection’, ‘communication’,
element in the Hand Model is that ‘cultural safety in
‘negotiation’ and ‘advocacy’ respectively. Each digit is
nursing is in your hands’ and the symbolism of the
connected to the palm where the ultimate evaluation
outstretched hand is presented with each digit being
of the Hand Model in promoting cultural safety
associated with a key word that conveys the essential
culminates in the clasping and shaking of hands: the
elements of the model (Figure 1.). Jurlina, the author
moment of shared meaning. When using this model,
of the Hand Model, describes her initial experience:
teacher and students can physically draw around their
I woke suddenly one night with an idea of how
own hand to embrace the ownership of the process,
I could teach cultural safety using a simple
thereby highlighting the importance of their sense of
hand model. This highlighted my own personal
self worth and identity as expressed in the uniqueness
awakening to who I was as a Māori woman. I
of their hand print (Jurlina, 1995).
I D E E
L P M A
traced my hand on paper thinking “cultural safety
A R
P
S S I X
Figure 1. The Hand Model: Cultural safety in nursing is in your hands. Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Page 17
Nursing Praxis in New Zealand The following discussion explores the model in more
awareness of the socio-political context of Aotearoa
detail and describes how it can be utilised in promoting
New Zealand it is essential they are engaged in
a culturally safe environment for international nursing
appropriate learning opportunities, such as Treaty of
students. It is important to understand the concepts
Waitangi workshops.
in the model not as separate elements. As fingers can intertwine so do the concepts interweave with one
The need for awareness is not solely the responsibility
another.
of the student. As Burnard (2005) notes, “what is
N O I T
logical and important in a particular culture may Awareness.
seem irrational and unimportant to an outsider” (p.
Cultural awareness is the first step towards cultural
177). Thus, teachers must also be aware of teaching
safety (NCNZ, 2009) and this is reflected in the model
and communication styles as the language used, both
by its allocation to the thumb: the dominant digit.
spoken and unspoken, may be interpreted differently
It encompasses awareness of one’s own culture,
by people from other cultures. Time and attention
self identity, and the recognition, acceptance and
needs to be given to understanding the international
respect of all other cultures. It also incorporates prior
student’s own cultural background, their worldview,
awareness of a Māori world view of health, including
learning needs and any factors that may impact on
the principles of Te Tiriti o Waitangi, biculturalism and
their ability to engage with living, learning and nursing
partnership.
in Aotearoa New Zealand.
I D E E
L P M A
Awareness is a complex and dynamic concept and,
It is beholden on academic staff to ensure that they are
according to Sayers and de Vries (2008), it encompasses
not attempting to homogenise international students.
being alert, perceptive and intuitive; recognising the
Cross (2008) argues the importance of seeking out
impact you have on other people and “how your
the differences before regarding the similarities, as
judgements can influence your conduct” (p. 294).
a focus on the similarities risks not attending to the
For the international student, ‘awareness’ involves
differences. Students need to be seen and valued as
not only learning about the Treaty of Waitangi and
individuals through awareness of their differences
A R
P
S S I X
the bicultural socio-political context in Aotearoa, but
(Shakya & Horsfall, 2000). For example, the use of the
also encompasses the student’s recognition of their
word ‘Asian’ may provide a general sense of location
own culture and the impact this has on their nursing
in the world as does describing oneself as ‘European’
practice. Most nursing programmes incorporate self
but it does little to signify cultural difference. There
awareness and cultural identification into curricula,
are over 30 diverse Asian cultures and there is diversity
it is vital that international students doing shortened
within and between cultural groups. Also it must not
programmes do not miss this.
be assumed, for example, that a group of students from India necessarily share the same mother tongue,
For many nursing students understanding the Treaty of
religion or cultural understandings.
Waitangi and its relevance to health care in Aotearoa
it is important to guard against stereotyping and
New Zealand is difficult. Further difficulties are faced
categorising perspectives.
Therefore,
by students who come from a largely monocultural environment or one where the critical dialogue on
Connection.
the impact of hegemonic processes are not occurring
A sense of connection with the teacher and other
or are actively repressed. To initiate the first steps in
students will not only assist with personal adaptation
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Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand but will ultimately facilitate the development of
This assists students to retain a sense of connectivity
sociocultural awareness and communication skills that
with their own culture through social networking with
will allow connection with the patient and significant
fellow students who speak the same language and
others. The next digit (refer Figure. 1) represents the
understand one another’s cultural perspective. It also
determination of a culturally appropriate connection
facilitates the ability of teachers to develop awareness
with other people from different cultures to ensure
and connectivity as they can develop a deeper
cultural safety in nursing. According to Xu et al. (2005)
knowledge of this particular culture rather than trying
international students must be able to function within
to develop understanding over a wide spectrum.
N O I T
the dominant culture, while at the same time valuing and maintaining their own cultural identity. It must
Communication.
not be forgotten, as Burnard (2005) reminds us, that
Communication is a subjective experience and cannot
these students are likely to be apprehensive, tired
be isolated from the other concepts in this model as
from having to constantly adapt, dealing with loss,
it interweaves throughout (refer Figure. 1). Language
loneliness and a lack of confidence.
has a constitutive role in social and psychological life
I D E E
and shapes our understanding of the world (Burr, 1995;
L P M A
As discussed under ‘awareness’ teachers need to attend
Davis & Gergen, 1997). It is the key to connecting with
to international students’ cultural differences. Teachers
other people and is closely intertwined with culture,
then enter the relationship with understanding of
as communication is essential to convey and protect
cultural differences and are more able to support
culture (Xu et al. 2005). This process can be fraught
connection. It is proposed by Gillespie (2005) that
because language is constructed (Phillips, 2000) and
student-teacher connection “creates a transformative
neither the structure nor the meanings of language
space in which students are affirmed, gain insight into
are viewed as fixed; they are contingent on context,
the potential, and grow toward fulfilling personal and
history, and the sender and receiver. Thus, the meaning
professional capacities: student-teacher connection
of language is contestible with different languages and
emerges as a place of possibility” (p. 211). Possibility
different discourses within languages constructing
as transformative space may well be a significant
meaning variously, so it cannot be perceived as stable
A R
P
S S I X
concept when interacting with international students,
or able to be known essentially (Weedon, 1987).
as these individuals are often in search of the personal and professional opportunities that arise from gaining
Communication is enacted in verbal or written
a nursing degree in an English-speaking country.
language and nonverbal means, which means that the participants must go beyond a mere focus on
To counteract the loss of connection experienced by
words. Wittgenstein (1994) describes the concept of
international students moving to a foreign country,
the language game. Language games, he proposed,
alternative social networks, such as online support
“are the forms of language with which a child begins
groups, can promote interdependency and the sense
to make use of words” (p. 47). In the same manner
of connection normally experienced within their own
in which they learn game playing, children learn
cultural group (Yeh & Inose, 2003; Ye, 2006). Another
language. As they play games they discover the rules
strategy is to work collaboratively with the agents
governing the players and the unwritten rules, which
and international office to enrol students from only a
regulate conduct during play; for example, cheating is
small number of cultures. So, for example, ensuring
not acceptable: “it’s just not cricket.” Wittgenstein’s
that students from India come only from one state.
premise was that words acquire meaning in a similar
Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Page 19
Nursing Praxis in New Zealand manner. Harding (2005) described his experience:
much about learning English as a second language
In my role as a clinical nursing tutor I was working
but developing an understanding of the clinical
alongside a group of Chinese students undertaking
jargon, New Zealand (Kiwi) slang and norms. Not
nursing education in Auckland in 2002 who
understanding may cause confusion, personal distress
were experiencing difficulty in establishing an
and possibly unsafe care. It can be as simple as the
effective mode of communication with a number
expectation that students will inform someone if they
of their elderly Pakeha (New Zealanders of
are leaving the workplace, no matter how briefly. An
European descent) patients. They were at a loss to
authentic connection is essential to uncover some of
understand the problem; they knew the words and
these differences in cultural norms. Students’ ability
thought they used them appropriately. They were
to communicate and collaborate with others within
not, however, using them in the mutual exchange
clinical placements is assessed in undergraduate
(or game) required by their patients in the New
nursing programmes in New Zealand. It is essential
Zealand context. They had to learn and practice
that it is not evaluated from the dominant ethnocentric
such rules as smiling when they said “hello”, and
framework without the international student having
that it also needed to be accompanied by “How
the opportunity to learn and practice the norms within
are you?” The next move would then be a similar
the new culture: both the culture of New Zealand and
question from the other player that required a
the culture of New Zealand nursing.
N O I T
I D E E
L P M A
response before moving to the next level of the
game. Such responses are legitimate in the word
Negotiation.
game of greeting, but the response “We shower
Negotiation is represented by the fourth digit (refer
now” to a greeting from the patient placed them
Figure. 1). It is associated with the presentation and
outside of the game. (p. 30)
opening out of the hand directed toward mutual
With
international
S S I X
students,
be more problematic for international students
differences related to verbal communication, there
owing to previously assimilated understandings of
are also non-verbal communication differences.
