Nursing Praxis in New Zealand
Vol. 18 No.2 - July 2002

EDITORIAL

Abstracts of Articles published in this volume:

Lynne Giddings &Pamela Wood
Discourse Analysis - Making Connections Between Knowledge and Power:
An Interview with Debbie Payne

Tony Farrow, Brian McKenna & Anthony O’Brien
Initiating Committal Proceedings “Just in Case” with Voluntary Patients:
A Critique of Nursing Practice

Beverley Mackay
Leadership Development: Supporting Nursing in a Changing Primary Health Care Environment

Sandra Richardson
Advanced Nursing Practice - Evolution or Revolution?

Barbara Warren
Intramuscular Injection Angle: Evidence for Practice?

DISCOURSE ANALYSIS - MAKING CONNECTIONS
BETWEEN KNOWLEDGE AND POWER:
AN INTERVIEW WITH DEBBIE PAYNE
Lynne S. Giddings, RGON, RM, PhD, Associate Professor
School of Nursing and Midwifery, Auckland University of Technology
Pamela J. Wood, RGON, PhD, Associate Professor
Graduate School of Nursing and Midwifery, Victoria University of Wellington

Abstract
Discourse analysis is a relative newcomer to the variety of qualitative research
methodologies used in nursing and midwifery research in Aotearoa/New Zealand. This is the seventh 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 discourse analysis as interpreted by Debbie Payne (RGON, MA [Hons]) in interview. Debbie has recently finished her PhD thesis (submitted for examination) and is a Senior Lecturer at the Auckland University of Technology. For her thesis Debbie used Foucauldian discourse analysis to explore the use of the term ‘elderly primigravida’ to describe mothers who are pregnant for the first time when aged 35 years or over.

Key Words: Research, methodologies, discourse analysis, Foucauldian discourse analysis, elderly primigravida.
Article Order No: 182A

INITIATING COMMITTAL PROCEEDINGS “JUST IN
CASE” WITH VOLUNTARY PATIENTS: A CRITIQUE
OF NURSING PRACTICE
Tony L. Farrow, RCpN, MHSc (Hons).
Senior Lecturer, School of Nursing, Christchurch Polytechnic Institute of
Technology, Christchurch
Brian G. McKenna, RCpN, MHSc (Hons). Senior Lecturer, Division of Nursing, University of Auckland, Auckland; and Nurse Advisor, Auckland Regional Forensic Psychiatry Services, Waitemata
District Health Board, Auckland
Anthony J. O’Brien, RGN, RPN, MPhil (Hons).
Lecturer, Division of Nursing, University of Auckland, Auckland

Abstract
Voluntary patients entering mental health units retain the right to accept or refuse treatment, including ongoing admission, as they see fit. However the nature of acute mental distress means that some patients have fluctuations in their mental status and competency to make informed decisions. Inpatient mental health nurses face the ongoing challenge of practising in a way that balances the requirement to support and promote the autonomy of voluntary patients with the need, occasionally, to take actions which although they may appear paternalistic are needed to protect those patients or other people. Anecdotal evidence together with a clinical audit undertaken by the authors suggest that the practice of nurses requesting that doctors sign medical certificates which are then placed on patients’ files ‘just in case’ they are needed has become a mechanism by which a minority of nurses deal with such challenges. A conceptual analysis of these issues indicates that such a practice is both legally questionable and ethically inappropriate. We suggest an alternative framework for practice that is legally and ethically preferable for both nurses and patients.

Key Words: Inpatient mental health/psychiatric nursing, Mental Health Act, mental health law, mental health ethics
Article Order No: 182B

LEADERSHIP DEVELOPMENT: SUPPORTING NURSING IN A CHANGING PRIMARY HEALTH CARE ENVIRONMENT
Beverley J Mackay, RGON, MA (App) (Dist), FCNA(NZ)
Doctoral Candidate University of Technology Sydney
Senior Lecturer, Faculty of Health and Science,
Northland Polytechnic, Whangarei

Abstract
New organisations to provide primary health care in New Zealand are evolving in response to changes in policy, funding and contracting arrangements. The premise of this paper is that involvement of nurses in the decision-making of health organisations is essential to maximise the contribution of nurses and thereby promote positive client outcomes. It is argued that development of key leadership skills will enable nurses to become more critically aware of underlying power structures in the health system and to move towards being acknowledged as interdependent health professionals in the Primary Health Organisations (PHOs). The particular competencies discussed are those proposed by Van Maurik (1997) namely ability to understand and manage organisational politics, work facilitatively with people and circumstances, and build a feeling of purpose.

Key Words: Nursing leadership, primary health care nursing, resourcing, primary health organisations.
Article Order No: 182C

ADVANCED NURSING PRACTICE - EVOLUTION
OR REVOLUTION?
Sandra Richardson, BA, Dip.Soc.Sci., Dip.Heal.Sci.(PG)
Nurse Researcher, Christchurch Hospital Emergency Department

Abstract
This article has been written to challenge the seemingly unquestioning acceptance changing roles in New Zealand nursing. It is evident in nursing history that a number of issues, such as community versus hospital services and generalist versus specialist practice, tend to resurface in a cyclic manner. Characteristics that are currently associated with ‘advanced’ nursing roles can be recognised when the origins and development of nursing in New Zealand are traced. This gives rise to speculation that changes to nursing scope of practice are not s much revolutionary as evolutionary, and can perhaps be viewed as a reclaiming rather than a redefining of nursing roles.

Key Words: advanced practice, nursing boundaries, New Zealand nursing history.

Article Order No: 182D

INTRAMUSCULAR INJECTION ANGLE: EVIDENCE
FOR PRACTICE?
Barbara L. Warren, RGN, RSCN, RM, BSc.(Hons), PGDip(Child and Family) Previously Immunisation Co-ordinator, Choice Health,
Public Health, Masterton Now Senior Nurse, Children’s Pavillion, Healthcare Otago, Dunedin

Abstract
This article presents the findings of a search for evidence to support the 45-60 degree angle of insertion for intramuscular injection of vaccine which is recommended in New Zealand. With the objective of discovering the evidence base for an intramuscular injection angle which differs from that recommended by the World Health Organisation and the accepted practice experienced by the author in the UK, Canada, Malawi and the USA, a comprehensive library and internet literature search was undertaken. As well, information was sought by personal correspondence and contact with a range of immunisation specialists. Both the literature specifically on needle angle and that which includes needle angle within a wider investigation of technique is included. Overwhelmingly the evidence supports a 90 degree angle of needle insertion for intramuscular injection as being that most effective in terms of patient comfort, safety and efficacy of vaccine.

Key Words: Intramuscular injection technique, vaccine, needle angle, immunisation.

Article Order No: 182E