Abstract: Registered nurses in residential aged care work with older people who have complex care needs. Besides providing direct care, these nurses have a wide range of responsibilities which include supervising staff and attending to the smooth running of the care facility. This grounded theory study using dimensional analysis was aimed at answering the question: How do registered nurses organise their work? Indepth interviews were conducted with 10 registered nurses who worked in a range of positions in aged care facilities. Theoretical sampling and constant comparative analysis was used to guide both ongoing data collectiona and data analysis. Categories were examined for their relationships and dimensions to arrive at a substantive grounded theory which the author has named 'shifting focus'. Individual and institutional philosophies of care were core elements in the registered nurses' focus of work. There was a relationship between staffing adequacy, individual and institutional philosophies of care, and the focus of registered nurse work. These relationships created conditions where the registered nurse would focus on ensuring the delivery of individualised resident care or focus on getting through the routine of care. The relationship between staffing adequacy, philosophies of care and the registered nurses' focus of work remained consistent when staffing adequacy changed. In instances of decreased staffing adequacy, the participants' focus shifted to either maintaining individualised care or focusing on safety. When the registered nurse aimed to change the philosophy of care, an increase in staffing adequacy enabled some aspects of cultural change to commence. The relationships between residents, family and staff were significant contrasting elements within an individualised philosophy of care, and an institutional philosophy of care. In the former, relationships were valued and developed. In the latter, they were benevolent, functional or conflicted. The significance of this study is that it reveals how registered nurses and management personnel in aged care facilities, can create conditions where the relationships between residents, their families and staff, are valued and developed to result in positive care outcomes. It is recommended that future research be conducted to examine the resources required to maintain an individualised approach to the nursing care of residents in aged care facilities.

Abstract: This thesis explores the nature of the emergency department environment as it continues to challenge emergency nurses to meet the health needs of an increasingly complex emergency department population. The emergency nurse is also facing conflict and challenge with regard to workplace safety and patient rights. The author suggests that, until recently, very little debate or consideration has been given to the moral dilemmas raised in the ability of emergency department staff to deliver timely and appropriate care in an overcrowded environment. She goes on to say that, in New Zealand, there is no national consistency with regard to the waiting crisis, no national guidelines and no national consensus putting the emergency nurse at risk. This thesis argues the need to acknowledge waiting times as a significant safety issue at a national level as increasing waiting times continue to impact on patient outcomes and nursing practice. It challenges current practice, in particular the role of the emergency nurse and the potential to legitimise expansion of the role to improve the patient experience of waiting in the emergency department.

Abstract: This report presents an evaluation of the implementation of a best practice information sheet related to tracheal suctioning of adults with an artificial airway. The Centre for Evidence-Based Nursing Aotearoa, based in Auckland, conducted a systematic review of the evidence and produced the best practice information sheet. A survey of 105 nurses was conducted at three sites, in New Zealand and Australia. Using a before/after design, data were collected at the time of release of the information sheet and then approximately 12 months later. The study suggests a trend towards a modest uptake of best practice recommendations into nursing practice demonstrated by some behavioural changes within a 12-month period in the context of an implementation plan and the best practice information sheet.

Abstract: This paper focuses on the work of primary health care nurses on chronic conditions, through both formal chronic care management (CCM) programmes and informal work. The author overviews the key components of CCM and describes Care Plus, a funding stream accessed via PHOs. The author gives examples of nurse led clinics and programmes in the general practice environment, and outlines the structures and processes necessary. A table summarises nurse involvement in several PHOs throughout the country. The author finds that the role of PHC nurses within a framework of inter-disciplinary chronic condition care is diverse and increasing.

Abstract: The objective of this research was to determine aspects of hospice based palliative care which patients described as being important and valued. This research is to be the basis of future work on the development of consumer generated quality indicators. Palliative care managers could use these to evaluate hospice based care, and provide output measures for health providers. The methodology used by the researcher was qualitative descriptive informed by phenomenology. Six recently discharged hospice patients who had at least two episodes of palliative care were interviewed about their experience of care. The resulting data, after reflection, formed a representation; the circle of care. This included aspects of valued care generated by actions of the interdisciplinary staff, and other aspects of care generated within the palliative care environment which the patient perceived as being meaningful and important. In conclusion, the reality of people receiving palliative care is characterised by a number of supportive traditional and non-traditional aspects of caring. Although some characteristics have been described within general health and the palliative care literature, some appear to have been generated by these particular participants as part their reality. The researcher believes that the resulting representation of care requires further research in other palliative care settings. The process of interviewing terminally ill people although not without concern to the interviewer, and inherently difficult for the patients, appeared to allow the patient to tell the story of both their illness and care

Abstract: Mobile computing is rapidly becoming a reality in New Zealand health care settings. Personal Digital Assistants (PDAs) are the most frequently used of these mobile technologies, giving nurses access to clinical learning resources, including drug references, medical encyclopaedias and diagnostic information. The implementation of mobile computing at Waikato Institute of Technology (Wintec) will ensure graduates of our Bachelor of Nursing Programme are able to meet health care service demands for knowledge in contemporary information technologies as well as the information technology requirements defined by the Nursing Council of New Zealand and the Health Practitioners Competency Assurance Act 2003 for registration as a nurse in New Zealand. This paper presents strategies for the implementation of mobile computing as a core element of the curriculum for the Bachelor of Nursing Programme at Wintec in Hamilton.

Abstract: This study explored the potential for extending the contribution nurses make in managing patients with chronic kidney disease as they progress to end stage kidney failure. In the context of a shortage of nephrologists and an escalating patient population suffering from kidney disease, the potential to include advanced nephrology nursing in early disease management was postulated. The literature was reviewed with regard to initiatives to reduce the progression of kidney failure and the prevention of associated complications. Local and international literature on advanced nursing practice and the nurse practitioner role was examined in relation to the management of chronic kidney disease. The introduction of the nurse practitioner in New Zealand could provide an ideal framework for independent nephrology nursing. Well-established nursing practice in dialysis, transplantation and pre-dialysis provide distinct scopes of practice in these areas for independent nursing in the future. It seems likely that these sub-specialties in nephrology nursing will be the first to experience the value of the nurse practitioner. The creation of early interventionalist nurse practitioners in nephrology health care would allow nurses to step outside these well-established sub-specialties, and provide new resources to help manage chronic kidney disease. A model of care was proposed that outlines how a nephrology nurse practitioner could work collaboratively with community health providers and the local nephrology health care team to manage the early stages of kidney disease.

Abstract: The purpose of this qualitative study was to analyse the learning experiences of nine nursing students on clinical placement in New Zealand. The students were in their third and final year of their baccalaureate nursing degree. The study specifically examined what impinged upon their learning experience in the clinical venue. Data was obtained from interviewing the students, initially individually and finally in a focus group. Themes emerged through words and concepts as the data was analysed. The themes included powerlessness; marginalisation; the move from a holistic to a reductionist approach in care; the exploitation of minority students and the myth of praxis. Clinical practice was a time for nursing students to apply their knowledge to their practice, and to gain experience and confidence. Their clinical practice was normally a positive experience, but, each student spoke of the occasional negative episode. These left them with feelings of powerlessness and marginalisation. The Maori students felt exploited. The students were concerned about the lack of time to debrief at the end of the day, and to share their experiences with their educator and colleagues. The students' negative experiences were often the result of a clinical practitioner's high workload, under resourcing and the nurse educator's unavailability.