A
student-teacher roles and workplace hierarchies.
nonverbal trait of South Indian students, from our
Those students acculturated in the Confucian
experience, is the lateral nodding of the head while
paradigm may be less capable of asking questions
engaged in conversation, which can have a multiplicity
and challenging those they see as an authority figure
of meanings, from a sign of friendship, to agreement
(Tweed & Lehman, 2002). A fundamental component
or understanding (Cook, 2009).
Supervising these
of Confucian thinking is the concept of li, which is
students in mental health practice required assisting
essential in forming harmonious relationships with
them to understand that patients may receive this
others (Bockover, 2003; Chen, 2000). Caldwell, Lu
gesture negatively.
Differences in verbal and non
and Harding (2010) noted that aspects of li can be
verbal communication styles, therefore, need to be
taught and learned, such as bowing down, hugging,
explored and addressed through discussion of possible
shaking hands and even smiling; however, another
clinical scenarios and how these might be managed in
aspect of li is expressed in the notions of ‘respect’
the student’s own culture and what is expected here
and ‘authority’. Thus, the teacher is not challenged
in New Zealand.
but is respected, trusted and imbued with parental
P
from
Negotiation may
the
A R
apart
understanding and agreement.
authority. It is expected that the teacher will approach An issue for international students is often not so Page 20
students individually to ascertain their understanding Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand (Xu et al. 2005). Thus, teachers from New Zealand
“client” can be understood from two perspectives.
need to be patient with international students who
First, is the definition of client, which is analogous with
may not engage in class discussion. They should seek
the patient. Second, is the understanding of the client
opportunities to talk with them in a ‘safe’ environment
as a customer, in this case the student who is paying
and help them develop the strategies to move toward
the international student fee for their education. The
confident participation in a new learning culture.
use of the Hand Model, as a framework in developing strategies to support the student’s interaction with
N O I T
Negotiation is not only between the teacher and the
the client (patient/family) perspective (incorporating
student, it must also occur between the education
the commitment to a Māori perspective mandated by
provider and the clinical placement.
the Treaty of Waitangi), also supports the international
It is not
enough to merely ‘negotiate’ a clinical placement,
I D E E
student.
there must be preparation beforehand to ensure a successful engagement between the student and the
When first considering advocacy on behalf of the
clinical staff. For example, accented English creates
patient/family perspective the international student
communication problems between students and
must be able to function within the dominant culture
registered nurses, requiring additional support from
(Xu et al. 2005); however more is required to operate
clinical tutors to assist the student in making sense of
safely in the context of contemporary Aotearoa New
the clinical environment (Shakya & Horsfall, 2000) and
Zealand. Recognition of the Treaty of Waitangi by
to negotiate problematic situations. Thought must
the Government in 1988 has led to ongoing critical
be given to developing the clinical staff’s awareness
deconstruction of the dominant culture. As a result
so they can comfortably work with the international
nursing has used this understanding of treaty issues
student, to better understand their learning needs and
to also develop the notion of partnership (Richardson
communication styles. The education provider must
& Carryer, 2005). Partnership is one of the three key
give consideration to what extra support needs to
principles in the Treaty of Waitangi (NCNZ, 2009).
be provided to both the student and the staff in the
Thus, there is a requirement that nurses work not
clinical area. If the international student is a source of
only in partnership with the patient but also with
L P M A
A R
P
S S I X
revenue generation for the educational institution then
the Tangata Whenua (the indigenous people of New
there must be some consideration and negotiation
Zealand). It is not compatible with the concept of
with respect to the resources needed to support both
cultural partnership if international students are
the student and the clinical organisations. Especially
acculturated only to work within a Pakeha framework.
when staffing resources are stretched.
It beholds teachers to ensure students can work safely within both a Pakeha and Māori cultural framework in
Advocacy.
the delivery of nursing care.
The last digit denotes ‘advocacy’ and according to Mallik (1997) “the core condition that is most
It can be argued that to be a true advocate the nurse
frequently cited as demanding an advocacy action
must work in partnership with the client and in New
is patient/client vulnerability” (p. 130). Within the
Zealand our understanding of what this means in
framework of cultural safety, safety and risk are
nursing has been influenced by the work of Judith
defined by the client/ family receiving the service or
Christensen (1990) and the ideal of the nursing
care, not by those delivering it. When working with
partnership. For some international students this may
the international nursing student, the concept of
well be a foreign concept, especially those who come
Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Page 21
Nursing Praxis in New Zealand from nations in which the ‘medical model’ of healthcare
good human being is dependent on how he or she
still predominates, or where gender, intergenerational
relates to others (Bockover, 2003); thus, there should
and professional hierarchies locate power with a
be understanding, not criticism, when international
person perceived as ‘superior’ in the relationship.
students from a particular country group together.
True partnership is negotiated between individuals/
Through relationship with others with the same
groups with mutual respect for their autonomy;
cultural attributes an individual feels more in touch
however, autonomy in New Zealand is encouraged and
with her or himself: one exists because one relates to
expressed predominantly at a personal or an individual
others.
N O I T
level through autonomy of self. In contrast the ‘self’ in Chinese culture is subordinate to relationship with
Conclusion
I D E E
others (Bockover, 2003). For these students the notion of working in partnership may also threaten their
When New Zealand is chosen as the place to study
sense of self within society.
both student and teacher enter into tacit accord that the education and lifestyle will be contextualised with
When considering the other perspective of the
New Zealand culture(s). While strategies developed
international student as client, there may be
elsewhere may prove useful to help the student
expectations that the teacher acts as their support and
acculturate these need to be made relevant to the
advocate. The teacher may need to advocate on their
local context.
L P M A
behalf with other students, the institution and the clinical providers to mediate when their international
The Hand Model of Cultural Safety provides a useful
status or cultural differences have the potential to limit
framework for the teacher to underpin the creation
their ability to succeed in the programme. Advocacy in
of a safe environment for the international student,
this sense is not to be seen as lowering the standards
while at the same time serving as a reminder of the
required for success, no matter the compassion that
need to incorporate awareness and the development
might be felt for the student; rather it is analogous
of cultural competence for the student who would
to Roy’s theory of nursing in which the student is
participate in the health care environment in this
A R
P
S S I X
in interaction with a changing environment and
country. The model provides a tool also for the student
attempting to adapt. According to Roy and Roberts
as they interact with others, using the hand they can
(1981) “one’s self-concept is defined by interaction with
‘work through the digits’, finishing at the palm of the
others. One to one interactions between individuals
hand, to come to the moment of ‘shared meaning’: the
are characterised by the use of verbal and nonverbal
metaphorical clasping of hands.
symbolic communication” (as cited in Meleis, 1997, p.
Acknowledgement
205).
The authors would like to acknowledge Dr Stephen The teacher advocates or negotiates for the
Neville from Massey University and Dr Denise Wilson
international student until they have the confidence
from Auckland University of Technology for their
and ability to do this.
assistance with this project.
The international student
may be isolated, confused and struggling to interact successfully with others.
Page 22
An individual’s life as a
References
Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand 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 Amaro, D., Abriam-Yago, K., & Yoder, M. (2006). Perceived barriers for ethnically diverse students in nursing programs. Journal of Nursing Education, 45(7), 247- 254. Barton, P., & Wilson, D. (2008). Te Kapunga Putohe (The Restless Hands): A Māori centred nursing practice model. Nursing Praxis in New Zealand, 24(2), 6-15. Bennett, S. (2002, November). Cultural identity and academic achievement among Māori undergraduate university students. In L. W. Nikora, M. Levy, B. Masters, W. Waitoki, N. Te Awekotuku, & R. J. M. Etheredge (Eds.), The Proceedings of the National Māori Graduates of Psychology Symposium 2002: Making a difference. Hamilton, New Zealand: Waikato University. Retrieved from http://researchcommons.waikato.ac.nz/bitstream/10289/845/1/NMGPS_Paper_Bennett.pdf
N O I T
Bockover, M. I. (2003). Confucian values and the internet: A potential conflict. Journal of Chinese Philosophy, 30(2), 270-273. doi: 10.1111/1540-6253.00112
I D E E
Burnard, P. (2005). Issues in helping students from other cultures. Nurse Education Today, 25(3), 176-180. Burr, V. (1995). An introduction to social constructionism. London: Routledge.
