Abstract: As has been the case internationally, deinstitutionalisation of dual diagnosis (intellectual disability and mental illness) services has also occurred in New Zealand. Inpatient services have been redefined to respond to the more acute focus that has arisen out of this deinstitutionalisation process and nurses are having to redefine their roles in response. This study was undertaken to explore and describe the culture of nursing practice in a dual diagnosis inpatient unit in one psychiatric hospital. A focused ethnographic approach was used to triangulate data gathered from fieldwork observations, review of documents and semi-structured interviews. Schein's (1985) levels of culture model, was used to identify and explore the artifacts, values and assumptions evident in this nursing practice. Analysis presents three key themes categorised as 'communication', 'assessment' and 'safety'. While these key themes are shown to be evident in the everyday practice of the nurses, how these relate to the notion of 'dual diagnosis nursing' is not clear. Therefore, the author describes the major finding of this study as revealing a nursing culture holding tight to traditional psychiatric and psychopaedic nursing practices and struggling to develop a distinctive culture in the absence of a defined dual diagnosis knowledge base. The author concludes that these findings suggest an urgent need to provide nurses with support in gaining contemporary knowledge regarding dual diagnosis nursing. Support for nurses in advancing these areas then impacts on support for the patients. It is suggested that additional research is undertaken to assess the learning needs of the nurses in order to develop clinical practice guidelines for this area. Further recommendations are made to address system issues which are contributing to the gap in knowledge.

Abstract: Identifies key factors senior perioperative nurses consider when making decisions about nurse staffing and skill mix in the operating room (OR). Uses a qualitative descriptive approach in undertaking semi-structured interviews with 7 senior nurses tasked with decision-making about OR staffing. Analyses the data using Braun and Clarke's thematic analysis process.

Abstract: Sense-Making, a qualitative research method, was used to obtain and analyse data from interviews with 10 registered nurses, in order to study reflective thinking in actual nursing practice. Ten non-routine nursing situations were analysed for the presence of reflective thinking. Reflective thinking was extensively manifest, especially in moments of doubt and perplexity, and consisted of such cognitive activities as comparing and contrasting phenomena, recognising patterns, categorising perceptions, framing, and self-questioning in order to create meaning and understanding. Self-questioning was identified as a significant process within reflective thinking. By exploring and analysing the type of questions respondents were asking themselves, the study uncovered three hierarchical levels of reflective thinking, focussed on action, evaluation and critical enquiry. The findings of this study resulted in the development of a model of reflective thinking, which is discussed in terms of the implications for learning in nursing practice.

Abstract: The New Zealand emergency department (ED) nurse is faced daily with the challenge of caring for patients of all ages with a wide variety of presenting complaints. Courses are available for ED specialty work such as trauma and paediatric assessment. However, this thesis argues, it is difficult to access updated and ongoing education in relation to caring for people with mental health problems who present to the emergency department. In addition to this education deficit, are the challenges of providing care in an overcrowded ED environment. The author goes on to say that such factors contribute to a perceived lack of confidence and sometimes ambivalence or frustration on the part of nursing staff in caring for this group. This may result in an inconsistent standard of care for the person with a mental health problem unless such issues are addressed. The aim of this research paper was to explore the education needs of ED nurses when caring for people with mental health problems. A literature review was undertaken to investigate the broad education strategies available to overcome these challenges. Diverse approaches were identified such as workshops, clinical guidelines, and mental health consultation-liaison roles. Research was also identified that examined ED nursing attitudes and their learning needs in relation to mental health. This paper concludes with a discussion of recommendations for the New Zealand setting with the intention of developing a more confident and competent nursing workforce, who are better prepared to care for the person with a mental health problem.

Abstract: The author notes that many registered nurses undertake a role in the community which may or may not be recognised for what it really is – one of these roles may be that of the unpaid health care provider. The nurse may be called on by family, friends, neighbours, or the wider community to provide a voluntary health service at any time of the day or night according to the need of the person wanting the information or assistance. This is the story of one such nurse. Four themes have been uncovered from a nursing practice that has spanned three decades of providing an on-call basic first aid service to a community of about two hundred households in a rural community. These experiences are used to shape the stories within the story of this voluntary role, and provide a framework to discuss the implications for the future of voluntary practice.The themes are: Maintaining personal and professional boundaries; Maintaining values and a high standard of care; Commitment to ongoing education; Accepting accountability for one's actions. The confidence and competence that such practice demands is explained from a personal perspective, along with an attempt to answer a question that is often asked – “Who will or indeed does anyone want to replace me when I retire or shift away from the district?” This question is addressed in the context that this story is written, the changes that the healthcare system is experiencing at present, and the impact that these changes may have for the future.

Abstract: This thesis is a theoretical exploration of the concepts of 'Compulsive caregiving' and 'helping profession syndrome' in relation to the choice of nursing as a career. These concepts are derived from Bowlby's attachment theory and psychodynamic psychotherapy. Both have evolved from psychoanalytic theory. The thesis explains Bowlby's development of compulsive caregiving in health professionals. The author notes that her life history and experience as a nurse educator and as a nurse practicing psychotherapy support this theoretical explanation. An argument is developed that the propensity towards compulsive caregiving is a strength in nurses. Nursing places high value on caring and many of the traits exhibited by compulsive caregivers are desirable in nurses. Nursing as a caring interpersonal process is explored with reference to the literature. However, nursing has been identified as a stressful occupation. Support strategies such as professional supervision and reflective practice are discussed. Thesis concludes with a suggestion for further research on compulsive caregiving and helping profession syndrome.

Abstract: Describes an innovative solution to designing meaningful learning activities as substitutes for clinical placements in primary health care settings, in which student nurses focus on collaborative learning in a virtual team. Backgrounds their participation in a project focusing on disaster nursing preparedness and management of the sequelae associated with a disaster, particularly the COVID-19 pandemic. Notes how e-learning short courses contributed to student preparation for clinical practice acting as substitutes for clinical experience.

Abstract: Examines whether the Family Partnership model could be considered a model for cultural responsiveness while simultaneously providing a platform for more accurate assessment of the cultural competence of Plunket nurse practice. Determines the relationship between Family Partnership training for Plunket nurses and Maori child health outcomes. Distributes an online survey to Plunket nurses who had completed the training and to a group who had not. Conducts 10 observations and interviews with Plunket nurses and Maori clients. Presents the findings in three areas: Plunket nurse practice, client experience, and the impact of Family Partnership training on Plunket as an organisation.