Abstract: In 1984 Mason Durie documented a framework for understanding Maori health, Te Whare Tapa Wha, which has subsequently become embedded in Maori health policy. This article presents a specific assessment framework, the Meihana Model, which encompasses the four original cornerstones of Te Whare Tapa Wha, and inserts two additional elements. These form a practice model (alongside Maori beliefs, values and experiences) to guide clinical assessment and intervention with Maori clients and whanau accessing mental health services. This paper outlines the rationale for and background of the Meihana Model and then describes each dimension: whanau, wairua, tinana, hinengaro, taiao and iwi katoa. The model provides a basis for a more comprehensive assessment of clients/whanau to underpin appropriate treatment decisions.

Abstract: This dissertation explores the assessment of nurses' clinical competence in the adult ICU setting. Specifically, methods for the assessment of competence are critiqued for their practical application to the novice nurse with less than six months experience in ICU. The assessment methods considered are continuous clinical assessment, self-assessment, peer review, objective structured clinical examination (OSCE), portfolio and computer assisted assessment. Several criteria are applied to the methods including the ability of each method to assess skills, knowledge and attitudes or values. Each method is critiqued for its implications in terms of cost and staffing resource, benefits and barriers to implementation. In addition, reliability and validity issues are considered for each method. The outcome of this exploration is the recommendation of a combination of methods; namely, portfolio and OSCE, for the assessment of competence in the ICU novice. The author concludes that this finding enhances current understanding within the ICU specialty of the multidimensional nature of competence assessment.

Abstract: Use of health assessment skills is undeniably part of everyday nursing practice, guiding nursing decisions and a part of facilitating patient outcomes. Undergraduate nursing education in New Zealand includes the use of health assessment skills within the context of nursing practice. The registered nurse working in their first year of practice is required to use effective assessment skills to identify potential risks to a patient's health, while learning to adjust to the many other demands of practice, but little research has explored these experiences. The purpose of this research study was to describe the experience of using health assessment skills within the first year of practice as a registered nurse. Using a qualitative descriptive method, informed by phenomenology, interviews were conducted with six newly graduated registered nurses working within a New Zealand setting. Findings of this study revealed that graduates endeavour to incorporate the skills of health assessment taught at undergraduate level into their practice. Six main themes of health assessment philosophy; tuning in; mobilising health assessment skills; recognition; anxiety; and identification and facilitation of outcomes can be aligned with Benner's (1984) model of skill acquisition. The author suggests that these research findings are useful to inform nursing education, clinical practice and further research. An awareness of these graduate experiences provides opportunities for nurses in both clinical practice and education to facilitate and support graduate nurses' of health assessment within their nursing practice.

Abstract: This study explores how registered nurses working within the acute surgical ward environment of a New Zealand hospital communicate changes in a patient's condition. The purpose of this research study was to examine the processes, communication techniques and behaviours that nurses use, in order to determine the critical requirements for registered nurses to effectively communicate changes in patients' conditions to doctors. The critical incident technique developed by Flanagan (1954) was adapted and used to explore incidents that occurred when six registered nurses working in acute surgical wards communicated a change in a patient's condition to a doctor. Communication is an integral part of everyday activity. This study has shown an assessment process occurs before communication can take place. A nurse's concern for a patient's condition initiates the assessment process. A judgement is formed from the nurse's concern that a patient's condition has changed. Judgements take into account multiple ways of knowing including pattern recognition, empirical knowing and intuition. Institutional protocols also affect judgements and the ability of a nurse to ensure support is received for the patient's well being. The communication process is initiated for two reasons, to support the patient, and to support the nurse in providing care for the patient. Significant in determining the need for support is the action required that might be outside the nurse's scope of practice. The response should address the nurse's concern and take into account the importance of the relationship, trust between all parties, respect of each other's positions and knowing team members and their capabilities. Understanding these aspects of the communication process should enhance nurses and doctors abilities to effectively communicate regarding a change in a patient's condition.

Abstract: The author reviews the report 'Fitness for Practice' by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) noting many areas of relevance for New Zealand educators in outlining possible strategies for nursing education. Discussion of some of the recommendations is put in the context of a strategic review of undergraduate nursing education recently commissioned by the Nursing Council of New Zealand. Issues such as recruitment and access to education; retention; clinical assessment and placements; clinical skill acquisition and partnership are valid concerns for educators here also. Internationally, the author suggests, the commonalties in issues of concern lend validity to the concept of the global village and the necessity for a global perspective in health care workforce planning, including educational preparation.

Abstract: Accurate nursing assessment is a critical element in the identification of health problems and treatment strategies for older adults who have delirium and/or dementia. This practice update provides information on the differentiation between these two debilitating and adverse health events, along with some useful assessment frameworks and other resources. Comments from people with delirium and dementia are interspersed throughout the article to draw attention to the impact of these conditions on people's lives and well-being. The article includes the 'A presenting concern framework', useful mnemonic devices to help nurses assess an older person who may have delirium or dementia, and a list of online resources.

Abstract: Clinical practice is an essential and integral component of nursing education. The decision-making process involved in student selection of clinical placements is influenced by a range of factors which are internal or external to students. As there was little research that explored these factors and the influence they have on student decisions, the author sought to investigate this further. A mixed-method approach was used, using a questionnaire and focus group interview, to give breadth and depth to the research. This study found that students are particularly influenced by previous positive experiences, or an interest in a particular area of practice. Their personality will also influence their placement decisions. Nurse preceptors and clinical lecturers also provide a key support role to students in the clinical environment.

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.