Caldwell, S., Lu, H., & Harding, T. (2010). Encompassing multiple moral paradigms: A challenge for nursing educators. Nursing Ethics, 17(2), 189-99. doi: 10.1177/0969733009355539 Chen, Y. C. (2000). Chinese values, health and nursing. Journal of Advanced Nursing, 36, 270-273. doi: 10.1046/j.1365-2648.2001.01968.x
L P M A
Christensen, J. (1990). Nursing partnership: A model for nursing practice. Wellington, New Zealand: Daphne Brasell Associates. Cook, S. (2009). What is the meaning of the Indian head wobble? The Indian head wobble demystified. Retrieved from http://goindia. about.com/od/greetingscommunication/a/head-wobble.htm Cross, B. B. (2008). Making diversity visible: A new approach to encourage inclusion. Retrieved from http://dev-diversityfactor.rutgers. edu/freearticle.jsp Davis, S. N., & Gergen, M. M. (1997). Toward a new psychology of gender: Opening conversations. In M. M. Gergen & S. N. Davis (Eds.), Toward a new psychology of gender: A reader (pp. 1-30). New York: Routledge. Education Act, (1989).
S S I X
Evans, C. & Stevenson, K. (2006). The experience of international doctoral education in nursing: An exploratory survey of staff and international nursing students in a British university. Nurse Education Today, 27, 499-505. doi: 10.1016/j.ijnurstu.2009.05.025 Gardner, J. (2005) Understanding factors influencing foreign-born students’ success in nursing school: A case study of East Indian nursing students and recommendations. Journal of Cultural Diversity, 12(1), 12-17.
A R
Gillespie, M. (2005). Student-teacher connection: A place of possibility. Journal of Advanced Nursing, 52, 211-219. doi: 10.1111/j.13652648.2005.03581.x
P
Harding, T. (2005). “Constructing the other”: On being a man and a nurse (Unpublished doctoral thesis). University of Auckland, Auckland, New Zealand. Jurlina, L. (1995). The Hand model: Cultural safety in nursing is in your hands. Unpublished manuscript. Kilstoff, K., & Baker, J. (2006). International postgraduate nursing students: Implications for studying and working in a different culture. Contemporary Nurse, 22(1), 7-16. Koskinen, L., & Tossavainen, K. (2002). Relationships with undergraduate nursing exchange students: A tutor perspective. Journal of Advanced Nursing, 41, 499-508. doi: 10.1046/j.1365-2648.2003.02562.x Mallik, M. (1997). Advocacy in nursing: A review of the literature. Journal of Advanced Nursing, 25, 130-138. doi: 10.1046/j.13652648.1997.1997025130.x Meleis, A. I. (1997). Theoretical nursing: Development and progress (3rd ed.). Philadelphia, PA: Lippincott. New Zealand Ministry of Education. (2001). Export education in New Zealand: A strategic approach to developing the sector. Wellington, New Zealand: Author. New Zealand Ministry of Education. (2003). Code of Practice for the Pastoral Care of International Students. Wellington, New Zealand: International Policy and Development Unit Strategic Information and Resourcing Division, Ministry of Education. New Zealand Ministry of Education. (2008). The experiences of international students in New Zealand: Report of the results of the national survey 2007. Wellington, New Zealand: Author.
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Nursing Praxis in New Zealand Nursing Council of New Zealand. (2009). Guidelines for cultural safety, the Treaty of Waitangi and Māori Health in nursing education and practice. Wellington, New Zealand: Author. Phillips, D. A. (2000). Language as constitutive: Critical thinking for multicultural education and practice in the 21st century. Journal of Nursing Education, 39, 365-372. Poyrazli, S., & Grahame, K. M. (2007). Barriers to adjustment: Needs of international students within a semi-urban campus community. Journal of Instructional Psychology, 34(1), 28-46. Ramsden, I. (2000). Cultural safety/Kawa whakaruruhau ten years on: A personal overview. Nursing Praxis in New Zealand, 15(1), 4-5. Ramsden, I. (2002). Cultural safety in nursing education in Aotearoa and Te Waipounamu (Unpublished doctoral thesis). Victoria University of Wellington, New Zealand. Retrieved from http://culturalsafety.massey.ac.nz/thesis.htm
N O I T
Richardson, F., & Carryer, J. (2005). Teaching cultural safety in a New Zealand nursing education program. Journal of Nursing Education, 44(5), 201-208. Rogan, F., San Miguel, C., Brown, D., & Kilstoff, K. (2006). ‘You find yourself’: Perceptions of nursing students from non-English speaking backgrounds of the effect of an intensive language support program on their oral clinical communication skills. Contemporary Nurse, 23(1), 72-76.
I D E E
Ryan, D., Markowski, K., Ura, D., & Chong-Yeu, L. (1998). International nursing education: Challenges and Strategies for success. Journal of Professional Nursing, 14(2), 69-77. doi: 10.1016/S8755-7223(98)80033-1 Salamonson, Y., Everett, B., Koch, J., Andrew, S., & Davidson, P. (2008). English-language acculturation predicts academic performance in nursing students who speak English as a second language. Research in Nursing and Health, 31, 86-94. doi: 10.1002/nur.20224
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Sanner, S., Wilson, A., & Samson, L. (2002). The experiences of international nursing students in a baccalaureate nursing program. Journal of Professional Nursing, 18(4), 206-213. Sayers, K. L., & de Vries, K. (2008). A concept development of ‘being sensitive’ in nursing. Nursing Ethics, 15(3), 289-303. doi: 10.1177/0969733007088355 Seibold, C., Rolls, C., & Campbell, M. (2007) Nurses on the move: Evaluation of a program to assist international students undertaking an accelerated Bachelor of Nursing Program. Contemporary Nurse, 25(1), 63-71.
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Shakya, A., & Horsfall, J. (2000). ESL undergraduate nursing students in Australia: Some experiences. Nursing and Health Sciences, 2(3), 163-171. doi: 10.1046/j.1442-2018.2000.00050.x Simon, V. (2006). Characterising Māori nursing practice. Contemporary Nurse, 22(2), 203-213. Tweed, R., & Lehman, D. (2002). Learning considered within a cultural context: Confucian and Socratic Approaches. American Psychologist, 57(2), 89-99.
A R
Wang, C., Singh, C., Bird, B., & Ives, G. (2008). The learning experiences of Taiwanese nursing students studying in Australia. Journal of Transcultural Nursing, 19(2), 140-150. doi: 10.1177/1043659607312968
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Weedon, C. (1987). Feminist practice and poststructuralist theory. Oxford, England: Blackwell. Wepa, D. (2005). (Ed.). Cultural safety in Aotearoa New Zealand. Auckland, New Zealand: Pearson. Wittgenstein, L. (1994). Meaning and understanding. In A. Kenny (Ed.), The Wittgenstein reader (pp. 51-66). Oxford, England: Blackwell. Xu, Y., & Davidhizar, R. (2005). Intercultural communication in nursing education: When Asian students and American faculty converge. Journal of Nursing Education, 44(5), 3. Xu, Y., Davidhizar, R., & Giger, J. (2005). What if your nursing student is from an Asian Culture? Journal of Cultural Diversity, 12(1), 1-11. Ye, J. (2006). An examination of acculturative stress, interpersonal social support, and use of online ethnic social groups among Chinese international students. The Howard Journal of Communications, 17(1), 1-20. Yeh, C., & Inose, M. (2003). International students’ reported English fluency, social support satisfaction, and social connectedness as predictors of acculturation stress. Counselling Psychology Quarterly, 16(1), 15-28. doi: 10.1080/0951507031000114058
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Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand UNDERSTANDING AND EVALUATING HISTORICAL SOURCES IN NURSING HISTORY RESEARCH Pamela J Wood, PhD, RN, Associate Professor, School of Nursing & Midwifery, Monash University, Australia
Abstract
N O I T
All nurse researchers need to address, in the manner most appropriate to their research methodology, issues of quality related to their research material. This concern is not about the care needed in generating data, rather it relates to understanding and evaluating material that already exists. This article describes four historical sources relevant to the
I D E E
history of nursing in New Zealand and uses them to explain how nurse researchers can evaluate their research material. The dimensions of this evaluation are the provenance, purpose, context, veracity and usefulness of the historical sources. The article explains the questions that need to be addressed in each dimension of the evaluation. The different kinds of information available in the four historical sources are illustrated by references to individual nurses.
L P M A
Key Words: History of nursing, historical research, research methodology, nurse researchers. Nurse researchers are careful to address issues of
colony, New Zealand produced an encyclopaedia
quality when planning their research and reporting
of its accomplishments.
their findings. Depending on the criteria appropriate to
volumes between 1897 and 1908, the Cyclopedia of
their research paradigm and methodology, they attend
New Zealand presented descriptions of the history,
to the validity, reliability, rigour or trustworthiness of
geography, government, industry and business in
the process used in generating and analysing their
each locality, as well as biographies of early settlers
research material. In historical research, however,
and noted people in the community.1 Although the
the researcher is usually locating, selecting and
biographical information related mostly to men, 25
analysing material that already exists. Issues of quality
trained nurses were represented.
