Nursing Praxis in New Zealand
Vol. 18 No.1 - March 2002

EDITORIAL

Abstracts of Articles published in this volume:

Pamela Wood & Lynne Giddings
Randomised Controlled Trials in Nursing and Midwifery:
An Interview with Maralyn Foureur

Robyn Brasell-Brian & Esther Vallance
Clinical Practice/Education Exchange: Bridging the Theory-Practice Gap

Mary Finlayson & Suzanne Gower
Hospital Restructuring: Identifying the Impact on Patients and Nurses

Brian McKenna
Risk Assessment of Violence to Others: Time for Action

RANDOMISED CONTROLLED TRIALS
IN NURSING AND MIDWIFERY:
AN INTERVIEW WITH MARALYN FOUREUR
Pamela J. Wood, RGON, PhD, Senior Lecturer
Graduate School of Nursing and Midwifery,
Victoria University of Wellington
Lynne S. Giddings, RGON, RM, PhD, Associate Professor
School of Nursing and Midwifery, Auckland University of Technology

Abstract
Randomised controlled trials are considered to be one of the best research designs for determining effective care in the clinical setting. Relatively few randomised controlled trials, however, have been carried out in nursing or midwifery practice, so few examples of the practical realities of this research methodology are readily accessible. This is the sixth article in a series based on interviews with nursing and midwifery researchers, designed to offer the beginning researcher a first-hand account of the experience of using particular methodologies. This article focuses on the randomised controlled trial as experienced by Maralyn Foureur (RGON, RM, BA, Grad Dip Clin Epidem, PhD) who used this methodology to demonstrate the effectiveness of a continuity of care model in midwifery practice.

Key Words: Research methodologies, randomised controlled trials, systematic
review, midwifery, continuity of care.
Article Order No: 181A

CLINICAL PRACTICE/EDUCATION EXCHANGE:
BRIDGING THE THEORY-PRACTICE GAP.
Robyn Brasell-Brian, RGON, RM, ADN, BHlthSc, Nurse Lecturer, School of Nursing, Faculty of Health Sciences, Christchurch Polytechnic Institute of Technology, Christchurch
Esther Vallance, RCpN, BN, Nurse Lecturer, School of Nursing, Faculty of Health and Sciences, Christchurch Polytechnic Institute of Technology, Christchurch

Abstract
Nursing education is directed toward development of nursing practitioners competent to nurse effectively in the reality of our present society. A major challenge to the nursing profession is to find ways of merging theory and practice in the delivery of nursing education and patient care. One option for achieving this goal is for nurse educators to spend time in clinical practice updating their clinical skills and re-experiencing the realities of practice. Joint appointments with practice, intermittent periods of clinical update in practice and work role exchanges have all been utilized by the profession. However clinical practice/education exchange (CPEE) involving two people - one in clinical practice and the other in education - who exchange jobs for a fixed period of time is a relatively new concept. Central to a CPEE is the aim of enhancing student learning and facilitating meaningful links between theory and practice for them. Hence the exchange occurs between the education institute and the service area where students are placed. This article positions the CPEE within nursing literature and presents narrative accounts from a nurse educator and clinician who exchanged jobs for one year.

Key Words: Theory-practice gap, nursing education, clinical practice, exchange
Article Order No: 181B

HOSPITAL RESTRUCTURING: IDENTIFYING THE
IMPACT ON PATIENTS AND NURSES
Mary P. Finlayson, PhD, RCpN, Senior Lecturer,
School of Health Sciences, Massey University, Albany
Suzanne E. Gower, PhD, RGON, Lecturer, Department of Public Health and
General Practice, Christchurch School of Medicine & Health Sciences,
University of Otago

Abstract
Health systems throughout the democratic world have been subject to ‘reform’ in recent years as countries have attempted to contain the rapidly rising costs of health care. Because hospital care accounts for a large proportion of health sector spending, hospital restructuring has been an important part of those changes. In an attempt to make hospitals more efficient and cost-effective, New Zealand, like other countries, has introduced extensive changes to the way in which treatment and care are delivered to patients, and to the way nurses’ work is organised and managed. International research has identified links between the way in which nursing is organised in a hospital, and that hospital’s patient outcomes. The current authors are part of a team of researchers undertaking research which uses the methodology of the International Hospital Outcomes Study to examine nurse staffing and patient outcomes in New Zealand’s secondary and tertiary hospitals across the period 1988-2001. The research involves a large survey of all nurses working in the study hospitals, an examination of the way in which the hospitals have been restructured, and an analysis of patient outcomes.
Key Words: Hospital restructuring, nurse outcomes, patient outcomes, organisation
Article Order No: 181C

RISK ASSESSMENT OF VIOLENCE TO OTHERS:
TIME FOR ACTION
Brian McKenna, RCpN, BA, MHSc (Hons) Senior Lecturer, Division of Nursing, the University of Auckland Nurse Advisor, Auckland Regional Forensic Psychiatric Services Waitemata District Health Board

Abstract
Possible expansion in the scope of practice of mental health nurses, together with the prevalence of nurses being assaulted by patients, accentuates the need for nurses to be more skilled in risk assessment. A literature search was undertaken on the topics of risk assessment, dangerousness, aggression, and violence in the data bases of CINAHL, MEDLINE and PSYCHLIT, in order to determine an evidence based approach to risk assessment of patient violence towards others. In the absence of reliable and valid nursing risk assessment measures, the approach suggested here focuses on the use of observation skills to detect behaviour antecedent to physical assault, and the ability to systematically assess evidencebased the need to adapt it to specific clinical settings. Failure to proceed rapidly with such developments may jeopardise the safety of both patients and staff.
Key Words: Risk assessment, aggression, dangerousness, violence
Article Order No: 181D