Abstract: Eighteen months after the first of many large earthquakes, Christchurch-based home health care provider Nurse Maude surveyed staff to identify the impact on the well-being of their mainly elderly clients. Responses from 168 staff identified five key issues. These were: mental health, anxiety, and depression, symptoms similar to post-traumatic stress disorder (PTSD); unsafe environments; loneliness and isolation; difficulty coping with change; and poor access to services. To meet the needs of clients in this challenging environment, staff felt they needed more time to care, including listening to stories, calming clients and dealing with clients who had become slower and more cautious. Damaged and blocked roads, and the fact that many clients moved house without warning, added to the time it took to deliver care in the home. This survey has helped Nurse Maude build on its initial post-earthquake responses to better meet the needs of clients and support health-care workers in this stressful environment.

Abstract: Case study research, as a qualitative methodology, attracts some criticism, especially related to rigour, reliability and validity. A New Zealand-based study that explored complex phenomena – flexible learning for postgraduate nurses – provides a practical example of how the case study design can address these criticisms. Through describing the mixed methods used, different sources and methods of data collection, and data analysis, the process of achieving data quality and trustworthiness are highlighted.

Abstract: This study describes the impact of a sudden, traumatic natural disaster on a bachelor of nursing programme, and the capacity and processes required to minimise disruption to programme delivery and student learning. This descriptive case study, undertaken across 2011-2012, collected data through interviews, a survey and artefact collection. Six key themes emerged from the inductive and descriptive statistical analyses: context; communication; leadership and followership; decision making; the need to balance shifting priorities around professional responsibilities and personal imperatives; and taking action and action plans. The conclusions reached emphasise safety as the first priority, encourage personal risk mitigation, and emphasise the importance of ongoing support and flexibility for all staff and students as well as the need for clear communication and decision-making. What is perhaps most important to take from this experience is that a plan does not, by itself, equal preparedness; every institution must look to its own context, consider its own priorities, and formulate its own approach to preparedness.

Abstract: The aim of this research was to ascertain the opinions of ward nurses (registered and enrolled nurses) on a critical care outreach (CCO) service and the early warning score (EWS) tool and how CCO helps them care for ward patients whose condition is deteriorating. An 18-item Likert scale questionnaire was adapted to gain opinions on three aspects of the service: The usability of the EWS tool and the escalation protocol; the role and usefulness of the critical care outreach nurse (CCON); and education and sharing of critical care skills. The research was conducted in a 270-bed New Zealand hospital with a nurse-led outreach team. The survey was distributed to adult general wards. It found 45 percent of ward nurses found EWS useful in identifying patients whose condition was deteriorating, 58 percent found EWS easy to use and 82 percent found EWS helped them prioritise workloads. On the role and usefulness of the CCON, 41 percent of surveyed nurses found the post-ICU review helpful, 65 said CCONs were approachable, 71 percent found the CCON shift time of 3pm-11pm was useful, 69 percent said the CCON demonstrated sound clinical knowledge, and 54 percent rated CCONs teaching as sufficient for their needs. When CCO was present, nurses were able to formulate an effective management plan for potentially deteriorating patients and acquired critical care skills needed to manage such patients. The results are comparable with other research which sought nurse opinion of CCO. It indicates nurses believe CCO to be instrumental in increasing critical care skills to prevent deterioration in the clinical area.

Abstract: It has been shown that intensive management of diabetes with type 2 diabetes is effective and has led to wider use of insulin. The conversion of patients from oral medication to insulin is usually managed in primary care. The study discussed here aimed to explore how patients with type 2 diabetes mellitus (T2DM) perceived insulin. The study was conducted in 2009 in an urban general practice in a large town in New Zealand with more than 300 patients with type 2 diabetes. A qualitative study was conducted with face-to-face interviews with 13 participants. The question focused on insulin initiation, lifestyle and routine. The transcribed responses were subject to thematic anaylsis. Interviews showed participants felt restricted by the prospect and eventuality of the routine and restrictions of being on insulin. Results show there needs to be a greater emphasis on the disease being progressive. This study provides the ground work for developing resources that will benefit patients with T2DM.

Abstract: There is a considerable body of literature discussing the stressors experienced by nurses and other health professionals when caring for those who are terminally ill and dying. Also, a number of articles offer suggestions, including the views of staff, as to what type of professional and organisational support is required when working in this often demanding specialty. There are, however, very few reports of assessment of the effectiveness of such supportive interventions and in particular, the impact of such support on the quality of patient care. This literature review examines any reported relationships between the quality of nursing provided by palliative care nurses and the staff support received by those nurses.

Abstract: This article reviews the recent evidence underpinning the New Zealand Ministry of Health's recommendation to offer free annual influenza vaccination to people aged six months to 64 years who have certain chronic medical conditions (eligible younger people). These results show there is relatively limited research providing evidence underpinning recommendations for influenza vaccination among people aged <65 years. These results show that there is a need to increase nurses' awareness of the rationale behind the New Zealand influenza vaccination policy, that this may in turn increase their willingness to recommend influenza vaccine to more eligible younger people.