Abstract: The author presents an overview of the impact and management of novovirus infections in New Zealand. The impact of this highly contagious virus on hospital settings is serious. With staff shortages already a problem, any outbreak of contagious disease has the potential to result in unsafe staffing, either through low numbers or poor skill mix. A report from New Zealand Environmental Science and Research (ESR) showed 35 reported norovirus outbreaks in New Zealand in the first quarter of 2004, resulting in 890 cases of the disease. Norovirus outbreaks are characterised by a rapid spread of infection, high uptake rate, and a high proportion of cases presenting with projectile vomiting. The author provides a definition of the novovirus, and looks at transmission, the management of hospital outbreaks, and the impact on emergency departments and hospital wards. Procedures include in-patient isolation. She notes there are no simple answers or “quick fixes” to the problem of norovirus outbreaks. While ongoing surveillance, recognition and isolation are key elements, there are wider structural and political implications that need to be acknowledged. These issues include overcrowding and staff shortages.

Abstract: The aims of the study were to provide a deconstructive analysis of the concepts of risk and risk management, and to explore the historical context of mental disorder and the concept of risk, the clinical context of risk assessment and management, the cultural, political and economic context of risk, and the impact on mental health nursing and consumers of mental health services. This is undertaken by providing a critical review of the history of mental illness and its relationship to risk, examination of government policy on clinical risk management, analysis of a risk assessment model and a discussion of the political and economic factors that have influenced the use of risk assessment and management in clinical practice. The concept of risk and its assessment and management have been employed in the delivery of mental health services as a form of contemporary governance. One consequence of this has been the positioning of social concerns over clinical judgement. The process employed to assess and manage risk could be regarded as a process of codification, commodification and aggregation. In the mental health care setting this can mean attempting to control the actions and behaviours of consumers and clinicians to best meet the fiscal needs of the organisation. The authors conclude that the mental health nursing profession needs to examine carefully its socially mandated role as guardians of those who pose a risk to others to ensure that its practice represents its espoused therapeutic responsibilities.

Abstract: Pain management practices within emergency departments require a more patient focused approach due to extended waiting times for analgesia. This dissertation questions current methods of providing timely and appropriate delivery of analgesia. Nurses represent the biggest resource in emergency departments therefore are in a position to be able to access patients in a timely fashion. A review of the literature pertaining to nurse initiated analgesia protocols has been evaluated and information relating to efficiency and safety utilised to discuss the processes for planning and implementation of a similar protocol. The author finds that the literature provides no evidence that nurse initiated analgesic practices prior to medical assessment compromises patient safety or delays diagnosis. A discussion of the benefits to patients, nurses and the institution has been included to highlight the appropriateness of extending nursing roles.

Abstract: Investigates the logistics and acceptability of an electronic medication dispenser (EMD) within a home-based medication management service as a substitute for face-to-face home visiting, as a means of reminding elderly clients to take their medication on time. Uses a qualitative usability study methodology to conduct the study, centred on a small group of clients receiving the service from a small group of clients receiving the service from a community nursing organisation in Christchurch. Involves patients, pharmacists, nurses and managers of the community nursing service. Identifies critical processes and protocols required to safely support a wider roll-out of the product within the service.

Abstract: Explores the role of family/whanau on self-management of end-stage renal disease (ESRD). Conducts semi-structured interviews with 7 haemodialysis patients, of which 5 were Maori, about their perspectives on whanau's role. Highlights 3 themes: whanau support, whanau importance and whanau hindrance.

Abstract: Evaluates the SIP/PIP process to illuminate the views of the nurse managers and preceptors on the effectiveness of the SIP/PIP programme in ensuring competent practice and provides recommendations for improvement and strengthening of the framework. Uses a qualitative approach with data collected through individual semi-structured interviews with preceptors and nurse managers. Due to lack of participation in the quantitative arm a mixed-method study was not completed using an anonymous survey. Undertakes thematic data analysis utilising NVIVO 10 software. Draws four major themes from the qualitative data: (1) Feedback- insight loop, (2) Process clarity, (3) Relationships, commitment & reflective response to participation in the SIP/PIP process, (4) Barriers and enablers to the SIP/PIP process.

Abstract: Considers whether the education component in a pulmonary rehabilitation programme (PRP) influences health outcomes for patients with chronic obstructive pulmonary disease (COPD) patients. Performs an integrative review of literature to integrate results from qualitative, quantitative and mixed-methods articles. Highlights the following concepts: disease knowledge, knowledge in relation to self-management, and the relationship between knowledge and education.

Abstract: An essential part of nursing practice for the nurse on the surgical floor is to relieve the discomfort of post operative pain for patients in their care. Post operative pain management encompasses a series of processes from assessing pain, providing relief, assessment of measures used to relieve pain through to documentation in the patient record. Yet literature, both internationally and from Australia and New Zealand, suggests that post operative pain continues to be poorly managed despite having the means to provide more than adequate relief. Events leading up to the commencement of this study indicated that locally, post operative pain assessment, including documentation in the patient record may be substandard. The objective of this study was to develop and test an audit tool; undertake a retrospective audit of nursing records, including nursing notes and the nursing care plan, in respect of what postoperative pain assessments nurses document in the patient record; evaluate data and make recommendations for practice. Methodology: A five part, 23 question Likert scale audit tool, designed specifically for this study was used to collect data over a period of two months. In total 40 patient records that met the inclusion criteria were audited.The results indicate that local practice reflects poor documentation standards found in other studies. The most complete recordings were those entered on specifically designed charts such as the Patient Controlled Analgesia and Epidural charts (N 28) but this did not carry over into the patient record. Despite that fact that the patient's self reports of pain is said to be the single most reliable indicator of pain, there was only four occasions when the patient's verbal response to pain was recorded. None of those responses were according to any type of pain rating scale. Evidence of evaluation following measures used to relieve pain was more likely to be recorded if pain was poorly controlled or when side effects such as nausea were experienced by the patient. The author concludes that overall the audit has highlighted many gaps in what is or is not recorded in the patient record in respect of post operative pain assessment and has highlighted the need to develop standards of practice that will improve post operative pain management practices.