A R
P
S S I X
Published in six regional
are therefore not about the generation of research material. Instead, the historian needs to understand
Four nurses listed in the Cyclopedia were matrons of
and evaluate existing sources. This article describes
large general hospitals: Alma Wooten at Auckland,
four sources relevant to New Zealand nursing history
Augusta Godfrey at Wellington, Mary Ewart at
and shows how the historian can understand and link
Christchurch and Isabella Fraser at Dunedin. Three
the information they contain. It then explains how the
others were matrons of mid-sized hospitals: Elizabeth
researcher can evaluate historical sources, using these
Rothwell at Waikato, Elizabeth Browne at New
examples to describe the dimensions of this evaluation
Plymouth and Ellen Dougherty at Palmerston North.
and the questions that need to be addressed in the
A further six were at small hospitals: Matilda Stewart
critique.
at Thames, Mary Warmington at Wanganui, Marion Macandrew at Ashburton, Margaret Fothergill at Grey
Historical Source Examples
River, A. Petchell at Wallace and Fiord, and Helena Willis
At the turn of the twentieth century, to mark its sense
Wood, P. J. (2011). Understanding and evaluating historial sources in nursing history research. Nursing Praxis in New Zealand, 27(1), 25-33.
of progress as a rapidly developing, modernising British Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Page 25
Nursing Praxis in New Zealand at Riverton. Charlotte Bird was described as the head
the authorities for appointing her.4
nurse at Riverton and a Nurse Wildman was on the staff of The Private Hospital in Wellington where the
Two other important sources in this time period
lady superintendent was Eva Godfray. Annie Christian
are the Appendices to the Journals of the House of
and M. Pope were in charge of private hospitals in
Representatives and the New Zealand Gazette, both
Timaru and Christchurch, the only other entries for
relevant to nursing history. Respectively they contain
private hospitals where nurses were mentioned.
annual reports from the government departments
Sophia Campbell was matron of the mental asylum at
concerned with hospitals and health and a cumulative
Auckland and Mary Sullivan and Emma Tuersley were
list of nurses registered under the Nurses Registration
noted as successive matrons at the Porirua Asylum.
Act 1901. A fourth significant source is the country’s
Four others who had previously held nursing positions
only professional nursing journal, Kai Tiaki, which was
were also mentioned.
established in 1908.
As the volumes were produced over 12 years, these
Only 15 of the nurses mentioned in the Cyclopedia
25 nurses were not necessarily in these designated
were on the nursing register in 1908, when the final
positions at the same time. For example, Augusta
volume of the Cyclopedia was published.5
Godfrey retired as matron of Wellington Hospital
would not have applied for registration when the
in 1898, the year after the Wellington volume was
register opened in 1902 as they were either no longer
In 1898, Wooten was just arriving in
working or did not need general nursing registration
New Zealand from Australia and starting as matron
for employment (as in Sophia Campbell’s case as
at Auckland Hospital, the position she held when the
matron of a mental asylum). Only eight were still on
Auckland volume of the Cyclopedia was published in
the register in 1920.6 It was the Registrar’s practice to
1902.3
remove the name of any nurse who died. Twelve of
published.
2
N O I T
I D E E
L P M A
A R
S S I X
Some
the nurses were mentioned in Kai Tiaki.
Entries could be brief. Besides noting nurses’ current or previous positions, they listed where they were born,
P
These four publications are valuable primary sources.
when they arrived in New Zealand (if immigrants) and
In using them the researcher needs to understand the
often by what ship, and where they trained as nurses.
kind of information they contain and how links can be
Others carried more descriptive comments.
The
made between them. Tracing one nurse, Eva Godfray,
writer of the Wellington matron’s entry, for example,
in these publications provides an example of how each
reported that ‘Miss Godfrey delights in her work, and
source contributes differently to historical research.
spares no effort to benefit the sufferers who come within the institution over which she so ably presides’. For Mary Warmington at Wanganui in 1897, the writer
Understanding and Linking Historical Sources
assured readers that ‘in the interest of the patients and sufferers generally’ he had ‘made particular
In the Cyclopedia Eva Godfray was described as the
inquiries in all quarters’ about her suitableness and
lady superintendent of The Private Hospital in Grant
was ‘convinced beyond all doubt that a more capable
Rd, Wellington, a hospital that combined ‘skilled
or popular officer could not be found’.
She had
nursing with the comfort and quiet of a private
‘that rare capacity for managing without seeming to
house’. It noted she was born in Jersey, had ‘specially
interfere’ and was ‘beloved by all’. He congratulated
trained’ as a probationer at the London Hospital, and
Page 26
Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand had derived ‘large experience’ as a staff nurse there
information about the gap of up to two years between
for nearly four years. She arrived in New Zealand in
her leaving Waipawa and starting at Dannevirke. The
January 1892 ‘in search of health’ and ‘rested from her
researcher often contends with gaps in historical
arduous labours’ for a year.
material.
Godfray’s name also appears in the cumulative lists
Although we know Godfray emigrated ‘in search of
of registered nurses contained in the New Zealand
health’, no information is available about her reason
Gazette following the Nurses Registration Act 1901.
for choosing New Zealand.
Nurses from overseas who applied for registration in
in Kai Tiaki for a Dr Godfray of Waipukurau in 1914,
New Zealand had to supply evidence that they had
commenting that his sudden death was ‘a great shock
undertaken the same length of training as required
and cause of deep regret’, suggested there might have
in New Zealand (three years) and had received a
been a family connection.9 A general electronic search
certificate from their training hospital. The matron of
revealed a record of his military service that showed
the London Hospital, Eva Lückes, vehemently held that
his next-of-kin lived in Jersey.10 Following this line of
a two-year training there was sufficient, as its quality
enquiry with the archive in Jersey confirmed that Eva
made it the equivalent of training in any other hospital.
was Dr Sidney Godfray’s older sister.11
7
N O I T
However, an obituary
I D E E
L P M A
This would not have been a sufficient argument to gain
registration in New Zealand. Godfray was already
Kai Tiaki also provides more information about Eva
in the country when the register opened in 1902.
Godfray than the brief notes in the Gazette. While
Although her training was less than three years, her
at Dannevirke Hospital she was granted nine months’
subsequent experience and her standing as a matron
leave in 1908 to visit England,12 and following her
in New Zealand when she applied for registration were
resignation from that hospital a detailed account of
clearly deemed sufficient.
her farewell in May 1909, reprinted from the local
A R
S S I X
newspaper, described the ‘speeches, music, and
All nurses were required each year to give the registrar
games’ and a gift of a silver tea-service.13
an update of the position they held. Brief details of
matron of Gisborne Hospital she welcomed Lord
P
When
a nurse’s career are therefore available in the yearly
Islington, the Governor-General, to a ceremony in
volumes of the New Zealand Gazette. Entries for
1912 to lay a foundation stone for the new hospital.
Godfray show that she had worked in private nursing
The hospital plans included five wards, each to hold 24
from 1892 to 1897. The Cyclopedia, however, says she
beds and with a verandah on each side and dayrooms
‘rested’ for a year in 1892 and that The Private Hospital
for convalescent patients. There were to be plentiful
in Wellington opened in 1893. No other available
cupboards, a new operating theatre, a room for
information addresses this apparent discrepancy.
accident and emergency cases and an isolation ward.
She left there in 1897 to become matron of the small
Godfray would have a suite of rooms ‘just off the main
rural Waipawa Hospital in Waipukurau, Hawkes Bay, a
corridor’ in the hospital, with windows ‘facing the sea,
position she held until 1904. In 1900 she undertook
with a beautiful view of the bay’.14 When she retired,
‘military nursing’, serving in the South African
the journal noted that Godfray was ‘now staying with
(Boer) war. In 1906 she became matron of another
friends in the district and enjoying station life’.15
small rural institution, Dannevirke Hospital, and in 1909 transferred to the same position at Gisborne
Hospital inspection reports in the Appendices to the
Hospital where she remained until 1916. There is no
Journals of the House of Representatives provide the
8
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Nursing Praxis in New Zealand official view of her role as matron and show the scope
For example, the annual inspection visits made to every
of her work. At Waipawa, for example, in the time she
hospital in the country were undertaken by MacGregor
was matron an average of 294 patients were admitted
or his Assistant Inspector. This position was held from
each year and the average length of stay in hospital
1895 to 1906 by Grace Neill, a Scottish-born English-
ranged from 34.17 days in 1897 to 28.13 days in 1904.
