Abstract: This paper focuses on the history of Plunket nursing and Truby King's ideology and other dominant ideologies, during the years 1905 – 1920. To provide a context, the paper explores the development of a new nursing speciality – Plunket nursing, that became part of the backbone of a fledgling health system and the New Zealand nursing profession. Correspondingly, Truby King presented the country with a vision for improving infant welfare underpinned by his eugenics view of the world and his experimentation with infant feeding. The author argues that nurses were drawn to the work of the newly created Plunket Society and that the Society had lasting influence on the development of nursing in New Zealand.

Abstract: This thesis represents an appreciative enquiry to identify features of effective verbal communication between nurses and patients. Using a method developed by the Language in the Workplace Project (Stubbe 1998) two nurse participants recorded a small sample of their conversations with patients as they occurred naturally in clinical practice. These six conversations constitute the main body of raw data for the study. The data was analysed using a combination of discourse and ethnographic analysis. Experience in nursing, particularly insider knowledge of the context of district nursing, helped me to uncover the richness of meaning in the conversations. The subtle interconnections and nuances could easily have been missed by an outside observer. The study has shown that in their interactions with patients, expert nurses follow a pattern in terms of the structure and content of the conversations and it is possible to identify specific features of effective nurse-patient communication within these conversations. The most significant of these are the repertoire of linguistic skills available to nurses, the importance of small talk and the attention paid by nurses to building a working relationship with patients, in part, through conversation. The findings have implications for nursing education and professional development.

Abstract: This research explores why and how nurse educators teach for social change. Critical feminist educators provide a useful framework for theorising about teaching for change that addresses issues of hegemony, agency, praxis, individual voice, difference, justice and equity. Six women Pakeha/Tauiwi nurse educators from throughout New Zealand volunteered to participate in this research and share their lived experiences of teaching for social change. In-depth conversations over two years unfolded new and rich material about how and why these six women continue to teach the evaded subjects, like mental health, women's health, community development and cultural safety. All teach in counter-hegemonic ways, opening students' eyes to the unseen and unspoken. Among the significant things to emerge during the research was the metaphorical construct of shape-shifting as an active process in teaching for social change. It revealed the connectedness and integrity between life as lived and the moral imperative that motivates the participants to teach for difference. Shape-shifting was also reflected in other key findings of the study. As change agents, the participants have had significant shape-shifting experiences in their lives; they live and work as shape-shifters within complex social and political structures and processes to achieve social justice; and, they deal with areas of health practice where clients are socially and politically displaced. The research also generated new methods for gathering life-stories and new processes for analysis and interpretation of life-stories. It is hoped that this research will open pathways for other nurse educators to become shape-shifters teaching for social change.

Abstract: This study is an extension of a previous study by Riker, Picard and Fraser (1999) to determine whether doctors and nurses rate patients similarly using the Sedation-Agitation Scale (SAS) in a natural Intensive Care Units (ICU) setting. The author notes that it is essential to establish whether these different professionals provide consistent scores and have a mutual understanding of the SAS and its constituent levels. This will help ensure that clinical decisions relating to sedation-needs can be made appropriately and consistently. This quasi-experimental reliability study was set in a 12-bed tertiary general ICU in New Zealand. The SAS had recently been introduced into this unit and a convenience sample of 42 nursing and medical staff performed paired ratings on 69 randomly selected adult ICU patients over an eight week time frame. The mean patient age was 58 years, and 79% of patients were on continuous infusions of Propofol. Intubated patients made up 91% of the sample. 74% of patients were given the same SAS score by the doctor-nurse pair. The weighted kappa score for inter-rater agreement was 0.82 indicating very good agreement. Of the 26% of scores where there was a difference, the two readings were only one score apart. Most of the difference occurred around SAS scores of 1-2 and 3-4. Further analysis found no staff or patient variables to be statistically significant in impacting on the ratings. The SAS was found to be a reliable sedation-scoring tool in a general ICU when used by nurses and doctors of varying experience.

