Abstract: The aim was to report on implementation of a nursing initiative of cardiovascular disease (CVD) screening risk assessment at the Mornington Health Centre, Dunedin, with initial outcomes after six months. The practice aim was 80% of their eligible population assessed within three to four years, particularly targeting high-risk groups. The audit indicates that in their first six months, Mornington Health Centre had screened 42% of their eligible patients. This is described as very successful progress towards their goal of 80%. A number of key organisational factors are identified that are likely to have contributed to the development and success of the nurse CVD risk assessment programme at Mornington Health Centre. The authors suggest that this case study demonstrates how organisational change, where the practice nurse role in the multidisciplinary team is clear, can facilitate a practice to meet a population-based goal.

Abstract: This article provides an overview of gastric cancer using a unique case study involving a Maori family genetically predisposed to diffuse gastric cancer. The pathophysiology of diffuse gastric cancer, including prognosis, diagnosis, and treatment, along with important patient considerations is highlighted.

Abstract: Current New Zealand health policy encourages collaborative health promotion in all sectors of health service delivery. The integrated approach to the acute management of coronary heart disease in a coronary care unit, combining medical therapy and lifestyle change, supports clinical health promotion. The aim of this study was to use the grounded theory approach to discover the main concerns of nurses' promoting health in an acute coronary care setting and to explain the processes that nurses used to integrate health promotional activities into their practice. Seventeen registered nurses from three coronary care units within a large metropolitan city in New Zealand were interviewed. Data were constantly compared and analysed using Glaser's emergent approach to grounded theory.The main concern for nurses promoting health within coronary care was ritualistic practice. In this study, ritualistic practice concerns the medically-based protocols, routines, language and technology that drives nursing practice in coronary care. This concern was resolved via the socio-cultural process of attitudinal shifting that occurs over time involving three stages. The three conceptual categories, environmental pressures, practice reality and responsive action are the main components of the theory of attitudinal shifting. In environmental pressures, nurses experience a tension between specialist medically-dominated nursing practice and the generalist nursing role of promoting health. In practice reality, nurses become aware that the individual needs of patients are not being met. This causes role conflict until the nurse observes colleagues who role model possibilities for practice, working with patients to promote health. Responsive action sees the nurse engaging in self-development, also focusing on the nurse-patient relationship, thereby enabling active patient involvement in individual health-promoting decisions. The author suggests that the findings from this research have implications for nursing practice and education. With the increasing specialisation in nursing practice, these findings may be of interest to nurses working in delegated medical roles where the reality of everyday practice precludes nurses from undertaking their essential nursing role. Health care facilities also need to ensure that there are opportunities for the personal and professional development of nursing staff. The place of health promotion within nursing undergraduate curricula needs to be examined, as many nurses found that they were ill prepared for undertaking health promotional activities.

Abstract: This literature review explores some of the issues related to women's experience of cardiac rehabilitation and demonstrates that women's experience may be different to that of men. Much of the research related to coronary heart disease (CHD) has been performed using either exclusively male populations or such small numbers of women that the results from the women studied were unable to be analysed independently. The author advocates that nurses working within this area of practice require an understanding of women's experience of recovery from a heart attack in order to better meet their needs.

Abstract: The research aim was to explore women's perceptions of living with endometriosis, its effects on their lives and the strategies used to manage their disease. A qualitative research design informed by feminist research principles was chosen for this project. Eighteen women agreed to take part in the research. The individual, audio taped interviews were semi-structured and interactive. The interviews were analysed using a thematic analysis approach. The dominant feature of data from the interviews was the experience of severe and chronic pain impacting on all aspects of life. Analysis related to pain resulted in four themes: manifestations of pain, the pain trajectory, intractable pain and controlling pain. The diagnostic process typically took 5-10 years indicating that primary health care practitioners need higher levels of 'suspicion' for this condition. Case studies and problem-based scenarios focusing on endometriosis in health professional education programmes would enhance diagnostic skills and knowledge development. No formal pain management follow up after diagnosis and treatment meant women actively sought information from other sources as they made major lifestyle changes in the areas of activity and nutrition. Pain management services specifically for women with endometriosis would provide much needed support with this neglected aspect of the disease. The authors conclude this is an area for the development of the nurse practitioner role which, also drawing on the considerable collective expertise of women with endometriosis, could provide significant information and support for women as they manage this highly complex condition.

Abstract: The public health nurses present a case study on adapting meningococcal disease public health protocols to work with the situation of a Cook Island family following the death of a member from meningococcal disease. They discuss the meningococcal disease epidemic in New Zealand and outline the signs and symptoms of the disease.

Abstract: This article describes a study conducted on the internal medicine, general surgical, and vascular wards of a large metropolitan hospital to assess the impact of a networked monitoring system and portable patient monitors. This pilot study was developed to address the needs of hospital patients who require continuous non-invasive vital signs monitoring (including heart rate, non-invasive blood pressure, pulse oximetry, cardiac waveform monitoring) with the addition of surveillance from a cardiac intensive care area. Data were collected from 114 patients over a three-month period to identify a patient group that could be managed appropriately under the new system and to determine the effect that flexible monitoring had on patient care management. Findings include identification of a specific patient group that can be managed successfully outside the cardiac intensive care area using this system. Other findings suggest a way to improve the management of patient monitoring in the general ward areas.

Abstract: This reports an audit of the assessment practices at Christchurch Hospital, compared to international guidelines. The clinical notes of all patients who were re- admitted acutely with chest pain within six months of PCI procedures performed between 1/4/05 and 30/9/05 were audited. Ethics approval was granted and an audit tool was designed based on the 2000 ACC/AHA Guidelines for the management of patients with unstable angina. The purpose of the audit was to determine to what extent best practice guidelines were followed in the assessment of patients re-admitted with chest pain and to determine if there were any indicators (lesional, procedural or risk factors for restenosis) that predicted a normal or abnormal repeat coronary angiogram. 448 consecutive patients had PCI procedures, 36 patients represented acutely with chest pain and had repeat coronary angiography. In 18 patients the coronary angiogram was unchanged, 11 patients demonstrated instent restenosis, one patient demonstrated thrombus and six patients developed new lesions. The authors concluded that at Christchurch Hospital assessment practices are consistent with international guidelines. Of the patients who had repeat angiography, 50% had no coronary obstruction for the cause of pain. There was a relatively low incidence of acute representation with chest pain. These results suggest a revision of the guidelines for repeat angiography following PCI is warranted.