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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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I D E E

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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CO NTE NTS

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.

N O I T

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.

L P M A

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.

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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.

I D E E

Associate Progessor Denise Wilson RN PhD FCNA(NZ) Editor-in-Chief/AUT University

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IN NEW ZEALAND

Subscribe to Nursing Praxis, rates for 2011 are as follows-

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All prices for 2011 include the Nursing Praxis journal, (inc postage) and online subscription (available soon, new website currently under development) All prices are GST free:

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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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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

S S I X

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

I D E E

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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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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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

Andrews, M., & Wallis, M. (1999). Mentorship in nursing: A literature review. Journal of Advanced Nursing, 29, 201-207. doi: 10.1046/j.1365-2648.1999.00884.x Burnard, P. (1991). A method of analysing interview transcripts in qualitative research. Nurse Education Today, 11, 461-466. doi: 10.1016/0260-6917(91)90009-Y

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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

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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

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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

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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

I D E E

L P M A

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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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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

L P M 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,

P

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,

A R

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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Nursing Praxis in New Zealand

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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.

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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

A R

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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

I D E E

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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.

S S I X

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.

A R

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

Nursing Praxis NZ April 2011 Vol 27 No 1  

Journal of Professional Nursing

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