Abstract: This thesis represents an appreciative enquiry to identify features of effective verbal communication between nurses and patients. Using a method developed by the Language in the Workplace Project (Stubbe 1998) two nurse participants recorded a small sample of their conversations with patients as they occurred naturally in clinical practice. These six conversations constitute the main body of raw data for the study. The data was analysed using a combination of discourse and ethnographic analysis. Experience in nursing, particularly insider knowledge of the context of district nursing, helped me to uncover the richness of meaning in the conversations. The subtle interconnections and nuances could easily have been missed by an outside observer. The study has shown that in their interactions with patients, expert nurses follow a pattern in terms of the structure and content of the conversations and it is possible to identify specific features of effective nurse-patient communication within these conversations. The most significant of these are the repertoire of linguistic skills available to nurses, the importance of small talk and the attention paid by nurses to building a working relationship with patients, in part, through conversation. The findings have implications for nursing education and professional development.

Abstract: This thesis uncovers a personal journey of reflective practice, focusing on the author's emerging role as a nurse facilitating transitions using a dialectical approach in the context of a private nursing practice. Transitions encompass: life changes, loss, and adjustment to changes in function. Dialectical nurse facilitation of transition (DNFT) is a way of exploring self in the transitional space between “the no longer and the not yet”. In this facilitated process people potentially discover paradoxes, tensions, and creative energy, as they search for a way forward. The research design details a dialectical heuristic quest through journaling and reflecting on practice supervision and peer review, over a two year period. Exemplars written after reflecting on case notes reveal the lived experiences of participants. These case reviews show the complexity of patterns for people undergoing transitions and nurse facilitation. A relational pattern for DNFT encompasses compassionate engagement, catalytic mirroring, and interconnectedness. An exploration of literature encompasses nursing theories, facilitation, dialogue, loss, grief, spirituality and transition. This thesis provides a basis for evaluative research on the effectiveness of DNFT in health care settings in the future. Discussions regarding the expansion of these reflective and praxis genres are included which may be of interest to nursing education and practice contexts.

Abstract: This article describes the development, delivery and evaluation of a pilot programme designed to help nursing and midwifery students from Asian and non-English speaking backgrounds improve their conversational skills in practice settings. Many such students, although previously assessed as competent in English, find that communication with patients and their families, and other health professionals is difficult. The study was conducted in a large tertiary educational institution in a major metropolitan centre. Each week for a period of 11 weeks students participated in an interactive session. Content for these was based on areas highlighted by a needs assessment involving interviews with both students and lecturers, and was subject to ongoing modification in response to feedback from participants. Evaluation questionnaires completed at the conclusion of the series indicated that students perceived the impact as positive. Students who attended regularly and were actively involved in the practice activities described gains in communication skills. From this it was concluded that further development of the pilot scheme was warranted in order to benefit English as an additional language (EAL) students enrolled in nursing and midwifery courses

Abstract: The transition of patients from intensive care to the ward environment is a regular occurrence in intensive care. Today patients are often transferred earlier and sicker due to the demands for intensive care beds. This results in patients with higher acuity being cared for in the wards. Here ward nurses have to meet the ongoing complex demands of caring for higher acuity patients, alongside managing high patient-to-nurse ratios, staffing concerns, and varying levels of experienced nurses. This research explored the experiences of ward nurses receiving patients transferred from intensive care. The aims were to identify any areas of concern, highlight specific problems that occur on transition and to address what information is pertinent to ward nurses when receiving patients from intensive care. A qualitative descriptive methodology using focus groups was utilised to gather information about these experiences. Three focus groups were held with ward nurses from various wards within the study setting hospital. All participants had considerable contact with intensive care and were familiar with the processes of transferring patients. Five themes emerged from the focus groups – Patients as intensive care staff say they are; Time to prepare the biggest thing; Documentation as a continuation of patient care; They forget what its like; and Families, a need to know about them. The theme Patients as intensive care staff say they are relates to reliable information sharing focused on the patient, their needs and condition. Participants expressed their concern that patients were not always in the condition that the intensive care staff stated they were on the referral. Having adequate time to prepare was considered important for the majority of ward nurses receiving patients from intensive care. Documentation was highlighted in the theme Documentation as a continuation of patient care particularly in relation to fluid balances and vital sign history. The theme They forget what its like suggests there is a perception that intensive care nurses have a lack of understanding of what the ward staff can actually manage. Decreased staffing levels during certain shift patterns and a lack of appropriately experienced staff on the wards is a common concern for ward nurses. Ward nurses also recognised that caring for families was part of their role. Patients and families may respond differently to the transfer process and their inclusion in transfer planning was seen as essential. Communication was a reoccurring element throughout all themes.The author concludes that communication is the paramount factor that impacts on a 'smooth transition' for ward nurses. A 'smooth transition' refers to the transfer of patients from intensive care to the next level of care. Subsequently, nurses' perceptions need to change, whereby transfer planning from ICU should be the focus rather than discharge planning. Transfer planning and education for all nursing staff is vital if the transfer process is to be improved. Consequently, transitional care within the context of ICU aims to ensure minimal disruption and optimal continuity of care for the patient. The knowledge gained from this research may provide better understanding of the multifaceted issues linked with transitional care that may be adapted for a wider range of patients in various clinical environments.

Abstract: This paper describes an attempt at effecting change with specific relevance to the discharge planning of clients from a New Zealand inpatient mental health unit to a community setting. It explores how a team of community mental health nurses, practising in an urban/rural area, used the concepts of practice development to endeavour to bring about change while still retaining a client-centred focus. It describes how, in their enthusiasm, they embarked on the road to practice change without undertaking some of the essential ground work, Although they did not achieve all they set out to achieve, much was learnt in the process. In this paper, the authors outline their key learning points concerning the importance of engagement, communication, consistency and cooperation to the process and outcomes of practice change.

Abstract: This paper reports a study to investigate the roles and experiences of nurses caring for clients undergoing assisted reproductive technologies (ART). Nurses are in a potentially unique position in the assisted reproductive technology environment as they maintain a more constant contact with the client. A qualitative approach was taken and a convenience sample of 15 nurses from New Zealand was interviewed in 2005. Data were analysed using interpretive description. The overarching theme identified was that of the potential role of the nurse to 'hold together' multiple components of the assisted reproductive technology process: holding together clients' emotional and physical experiences of assisted reproductive technologies; holding together the roles of different specialist team members; and holding together personal own emotions. It encompasses practices such as information-giving, interpreting, supporting and advocating. The researchers note that recognition of and support for the complexity of the role of ART nurses may positively contribute to clients' experiences.

Abstract: Reports findings from semi-structured interviews with 6 nurses and 7 women patients at a sexual health clinic where the women reported positive experiences of speculum examinations. Combines data with that from interviews with 16 patients and 16 clinicians regarding positive examinations, and analyses data to identify which clinical communication strategies were used, and how the women responded. Highlights the legacy of the Cartwright Report of the Cervical Cancer Inquiry of 1987/88.

Abstract: Introduces the Clinical Communication Assessment Framework (CCAF), adapted by Nelson Marlborough Institute of Technology from communication assessment guidelines developed in Australia to assess nursing students' English language proficiency. Uses this framework to assess nurses, before the competency assessment programme (CAP) four-week clinical nursing placement, for the first time in NZ.