Abstract: A retrospective descriptive design was used to examine the records of all presentations to the emergency department of patients with COPD over a 3-month period to determine whether there is a subset group of people who present with hypercarbia. There were 114 presentations, amongst those there were 71 individuals, a number presenting more than once within the three months. 80% of the 71 individuals had a smoking history of which 53% were female. Of the 114 presentations, 76 had arterial blood gases taken during their emergency department presentation. Of these 76 presentations 30 had hypercarbia and 46 were non-hypercarbia. These 76 presentations involved 58 individuals, with some individuals presenting five times over the three-month period. Three groups emerged, some who were only hypercarbia (n= 18), some in the non-hypercarbia group (n=35) and 5 individuals who had presentations in both the hypercarbia and non-hypercarbia groups. Data showed that there was no definable subset group of hypercarbia patients within acute exacerbations of COPD presenting to the emergency department according to the variables. However the sample of presentations (with a blood gas) found within the study suffering hypercarbia was much higher (31.1%) than anticipated. Further analysis showed that the hypercarbia group had a significant lower forced expiratory volume in one second (FEV1) and a combination diagnosis of emphysema or asthma and congestive heart failure. An implication to the clinician is that identification of hypercarbia within COPD exacerbation is problematically difficult until the late signs are shown with the individual. By that time effective treatment patterns may have changed from the initial presenting problem. The author concludes that future areas of research within this field needs to lie within the community, and look at when these people start the exacerbation, what leads them to progression presentation to the emergency department, and whether these people are chronic sufferers of hypercarbia or presenting after a period of days exacerbation within their own home.

Abstract: This observational study analyses the responses of 38 nurses from two similar units that use different patient handling systems to test the reliability and validity of the Safe Patient Handling Survey (TM) SPH Survey(TM), a perception survey and improvement tool for employees and employers. Currently there is a lack of tools for evaluating patient handling systems. The survey contains 55 questions divided into 6 clusters, staff and patient injury and violence questions, and picture questions depicting unsafe techniques. The data were analysed to see how the SPH Survey(TM) scores correlate with incidents, and its ability to detect differences between the two units. The results of the Pearson and Cronbach(TM) alpha tests show strong reliability, validity and consistency of the SPH Survey(TM). ANOVA comparison of means and Spearman(TM) rho tests shows that higher (better) scores on the SPH Survey(TM) clusters correlate with lower numbers of patient injuries, lower reports of verbal and physical violence episodes, and lower staff injuries. Differences were detected between the units with Unit 2 scoring higher than Unit 1 in all SPH Survey(TM) clusters and scoring lower in staff and patient injuries and violence incidents. Although the analysis was limited by the small sample size, the study has created a sound basis for further investigation. The SPH Survey(TM) is shown to be an easy way to reliably evaluate patient handling systems and workplace culture, target improvement initiatives, and continually monitor the level of patient handling risk in the workplace. Low-risk patient handling gives health care providers the means to focus on delivering high quality patient care, without endangering their own health and well-being.

Abstract: This study explored what some New Zealand families believe constitutes the successful management of unsupervised childcare. It was designed to increase social understanding and practitioner knowledge of the issue by exploring families' beliefs, practices and perspectives. The researcher was concerned with the professional role nurses may play with this group of children. A qualitative descriptive approach was used to obtain a straight description of successful unsupervised childcare, using the everyday language of the participating families. Data was collected in semi structured interviews with five family groups, and subjected to content and thematic analysis. Findings suggest unsupervised childcare is both choice and solution, though parents are fearful of the legal and social consequences of using it. Context of the care is important, with the child's preference, community context and availability of adults through distal supervision critical components of its success. Trust between parent and child, the use of rules and boundaries to regulate child behaviour, the teaching of skills and strategies to build child competency, and parental support of children while unsupervised are identified by parents as factors linked to success. Parents identify increasing child independence and self responsibility as positive outcomes from the successful use of unsupervised childcare. This study has helped to identify positive factors resulting in good outcomes from which successful interventions could be developed, provides information that will be of particular interest to practitioners and policy makers, and provides a platform to launch larger studies into the issue of unsupervised children.