Abstract: A qualitative framework was used to explore the nature and the quality of interactions between sole on-call primary health care rural nurses and secondary care doctors as a component of rural nursing practice and representative of the primary-secondary care interface. Crucial to patient centred care, the premise was that the quality of this interface would be variable due to multiple influences such as: the historical nurse/doctor relationship that has perpetuated medical dominance and nursing subordination; current policy direction encouraging greater inter-professional collaboration; and changing role boundaries threatening traditional professional positioning. A total of 11 nurses representing 10 separate rural areas participated in semi-structured interviews. Rural nurses typically interact with secondary care doctors for acute clinical presentations with two tiers of interaction identified. The first tier was presented as a default to secondary care doctors for assistance with managing primary care level clinical presentations in the absence of access to a general practitioner or an appropriate Standing Order enabling appropriate management. The second tier presented itself as situations where, in the professional judgement of the nurse, the client status indicated a need for secondary level expertise and/or referral to secondary care. The needs of the rural nurse in these interactions were identified as access to expertise in diagnosis, therapy and management, authorisation to act when intervention would exceed the nurse's scope of practice; the need to refer clients to secondary care; and the need for reassurance, encompassing emotional and professional issues. The quality of the interactions was found to be variable but predominantly positive. Professional outcomes of positive interactions included professional acknowledgement, support and continuing professional development. For the patient, the outcomes included appropriate, timely, safe intervention and patient centred care. The infrequent but less than ideal interactions between the participants and secondary care doctors led to professional outcomes of intraprofessional discord, a sense of invisibility for the nurse, increased professional risk and professional dissatisfaction; and for the client an increased potential for deleterious outcome and suffering. Instead of the proposition of variability arising from interprofessional discord and the current policy direction, the data suggested that variability arose from three interlinking factors; appropriate or inappropriate utilisation of secondary care doctors; familiarity among individuals with professional roles and issues of rurality; and acceptance by the primary care doctor of the sole on-call primary health care rural nurse role and the responsibility to assist with the provision of primary health care. Recommendations for improving interactions at the interface include national, regional and individual professional actions.

Abstract: A qualitative study of factors affecting four registered nurses participating in continuing education.Data was collected through unstructured interviews and then analysed using themetic analysis The data revealed that the nurses had ambient feelings towards the benefits of post registration nursing education and that these were many work related, supervisal, and financial and logistial barriers affecting their ability to participate in further study. The nurses were also disturbed and frustrated by a lack of clinically based programmes for them to attend. Implications from this study are discussed and recommendations are presented

Abstract: A report prepared in association with the Nursing Subcommittee of the North Canterbury Geriatrics Advisory Committee

Abstract: A research portfolio submitted in partial fulfilment of the requirements for the degree of Master of Nursing, The University of Auckland, 2009
This paper is a report of a study seeking to understand the experience of New Zealand rural dwelling Mäori clients with end-stage renal disease who receive haemodialysis. End stage renal disease (ESRD) is related to lifestyle, genetic factors and environment, and Mäori are at higher risk of renal disease which results of need for renal replacement therapy to sustain their lives. Dialysis clients are a group of ?silent? clients under the care of the dominant health professionals. Adherence with therapeutic regimes has been a main issue for health care professionals and service delivery, as it directly contributes to the efficacy of the treatment and cost effectiveness. Mäori clients? experience of living with haemodialysis has not been explored. Although there are a number of studies describing the experience of patients living on dialysis so far, no studies have yet focused specifically on the experience of Mäori clients towards their renal replacement therapy. The continual demands of dialysis treatment are significant and given the high proportion of Mäori having dialysis. It is timely to explore the experience of Mäori clients and their family/whänau in order to understand the need for quality of care and to promote Mäori health outcomes in chronic kidney disease management

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: A review of the current status of midwifery in NZ and potential for its' development

Abstract: A simple descriptive longitudinal survey monitoring self- reported incidence of satisfaction/ dissatisfaction to nine job related factors. The two hundred RN's participating in the pilot implementation of the Clinical Career Pathway (Canterbury Area Health Board) were surveyed in June 1992 and February 1993. This was a time of change in New Zealand's Health service