16
trained nurse. Her successor was an Australian nurse,
In his first report following Godfray’s appointment
Hester Maclean. In this position they were responsible
as matron, Duncan MacGregor, the government’s
for all nursing matters in the country and were
Inspector-General
Charitable
therefore in effect the chief nurse. No other country
Institutions, considered her a ‘great acquisition’ and
at this time had a similar nursing position in a central
it was evident ‘even to the casual observer’ that the
government department.
hospital was a ‘well managed institution’.17 In 1902
reports were printed in the Appendices to the Journals
he noted that she and Dr Godfray were ‘practical
of the House of Representatives, large volumes that
believers in the healthfulness of an abundance of fresh
published annual reports from every government
air’, keeping the wide windows at the end of the wards
department or reports of special commissions. The
open.18 The hospital was still doing ‘admirable work’
New Zealand Gazette was the official vehicle for any
in 1903 and MacGregor remarked that a ‘very kindly
material relating to legislation so an updated list of
atmosphere pervades the whole place’.
These four
nurses registered under the Nurses Registration Act
sources therefore offer different kinds of information
1901 was made available to the public in this annual
and need to be evaluated.
publication.
of
Hospitals
and
19
I D E E
L P M A
S S I X
Evaluating Historical Sources
N O I T
The hospital inspection
The link between a document’s preservation and its authenticity also needs to be considered. The
An historical or primary source is one created in the
official status of government publications such as
time period being studied in the research. Its evaluation
the Appendices and the Gazette has ensured their
needs to address five dimensions: provenance,
preservation. They are held in the national archive,
purpose, context, veracity and usefulness.
These
Archives New Zealand, and are also often available
dimensions and the questions to be used in critiquing
in specialist or larger public libraries. Kai Tiaki was
sources are presented in Table 1.
closely linked with the New Zealand Trained Nurses
A R
P
Association. The preservation of both this journal
Provenance.
and the Cyclopedia continues through their recent
The provenance of these documentary sources – how
digitisation and on-line accessibility.20
they have come into existence and been preserved – needs to be considered. Historians use a range of
Purpose.
documentary primary sources, including archival
The writer’s purpose in creating a document, their
records (such as the minutes of meetings and annual
intended audience and their strategy for getting their
reports), newspapers, journals, personal papers (such
message across are important considerations.
as diaries and letters), ephemera (such as posters,
example, members of the public represented in the
pamphlets and cards), photographs and, in the case
Cyclopedia paid for their entries and supplied the
of nursing history, patient records and nursing notes.
information, so their portrayals should be regarded
Determining who created them and why they were
as likely to be flattering. Entries for private hospitals
created are important first steps in evaluating a source.
acted as a form of advertising.
Page 28
For
Godfray’s private
Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand Table 1. Understanding and Evaluating Historical Sources
N O I T
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S S I X
hospital in Wellington had a lengthy and fulsome
focused on a positive presentation. The writer of
description. The comfortably furnished building, its
the piece on Mary Warmington at Wanganui seemed
‘high and healthy’ position, ‘fine views’ and ‘pleasant
to go to considerable trouble to form an opinion of
and cheerful’ aspect were so impressive that ‘it
her worth, which raises the question as to whether
almost made the writer wish to be sick’ so ‘the quiet
there had been some controversy.22 Cross-checking
and rest which appear to dwell there might enter his
comments in different sources can strengthen the
soul’.
It was no accident that Godfray mentioned
evaluation. The complimentary opinion of Augusta
she had ‘specially trained’ at the London Hospital as it
Godfrey, for example, is borne out by comments
had an excellent reputation, and that she had been a
made by MacGregor. In 1891 he remarked that the
‘probationer’ – someone of good social standing who
nursing department of Wellington Hospital was
had paid to be trained.
‘well organised and admirably managed by Miss
The entries for general hospital matrons, however,
Godfrey, whose energy and devotion are beyond
were embedded in sections relating to hospital boards
all praise’. He considered it the best hospital in the
so tended to be more straightforward although still
country.23 MacGregor was equally prepared to praise
21
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Page 29
Nursing Praxis in New Zealand or castigate matrons, doctors and hospital trustees
replaced by the best certificated nurse that can be
when warranted so his view of Godfrey supports the
found’. Clearly the situation at Waimate had come to
complimentary comment in the Cyclopedia.
a head as he added that it was ‘almost too much to expect that friction will not arise between a Matron of
References to individual nurses in Kai Tiaki are usually
Mrs Chapman’s age and certificated nurses under her
brief notes in the section giving news of appointments,
command’. It was a position of ‘unstable equilibrium
resignations, marriages and holidays, included near
and full of difficulty’.25 This was not an example of
the end of each issue. Longer pieces recount farewells
ageism but recognition of the shift at the turn of the
when matrons retired or moved from one hospital to
century to trained nursing staff and the need for them
another. In the January 1911 issue, for example, a
even in small rural hospitals.
N O I T
I D E E
lengthy description of the farewell for Matilda Stewart on her retirement from Thames Hospital records the
Historical research on New Zealand draws mainly on
presentation of a ‘handsomely framed’ ‘illuminated
New Zealand sources but issues can also relate to other
address’ and the gift of a ‘handbag containing 200
geographic and professional contexts, such as British
sovereigns’ (a large amount of money at that time
nursing. News of Eva Godfray, for example, appears
but not an uncommon farewell gift).
The text of
in the annual newsletter sent by Lückes to nurses
the address is given, as well as ‘an appreciation’ of
previously at the London Hospital.26 Social, political
her contribution to the hospital, to Thames and to
and cultural contexts also need to be considered. The
Farewell speeches and
Inspector-General’s overall reports provide valuable
testimonials of this kind traditionally focus on positive
material on contemporary views of a society’s wish to
aspects of individuals and their work so give one
provide hospital care and charitable aid to the poorer
particular view.
population and the difficulties associated with this,
the ‘goldfields generally’.
24
Context.
A R
L P M A
S S I X
including ideas about the causes of poverty.27 Both MacGregor and Neill worried that aid in the form of
The document also needs to be evaluated in relation
‘outdoor relief’ provided by Boards would create
to its context. In historical research, the first context
dependency.
P
In MacGregor’s view, outdoor relief
is temporal, relating to the time or point in history
was ‘as catching as small-pox, and just as deadly’.28
when the document was created. Present-day values
Comments need to be considered in the context of the
cannot be used to judge actions, opinions, events
tensions at that time between a Liberal government’s
or people in the past. The content of each source
welfare policy and financial problems faced by hospital
therefore needs to be related to the prevailing ideas
boards in delivering it.
at the time. For example, MacGregor occasionally commented about older matrons needing to retire.
An evaluation also needs to be made as to how
These remarks should be understood in the context
representative the historical source and its writer are
that many small rural hospitals in the nineteenth
of other sources and people in the field. Maclean, for
century had a husband-and-wife team as ‘master’ and
example, had a particular vantage point in her central
‘matron’ and the matron was not necessarily a trained
government department position.
nurse. In 1905 he commented that Mrs Chapman at
information from matrons throughout the country and
Waimate Hospital ‘has done good service for many
news of nurses in government services in her official
years, but the time has now come when she should
position and used her editorial role to publish news,
be retired on the most generous terms possible, and
and her views on professional issues, in the journal.
Page 30
She received
Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand She was therefore a conduit for nurses sharing
therefore needs to consider whether accuracy of
information, as well as a nurse commenting from a
information in any particular document is important
leadership position. Nevertheless, her views could
for the research. An opinion piece, for example, is
have differed from those of rank-and-file nurses.
understood to be different from an inspection report; both could contain misleading information but there is
Veracity.
an expectation that writers overtly giving their opinion
Ideas relating to the truthfulness or reliability of the
might feel freer in constructing their argument than
historical source are captured in the notion of veracity.
writers reporting in an official role to the government.
The reader needs to evaluate the credibility of the
Both kinds of sources, however, need to be viewed
person creating the document, how their purpose
with healthy caution.
N O I T
I D E E
in creating it might have introduced bias, and how their values and assumptions are embedded in it.
Usefulness.
On professional issues, Maclean was credible as a
The final dimension in evaluating an historical source
commentator holding a privileged position within the
relates to its usefulness in providing material for
profession and central government department. She
the research. The Cyclopedia would give valuable
had a thorough knowledge of all nursing matters as
material, for example, for a study of the way women
well as of individual nurses throughout the country,
with or without formal professional training and in
at least those in more senior roles and in government
different positions in a variety of institutions could
nursing services. She presented her views forcefully,
all be portrayed as nurses or matrons and how the
whether criticising nurses or championing their needs.
introduction of state registration might have affected
MacGregor had credibility in reporting on hospitals
this. In addition to the 25 nurses mentioned in this
but his reports should also be seen as a wish to put on
article, other women were described as nurses or
record any identified problems so either the hospital
matrons but were untrained. The entry for Mrs Mee,
board or government would then need to attend
matron of the Otago Benevolent Institution in 1905,
to issues beyond his own responsibility. In 1905 he
presents her work in Dunedin as head laundress of one
commented that hospital boards seemed to think
mental asylum and then as head nurse of another, as a
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S S I X
that because ‘things are smooth on the surface’ the
kind of matter-of-fact career progression.30
hospital was well managed whereas this might be ‘only the smooth surface of stagnation, allowing an
The Appendices occasionally mention nurses by name.
