Abstract: Part of an international project, the aim of this study was to evaluate a nurse managed primary health care clinic (Mana Health Clinic) from the perspectives of users, funders, and providers of clinical services in order to identify factors which contribute to success. The method used was Fourth Generation Evaluation (FGE) whereby, consistent with the methodological precepts of the constructivist enquiry paradigm, there was active involvement of clients in the process and outcome of the evaluation. Open-ended interviews were conducted with 13 individuals and one focus group. The data yielded four main categories: factors that contribute to success; contrasting past experience of health care with that of nurse-managed care; the effectiveness of nurse-managed care; and suggestions for change in current practice. The authors note that the results to date support a tentative conclusion of success for the clinic. As the study is on-going, summaries of the four categories were fed back to the participants for further discussion and interpretation and eventual integration with data from the similar study being undertaken in the United States. The authors conclude that this paper demonstrates how the use of an appropriate method of evaluation can itself contribute to the success of the nurse managed clinic.

Abstract: The author argues that the involvement of nurses in the decision-making of health organisations is essential to maximise the contribution of nurses and promote positive outcomes for patients. She suggests that development of leadership skills will make nurses aware of power structures in the health system and allow them to become interdependent health professionals in primary health organisations (PHO). 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.

Abstract: This paper reviews currently identified issues concerning emergency department attendance, and examines the core question of the role of primary care in the emergency department. Asks whether this is an appropriate use of emergency department resources, and if so, what the implications are for the role of the emergency nurse. Suggests the establishment of Minor Injury Units in New Zealand like those in the UK.

Abstract: In 2003, as part of implementing the Primary Health Care Strategy, the Ministry of Health announced contestable funding, available over three years, for the development of primary health care nursing innovation projects throughout Aotearoa/New Zealand. The Ministry looked for proposals that would: support the development of innovative models of primary health care nursing practice to deliver on the objectives of the Primary Health Care Strategy; allow new models of nursing practice to develop; reduce the current fragmentation and duplication of services; and assist in the transition of primary health care delivery to primary health organisations. This report describes the findings from the evaluation of the 11 primary health care nursing innovations selected for funding by the Ministry of Health. It provides an overview of the innovations' success and of the lessons learnt from this policy initiative.

Abstract: This study used a non-experimental correlational design to research the relationship between the experience of the nurse, with the application of continuous positive airway pressure therapy (CPAP) to patients presenting to a metropolitan emergency department with cardiogenic pulmonary oedema (CPO), and to establish what difference, if any, CPAP made to outcomes. A retrospective audit of records was used to extract data on all 54 patients that received CPAP over a 12-month period. The primary outcome measures were off CPAP within two hours, transfer to intensive care unit or cardiac care unit, and secondary outcome measures were length of hospital stay and death. There was a trend towards more experienced nurses attending patients who required immediate treatment or treatment within 10 minutes. These patients were more likely to be recognised at triage as requiring CPAP therapy. The early application of CPAP reduced hospital mortality, length of stay, and the need for intubation and ventilation. Attention needs to be given on how best to educate nurses so that more patients presenting with acute respiratory failure can benefit from nurses' decision-making regarding the commencement of CPAP.

Abstract: This paper reports on a study of the maternity care experiences of women from Goa (India) in Auckland. Multiple research strategies were incorporated into the process to prevent reproduction of deficiency discourses. Interviews were carried out with Goan women who had experiences of migration and motherhood. The findings revealed that as a consequence of motherhood and migration, migrant mothers were able to reclaim and re-invent innovative solutions. Nurses and other health professionals can have a significant role in supporting women and their families undergoing the transition to parenthood in a new country and develop their knowledge and understanding of this dual transition.

Abstract: The aim of this study was to determine the feasibility of establishing a nurse practitioner-led, family focused, primary health care clinic within a New Zealand primary school environment as a means of addressing the health needs of children and families. A secondary aim was to ascertain whether public health nurses were the most appropriate nurses to lead such a clinic. Utilising a community needs analysis method, data were collected from demographic data, 17 key informant interviews and two focus group interviews. Analysis was exploratory and descriptive. Findings included the identification of a wide range of health issues. These included asthma management and control issues, the need to address poor parenting, and specific problems of the refugee and migrant population. Findings also demonstrated that participant understanding of the role of the public health nurse was less than anticipated and that community expectations were such that for a public health nurse to lead a primary health care clinic it would be likely that further skills would be required. Outcomes from investigating the practicalities of establishing a nurse practitioner-led clinic resulted in the preparation of a community-developed plan that would serve to address the health needs of children and families in the area the study was undertaken. Services that participants identified as being appropriate included health information, health education, health assessment and referral. The authors conclude that the establishment of a nurse practitioner-led, family focused, primary health care clinic in a primary school environment was feasible. While a public health nurse may fulfil the role of the nurse practitioner, it was established that preparation to an advanced level of practice would be required.

Abstract: This research presents a discourse analysis of articles published in the New Zealand Herald between October 1999 and September 2005. The terms “nurse prescribing” and “prescribing fights” identified seven articles published which referred specifically to this issue. They were predominantly editorial comments and statements attributed to senior doctors. Examples of comments from these articles are presented and discussed in this article, and three inter-related themes are identified – competence, responsibility and competition. Discussion on competence centred on education, skill and experience level of nurses, as described by editorial comment and senior doctors. Positive international research and experience of nurse prescribing did not feature. A number of comments in the articles analysed could be seen to represent concerns about competition between medicine and nursing. One interpretation of the comments contained in these articles is to see medical practitioner groups defending their status and desire to define and control nursing practice. The media has the power to select the information conveyed and, in these instances, appears to have demonstrated a bias towards the medical community's perspective.