Factors influencing Maori student nurse retention and success: An integrative literature review.

BACKGROUND: Improving indigenous health outcomes requires a strong indigenous nurse presence. Increasing the retention and success of nursing students during their education supports the critical mass needed to implement change in the health workforce to better address indigenous population health needs. OBJECTIVES: To explore the factors affecting retention and success of Maori undergraduate nursing students in New Zealand. DESIGN: A Kaupapa Maori research framework was utilised within an integrative review design. DATA SOURCES: CINAHL Plus, Scopus, and Google Scholar databases were searched using the keywords Maori, indigenous, nursing, health, education, retention and success. REVIEW METHODS: An iterative process was used to integrate and synthesize the literature. Thematic analysis was carried out to establish key concepts present in the literature and to establish gaps. RESULTS: Maori student identity, institutional support factors and programme factors play a role in Maori student success and retention. Both the university environment and whanau (family) support contribute to a strong sense of identity. The institution's ability to facilitate peer mentoring, provide safe spaces for study and specialised support services also play a role. Finally, programme factors such as faculty culture, teaching practices and curriculum content affect the student's experience and desire to remain in nursing. CONCLUSIONS: Improving student retention and success requires an environment which is welcoming and respectful of indigenous values and strengths. Strategies which encourage students to be self-empowered in their learning, ensure equity of opportunity, facilitate working together and enable the development of good relationships will meet the needs of all students, not just Maori.

The consequences of using advanced physical assessment skills in medical and surgical nursing: A hermeneutic pragmatic study.

AIMS AND OBJECTIVES: The aim of this study was to explore the consequences of the nurse's use of advanced assessment skills on medical and surgical wards. BACKGROUND: Appropriate, accurate, and timely assessment by nurses is the cornerstone of maintaining patient safety in hospitals. The inclusion of "advanced" physical assessment skills such as auscultation, palpation, and percussion is thought to better prepare nurses for complex patient presentations within a wide range of clinical situations. DESIGN: This qualitative study used a hermeneutic pragmatic approach. METHOD: Unstructured interviews were conducted with five experienced medical and surgical nurses to obtain 13 detailed narratives of assessment practice. Narratives were analyzed using Van Manen's six-step approach to identify the consequences of the nurse's use of advanced assessment skills. RESULTS: The consequences of using advanced assessment skills include looking for more, challenging interpretations, and perseverance. The use of advanced assessment skills directs what the nurse looks for, what she sees, interpretation of the findings, and her response. It is the interpretation of what is seen, heard, or felt within the full context of the patient situation, which is the advanced skill. CONCLUSION: Advanced assessment skill is the means to an accurate interpretation of the clinical situation and contributes to appropriate diagnosis and medical management in complex patient situations. RELEVANCE TO CLINICAL PRACTICE: The nurse's use of advanced assessment skills enables her to contribute to diagnostic reasoning within the acute medical and surgical setting.

Impact of colonialism on Maori and Aboriginal healthcare access: a discussion paper.

BACKGROUND: Historical socio-political processes have produced gross inequity of health resource for Aboriginal Australians and New Zealand Maori. OBJECTIVES: This paper argues that socio-political factors resulting from the entrenchment of colonialism have produced significant personal and structural barriers to the utilisation of healthcare services and directly impact the health status of these two vulnerable groups. DESIGN: Discussion Paper. CONCLUSIONS: Understanding the actual barriers preventing the utilisation of healthcare facilities, as perceived by Indigenous people, is essential in reducing the gross disparity between Indigenous and non-Indigenous morbidity and mortality in Australia and New Zealand.

Hermeneutics and pragmatism offer a way of exploring the consequences of advanced assessment.

Linking specific nursing actions to outcomes in the healthcare setting is challenging. Patient outcomes are varied and influenced by a myriad of factors, and always involve a wider team than any one nurse. It is difficult to control for a single action or set of actions of a particular nurse. Furthermore, practice is seldom about any 'one' action, for one thing leads to another, all within a complex interplay of influencing factors. In this article, we outline a research method which combined Dewey's pragmatism with Gadamer's hermeneutics to explore the consequences of the nurse's use of advanced assessment skills in the acute care setting of medical and surgical wards. This pragmatic hermeneutic methodological approach allowed the complex interplay of influences to be revealed in the unfolding story. Reflection of the nurse brought insights that may otherwise have been passed over. The philosophical notions of Dewey drew attention to the play of 'means' and 'ends'. A hermeneutic approach that calls for 'thinking' extends understanding and raises insights that can inform education and practice.