On the
Even if a nurse is not named, a researcher can use
other hand, entries in the Cyclopedia, even the more
the inspection report for a particular hospital to get
straightforward descriptions of hospital boards, were
information on the environment in which the nurse
designed to portray an institution and its staff in a
was working or the matron’s perceived efficiency.
positive light and reflect the pride each town had in
The cumulative list of nurses on the register printed
the services it provided for its citizens.
in the Gazette gives brief information on the career
If a document presented material as factual
of each nurse and Kai Tiaki fleshes this out with more
information, the likelihood of it being accurate needs
‘human interest’ information. These three sources
to be evaluated, either by judging the credibility of the
would therefore be useful for a nursing biography or
writer or by checking against information recorded
for tracking the career patterns of a group of nurses
elsewhere. Information might be presented selectively
who registered in a similar period.
accumulation of weeds to check progress’.
to bolster the writer’s argument.
29
The evaluation
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Nursing Praxis in New Zealand Evaluating Historical Sources
the ideas and information it contains can be assessed appropriately. Circumstances affecting nursing in New
Whatever the historical source, the researcher must
Zealand in 1900, for example, could be different from
understand it and take care to evaluate it.
Each
those influencing practice in Britain. The veracity of a
offers different information about individual nurses,
source can be addressed by considering the writer and
institutions and issues affecting nursing as an emerging
the nature of the document. Hester Maclean’s official
profession. In evaluating them as historical sources,
inspection report of a hospital can be understood and
the dimensions of provenance, purpose, context,
evaluated differently from her opinion-based editorials
veracity and usefulness must be considered. Annual
in the nursing journal. The usefulness of all sources
reports to government ministers and lists of registered
depends ultimately on all these factors as well as on
nurses, for example, are official documents so have
the requirements of a particular research project.
a reliable provenance. The purpose of an inspection
Just as researchers using other methodologies pay
report of a particular hospital is very different,
attention to issues of quality in relation to the research
however, from a self-funded promotional description
data they generate, so too must historians of nursing
of the same institution. Each document must also
when locating, selecting and evaluating their primary
be considered in its temporal, geographic, social,
source research material.
N O I T
I D E E
L P M A
cultural, political and professional contexts so that
Acknowledgement
S S I X
I am grateful to Mrs Janne White, Archive Assistant at Jersey Heritage, for her generous provision of information relating to the family connection between Eva and Sidney Godfray.
1. The Cyclopedia of New Zealand, Volume 1, Wellington Provincial District, Cyclopedia Company Ltd, Wellington, 1897; Volume 2, Auckland Provincial District, Cyclopedia Company Ltd, Christchurch, 1902; Volume 3, Canterbury Provincial District, Cyclopedia Company Ltd, Christchurch, 1903; Volume 4, Otago and Southland Provincial Districts,
A R
Cyclopedia Company Ltd, Christchurch, 1905; Volume 5, Nelson, Marlborough and Westland Provincial Districts, Cyclopedia Company Ltd, Christchurch, 1906; Volume 6, Taranaki, Hawke’s Bay and Wellington Provincial Districts,
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Cyclopedia Company Ltd, Christchurch, 1908. 2. ‘Register of Nurses’, New Zealand Gazette, Government Printer, Wellington, 1908, pp.170-186, entry p.176; The Cyclopedia of New Zealand, Volume 1, p.357. 3. ‘Register of Nurses’, New Zealand Gazette, 1908, pp.170-186, entry p.185; The Cyclopedia of New Zealand, Volume 2, p.189. 4. The Cyclopedia of New Zealand, Volume 1, p.1384. 5. ‘Register of Nurses’, New Zealand Gazette, 1908, pp.170-186. 6. ‘Register of Nurses’, New Zealand Gazette, 1920, pp.579-664. 7. The Cyclopedia of New Zealand, Volume 1, p.493. 8. ‘Register of Nurses’, New Zealand Gazette, 1908, pp.170-186, entry p.175; ‘Register of Nurses’, New Zealand Gazette, 1920, pp.579-664, entry p.608. 9. ‘Obituary’, Kai Tiaki, April 1914, p.140. 10. ‘S C Godfray’, New Zealand History Online, retrieved 25 March 2010 from http://www.nzhistory.net.nz/soldiers/sc-godfray.
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Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand 11. Email correspondence with Jersey Heritage, April 2010. The 1871 census shows Eveline F. aged 7 and Sydney C. aged 4, living with their parents Alfred and Henriette Godfray, six other siblings and an aunt at 45 La Motte Street, St Helier, Jersey. 12. ‘Notes from the Hospitals, and Personal Items’, Kai Tiaki, April 1908, p.50. 13. Untitled, Kai Tiaki, July 1909, p.123. 14. M. E. Hobbs, ‘The New Hospital at Gisborne’, Kai Tiaki, April 1912, p.6. 15. ‘Resignations and Appointments’, Kai Tiaki, April 1916, p.115.
N O I T
16. ‘Hospitals and Charitable Institutions of the Colony’, Appendices to the Journals of the House of Representatives [hereafter AJHR], 1898, H-22, p.32; ‘Hospitals and Charitable Institutions of the Colony’, AJHR, 1904, H-22, p.29. 17. ‘Hospitals and Charitable Institutions of the Colony’, AJHR, 1898, H-22, p.32.
I D E E
18. ‘Hospitals and Charitable Institutions of the Colony’, AJHR, 1902, H-22, p.28. For a description and photograph of Waipawa Hospital see The Cyclopedia of New Zealand, Volume 6, Taranaki, Hawke’s Bay and Wellington Provincial Districts, Cyclopedia Company Ltd, Christchurch, 1908, p.500.
19. ‘Hospitals and Charitable Institutions of the Colony’, AJHR, 1903, H-22, p.29.
20. Issues of Kai Tiaki between 1908 and 1929 are available through the National Library of New Zealand’s digital
L P M A
collection at http://paperspast.natlib.govt.nz/cgi-bin/paperspast. The digitised version of The Cyclopedia of New Zealand is available through the New Zealand Electronic Text Centre at http://www.nzetc.org. 21. The Cyclopedia of New Zealand, Volume 1, p.493.
22. A search of the local newspaper, the Wanganui Chronicle, for this time period however, revealed the only controversy was one that arose regarding her resignation the following year, 1898. See the Wanganui Chronicle between 8 and
S S I X
27 September 1898, especially 8 September 1898, p.2 and 17 September 1898, p.2. She was complimented for her ‘zeal and tact’, Wanganui Chronicle, 1 October 1898, p.2.
23. ‘Hospital and Charitable Institutions in the Colony’, AJHR, 1891, H-7, p.26. 24. ‘A Popular Matron: Miss Stewart’s Retirement. Presentation of an Address and Purse of 200 Sovereigns’, Kai Tiaki,
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January 1911, pp.24-25.
25. ‘Hospitals and Charitable Institutions of the Colony’, AJHR, 1905, H-22, p.31.
P
26. See for example Matron’s Annual Letter, May 1894, RLH/LH/N/7/1/1; Matron’s Annual Letter, June 1897, RLH/ LH/N/7/1/4, The Royal London Hospital Archive, London. 27. See for example ‘Hospitals and Charitable Institutions of the Colony’, AJHR, 1896, H-22, p.2. 28. ‘Hospitals and Charitable Institutions of the Colony’, AJHR, 1897, H-22, p.1. 29. ‘Hospitals and Charitable Institutions of the Colony’, AJHR, 1905, H-22, p.7. 30. The Cyclopedia of New Zealand, Volume 4, p.150.
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S S I X
Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand OUR STORY PETER HARLEY: A BEACON OF HUMILITY AND PROFESSIONALISM Associate Professor Thomas Harding RN PhD Deputy Head, School of Nursing (NSW & ACT) Australian Catholic University, North Sydney, Australia
N O I T
The history of nursing has largely been associated with
reluctance to encourage more men into the profession
women. Hence it is not surprising that stories of men
extended even to difficulty in recruiting someone
as nurses have not been widely documented. Some
to teach this first class of men. Two days before
years ago I began to explore men’s contribution to
commencement there was still no one. Eventually
nursing and was fortunate to be introduced to Peter
the tutor of the Registered Nurse Aides transferred to
Harley.
“take the males on”.
I D E E
L P M A
On January 31, 1961, as one of the 10 men in the
Peter recalled that the common reaction to men in
North Canterbury Hospital Board’s inaugural three-
nursing was one of “suspicion”. It was noted there
year course leading to registration for men, Peter
was always emphasis that “you were a male nurse”
Harley became a pioneer. Although following the 1939
and underlying this the belief that you were probably
amendment to the Nurses and Midwives Act there
homosexual. From day one it was stressed that male
was a Male Nurses Register, until 1958 when the first
nurses would not be nursing women and children,
three-year course became available, programmes for
and that they “were not to have grand ideas”. It was
men were only of two-year duration – comprising 18
made clear “If we were lucky enough to complete our
months geriatric and 6 months acute nursing.
training we could never hope to be anything other
A R
S S I X
than staff nurses”.
The following account can only briefly highlight
P
Peter’s very considerable contribution to nursing. The
Of that original class only five “survived” to registration.
information is based on my conversations with two
Peter endured, he thought, because he focused on
people: Peter himself, and Susanne Trim, a longstanding
doing “the right thing” and “being a good boy”. He
colleague of Peter. It was she who introduced us.
avoided getting into trouble with the nursing hierarchy,
Having worked with Peter as a student and as an RN
but recalled others who did not and they departed.
colleague in both general and mental health settings she was able to provide an insightful perspective on
Early career development
the man and nurse.
In his final months as a student Peter was told that “Casualty Doctor has decided that he might like to try a
“We were made to feel odd”
male nurse in Casualty”. He was the first male student
According to Peter the Board’s decision to provide
to work there. He stayed for two years following
registered nurse education to men was not universally
registration but, wanting experience in the wards
supported. He heard later that “the Matron-in-Chief,
and loving night work, he asked for a position on the
or the Lady Superintendent as she was then called,
night team. A Night Sister was leaving and he was told
didn’t want it. We were unwanted from day one”. The
he could take her place. He wondered if this meant
Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
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Nursing Praxis in New Zealand promotion. However he did not voice the question as
the huge, bare waiting room.
“you didn’t ask those sorts of things and were grateful for what you received”. He was about to start when
His next role was as Afternoon Supervisor, followed
he was called into Second Assistant Matron’s office,
by that of Senior Supervisor, Night Duty. Susanne
“Mr. Harley – it was always ‘Mr.’ in those days – I’m
Trim recalled one of her first experiences with Peter
sorry to have to tell you, you will not be able to go
as a second year student nurse in the 1970s:
onto the night duty job.” He was informed that the
I was put on night shift as the sole nurse looking
Lady Superintendent on hearing of the appointment
after a ward for infectious patients, and staff
asked, “How can a man possibly do night duty when
members. This was terrifying I had only one
there were women and children in the hospital?”
year’s training and had never worked here
N O I T
I D E E
before. The Sister had the reputation of being
He was disappointed. In the mixed wards at Burwood
a tyrant. Supervisors were beings apart and
Hospital where he had been based for much of his
for we mere students certainly not people we
student days, he had been constantly called upon to help female colleagues with lifting and transferring
would approach directly! Peter was the night
L P M A
female patients. It was ingrained in him and other staff to always ensure that he was chaperoned
when with a female patient. He believed that many
supervisor. It did not take me more than a couple of nights to learn that not only could I call on this esteemed being, but he would arrive, I could explain the problem without being made to feel
female nurses did not perceive their male colleagues
incompetent, and he would help! Supervisors
as their equals, but they were pleased when a male
really did know what they were doing, they were
was on duty, “Oh, great, help with the lifting.” To
good coaches, they did support me and they were
him it seemed that they were appreciated only for
even human! What a revelation!
S S I X
their strength and ability to deal with the ‘difficult’ male issues, such as catheterisation.
A R
Exceeding expectations
P
Apart from a break in 1975-76 when he undertook a 40-week Psychiatric Nursing Bridging Programme offered at Sunnyside Hospital, Peter continued in
He remained in Casualty for a further short time
the Supervisor role for nine years. His motivation
until he travelled to the UK where he studied
for completing this latter course stemmed from
neurosurgery in Dundee, followed by the spinal
an earlier sense of inadequacy when in general
course at Stoke-Mandeville Hospital.
nursing he had needed to deal with people who on
Soon after
his return to Christchurch Hospital, in 1968, he was
admission also had mental health issues.
appointed Charge Nurse of East Side Outpatients and a year later, on the retirement of the Sister-in-
He returned to the role of Night Supervisor at
Charge, West Side, he was asked to amalgamate the
Christchurch Hospital for a further three years.
two wings. Peter was “chuffed” at being asked to
There he brought new knowledge and expertise
be a Charge Nurse as he “never had any expectation
from mental health and used his position as a Senior
from day one. I accepted that I would always be a
Supervisor to have the Board Psychiatrist review
Staff Nurse, that’s me”. He enjoyed the challenge
the management of patients who at admission also
of bringing together the two separate wings,
had mental health issues. As well, he established a
and introducing by way of posters and booklets,
‘time out’ room where patients could be secluded,
innovations – such as a public health focus – into
if necessary, for their safety.
Page 36
Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand Stepping down
the very best and the worst of nursing in my
In 1979, Peter moved out of general nursing
experience. In one placement, I came across
altogether to work in mental health. After 18 years
Peter again. He was working as a clinical
and what, in terms of hierarchical progression,
psychiatric nurse. The unit leadership was poor
would be viewed as a successful career he embraced
in my view and it was far from a positive and
a substantial reduction in salary and authority
therapeutic environment. As a beacon, Peter
to be a staff nurse in mental health. For the next
stood out as a true professional amongst others
24 years he worked as a Staff Nurse at Sunnyside
who failed to reach the profession’s standards as
Hospital, declining the senior roles which were
I understood them. I became very distressed at
offered. In 2002, as he contemplated retirement,
what I saw and experienced. After two weeks I
the Manager of the Christchurch City Mission asked
I D E E
N O I T
sought Peter out to discuss the situation. I asked
him to develop a role as a Community Mental Health
him how he could continue to practise in such an
Nurse and he spent the final four years of his career
unprofessional place. His response – “if I am not
working in the community until retirement in 2007.
here for the patients who will be, Susanne?” He
L P M A
Peter Harley’s career has been one characterised by humility, kindness and commitment to the highest of standards in all he did. In attempting to sum up the
was right. He was the person patients turned to. He was the person they trusted to treat them with fairness and professionalism.
influence this man has had on colleagues, patients
Postscript
and the profession nothing could encapsulate it
Peter continues to live in Christchurch where
better than these words from Susanne Trim:
he maintains contact with nursing friends and
S S I X
After a decade of general nursing I became
colleagues.
a mature student psychiatric nurse and I saw
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Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
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Nursing Praxis in New Zealand CONFERENCE REPORT 3RD PHILIPPINE NURSING RESEARCH SOCIETY (PNRS) NATIONAL RESEARCH CONFERENCE Reflexivity in Nursing Practice: Journeying with Qualitative Research as a Mode of Nursing Inquiry 18-19 November 2010, Iloilo City, Philippines
N O I T
Associate Professor Thomas Harding RN PhD Deputy Head, School of Nursing (NSW & ACT) Australian Catholic University, North Sydney, Australia
I D E E
In November 2010 I attended the 3rd PNRS Research
a mode of enquiry touched upon reflexivity, gender
Conference were I had the honour to present a plenary
and human rights. She highlighted the importance
session, ‘Research and a critical poststructuralist
of context and the need for critical reflection in the
paradigm’. Building upon the success of the previous
research we undertake.
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two conferences in 2008 and 2009, this conference had an explicit aim to create a forum for exploring the
The major focus of this day was providing delegates
world of qualitative research in nursing and health
with a glimpse into the world of qualitative
care practice for emerging nurse researchers in the
research with presentation and discussion of critical
Philippines.
poststructuralism, qualitative research approaches
S S I X
such as historiography, phenomenology and grounded
At this interesting, wide-ranging and culturally rich
theory, feminist research and critical social theory,
event 240 delegates from throughout the Philippines
ethnography and participatory action research. The
were bolstered by the presence of the academic
concurrent sessions in the afternoon provided four
staff of the host organisation the College of Nursing,
concurrent sessions: care of women, children and
West Visayas State University. As well, a large group
adolescents; initiatives and innovations in health and
of fourth year undergraduate nursing students, not
nursing; community health nursing; and caring for
just from the local College of Nursing, also attended.
special populations. I attended Stream C, community
As part of their final year they undertake a research
health nursing, as three of the speakers discussed their
project; many were displayed as posters and five gave
research among Filipino indigenous communities. It
oral presentations of their projects during one of the
was fascinating to learn of the work being done to
concurrent sessions.
learn from the indigenous knowledge and healthcare
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practices presented.
Jezyl Cempron from Cebu
On the first day of the conference the delegates were
Normal University presented her team’s study ‘Botika
welcomed, in speech and song, and the invited keynote
sa Barangay’ (The Pharmacy in the Village), which
and plenary speakers were formally introduced. The
is an initiative to address the issue of access to
keynote speech was delivered by Professor Fatima
affordable medicine for those living in impoverished
Castillo, who holds a Chair in Social Sciences at the
circumstances in rural areas. The findings of this study
University of the Philippines, Manila. Her erudite and
conducted in Cebu province revealed that the health-
wide-ranging introduction to qualitative research as
related expenditure of the respondents was reduced
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Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand and significantly there was a decrease in infant and
showcasing of their work, although I was concerned
child mortality rates post introduction of the project.
about their undertaking research projects with indigenous peoples and vulnerable populations often
The evening began with the fellowship dinner and
without ethics approval or consideration of the issues
the opportunity to enjoy the local food and the
with respect to colonisation and appropriation of
entertainment provided by the talented West Visayas
indigenous knowledge. I discussed this with two of
State University dance troupe who performed
my Filipino colleagues who also played a major role in
traditional dances. The male members dancing with
the organisation of the conference, Professor Jerome
coconut shells strapped to strategic parts of the body
Babate and Dr Erlinda Palangas, President PNRS and
which they clashed against one another as they danced
Co-Convenor of the conference.
was an exciting highlight. The School of Nursing staff
my concern and emphasised the importance of such
brought down the house with their dance routine and
conferences and the involvement of researchers
members of the audience also participated with song;
from other countries to support them in working
the New Zealand contingent – of one – responded to
with emerging nurse researchers in the Philippines to
the hospitality with a rendition of “Pokarekare ana”.
develop the research culture. Nurse researchers from
N O I T
They understood
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Aotearoa New Zealand have a lot to offer in this area
Day two focused on the practicalities of the research
and any interaction would be warmly welcomed by
process with presentations on data collection, ensuring
colleagues in the Philippines.
rigor, postgraduate supervision, thesis advising and
writing for publication. The concurrent sessions were:
The day concluded with the presentation of awards
care of women, children and adolescents; perspectives
for the best student and professional posters, and the
in nursing education; caring for special populations; and
best student and professional research, and farewell
student research, which I attended. The students, who
to all the participants. Reflecting on the experience
worked in groups, undertook ambitious projects which
of attending this conference, it was one of the most
included: food culture care of the indigenous people of
exciting and enjoyable conferences I have attended. It
Lambunao; the lived experience of elderly living alone;
was characterised by warmth, humour, generosity and
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S S I X
the lived experience of adolescents with cancer; and a
a sense of community that I have never experienced
transcendental perspective of describing experiences
before at such an event.
of first-time mothers. It was a delight to experience
kindness, generosity and friendship I received and
the enthusiasm these young nursing students have for
touched by the mutual respect and affection between
undertaking research and for learning more about the
the students and staff of the host School of Nursing.
process from others.
Underpinning the overall success of the conference
I was humbled by the
was the enthusiasm of all the participants and their For me one of the highlights of the conference was
desire to learn more and become actively involved in
the inclusion of undergraduate students and the
research.
Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Page 39
Nursing Praxis in New Zealand BOOK REVIEW Title: Author: Publisher:
Women’s Health in General Practice (2nd Edition) Danielle Mazza Churchill Livingstone
Reviewer:
Ruth Davy, Women’s Health Nurse Specialist, WONS
N O I T
This is a comprehensive book with seventeen sections
the trickier issues. Pregnancy and delivery are not
covering adolescent gynaecology to menopause and
included in this book.
osteoporosis. Written for general practitioners it is
I D E E
well laid out and easy to read. Each section contains
Pelvic pain is a common complaint that can be
the latest research evidence. Tables and flow charts
challenging for women and practitioners.
provide practical reference points for each section.
section on this topic addresses, in a sympathetic and
Throughout the book case studies give an holistic
comprehensive manner, the many possible reasons for
and practical overview of how to manage the more
it. This is very reassuring for women who suffer pelvic
challenging cases.
pain, and I encourage all primary health care providers
The
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to read it carefully. It was also reassuring to find that
The text is not dominated by medical remedies,
sexual abuse and violence against women – conditions
which was a pleasant surprise.
Natural remedies
often undiagnosed – are included in the book. There
and vitamin use were discussed on a regular basis,
are clear guidelines on how to manage partner abuse.
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although in some sections diet and exercise were
This aspect was disappointing especially
On a personal note, this is one of the few books medical
in the premenstrual syndrome section where diet
books I have really enjoyed reading. I found it difficult
and exercise can dramatically help women cope
to put down and can highly recommend it for anyone
with symptoms. However, menopause and dietary
working in primary health care setting.
missing.
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management were well covered and offered general
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practitioners comprehensive information on the use and benefits of phytoestrogens. The debate about hormone replacement therapy is well covered, explaining the difference between relative and absolute risk in research. Although in the main the account of breast screening is similar to our programme the recommendation to screen young women under the age of 20 years for cervical abnormalities is something not recommended in New Zealand. The pregnancy section covers unplanned pregnancy, initial management of infertility, preconception care, early pregnancy loss and postnatal care. All sections are written in a manner that allows for informed consent and reflect empathy and understanding for Page 40
Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand RESEARCH BRIEF MELAA REPORT SUMMARY Dr Annette Mortensen, RN PhD Project Manager: Auckland Regional Settlement Strategy, Migrant and Refugee Health Action Plan Northern District Health Board Support Agency, Auckland
N O I T
This report was commissioned by the Auckland
Of the three groups, Middle Eastern peoples are
District Health Board on behalf of the Auckland
the largest group in the Auckland region.
Regional Settlement Strategy Health Steering Group
report shows the need for targeted diabetes and
which represents Waitemata, Auckland and Counties
cardiovascular disease preventive strategies. Better
Manukau District Health Boards.
access to womens’ health, and primary oral health
I D E E
The
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services in adults and children is also a key priority
The Middle Eastern, Latin American and African
for Middle Eastern groups. African peoples are the
Health Needs Assessment (MELAA HNA) (Perumal,
second largest MELAA group in Auckland. The report
2010) is the first and only report to present MELAA
highlights the need for targeted diabetes prevention
population health trends in New Zealand. The MELAA
strategies for African groups, along with improved
ethnicity grouping consists of multiple diverse cultural,
access to screening services, womens’ health services,
linguistic and religious groups from refugee and
and better access to oral health care. Latin American
migrant backgrounds. In the 2006 census, 1% of the
peoples make up the smallest proportion of the MELAA
New Zealand population identified as MELAA and half
group. The rising prevalence of diabetes and heart
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S S I X
resided in the Auckland region. Today, 28,637 people
disease in all three MELAA populations may indicate
in Auckland identify as being MELAA; approximately
the acculturation effects of changes in diet, nutrition
14,000 are Middle Eastern; 3000 are Latin American;
and physical activity that are associated with residence
and 11,000 are African. This group is one of the fastest
in New Zealand.
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growing population groups and has unique health needs.
The findings of the study indicate the need to include MELAA groups in CVD/Diabetes screening, prevention
MELAA groups face significant barriers to accessing
and management programmes. The importance of
health care including: language and communication
ethnic and religious communities in health service
difficulties; health illiteracy in some groups; the cost
consultation and planning processes is highlighted.
of health care; a lack of cultural understanding by
The need for cultural competency training for the
Health Service Providers; and poor understanding of
health and disability workforce, including how to work
the New Zealand health system, and, for some groups,
with interpreters, is also highlighted.
of Western health care models.
Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Page 41
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.
N O I T
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
I D E E
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
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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
S S I X
While we encourage authors to be creative in the way they present their information, the following requirements need to be met: •
Manuscripts should be word processed on A4 size paper, with double line spacing, page numbers on the bottom of the page.
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•
Use a plain font (Arial, Calibri, or Times New Roman).
•
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.
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•
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.
•
If the article is a research report then details of ethical processes followed must be included in the body of the manuscript.
•
Tables and diagrams need to be presented on a separate page.
Further details are available on the Nursing Praxis in New Zealand website. 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.
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 and page numbers.
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Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Nursing Praxis in New Zealand •
Check you have used a plain font (Arial, Calibri, or Times Roman).
•
No details of the author 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
N O I T
be signed by all contributing authors. •
Where a manuscript is co-authored, each author must declare that they have actively participated in the development and writing of the manuscript.
I D E E
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. References in the text should cite the author’s name(s), followed by the date of publication. Where direct quotations are
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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
S S I X
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
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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
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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.
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.
Vol. 27 No. 1 2011 - Nursing Praxis in New Zealand
Page 43
Nursing Praxis in New Zealand Research Briefs Generally should not exceed 500 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
N O I T
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,
I D E E
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
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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
S S I X
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:
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E-mail –
as a Word document together with scanned original copy of author information to:
admin@nursingpraxisnz.org.nz OR Post –
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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. 27 No. 1 2011 - Nursing Praxis in New Zealand