Abstract: This study is an extension of a previous study by Riker, Picard and Fraser (1999) to determine whether doctors and nurses rate patients similarly using the Sedation-Agitation Scale (SAS) in a natural Intensive Care Units (ICU) setting. The author notes that it is essential to establish whether these different professionals provide consistent scores and have a mutual understanding of the SAS and its constituent levels. This will help ensure that clinical decisions relating to sedation-needs can be made appropriately and consistently. This quasi-experimental reliability study was set in a 12-bed tertiary general ICU in New Zealand. The SAS had recently been introduced into this unit and a convenience sample of 42 nursing and medical staff performed paired ratings on 69 randomly selected adult ICU patients over an eight week time frame. The mean patient age was 58 years, and 79% of patients were on continuous infusions of Propofol. Intubated patients made up 91% of the sample. 74% of patients were given the same SAS score by the doctor-nurse pair. The weighted kappa score for inter-rater agreement was 0.82 indicating very good agreement. Of the 26% of scores where there was a difference, the two readings were only one score apart. Most of the difference occurred around SAS scores of 1-2 and 3-4. Further analysis found no staff or patient variables to be statistically significant in impacting on the ratings. The SAS was found to be a reliable sedation-scoring tool in a general ICU when used by nurses and doctors of varying experience.

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.

Abstract: The intention of this research is, through collaborative discussion and selective conversations, to explore female caregivers' expectations and perceptions of primary health services for some Te Atiawa Maori children. The research process was developed in a partnership between the Maori women participants and the researcher. In addition, two local kuia actively participated in and supported the process. Emancipatory critical social theory underpinned and informed the project. Power relationships between the researcher and the participants can be overtly explored within this theoretical framework. In terms of this particular exploratory study, participatory research appeared to be applicable. The participants are female caregivers of Te Atiawa children. Data collection was done using group interactions and semi-structured interviews in the winter of the year 2000. A thematic analysis of the data was used, in which common themes were identified, compared and discussed. From the analysis of the data of the participants' conversations, key ideas were identified. The major findings have been identified within two main themes. These are: a concept of health is not the same for Pakeha as for Maori, and access issues are still problematic for the participants in this study. Many quotes from the interview participants are included in order to keep the focus of the project on the voices of the women interviewed. In terms of the significant contribution of this research, this study aims to allow voices of female caregivers of Te Atiawa Maori children to be heard. Individual and collaborative interactions offer insights into what is important to them in terms of Maori child health. Clearly, the primary health initiatives promoted by the New Zealand government are not reaching at least some of the people for whom they are intended. The research participants offered their ideas as to how these deficits could be remedied in their community.

Abstract: This study investigated issues surrounding the high numbers of preventable admissions of young children with acute illnesses, particularly amongst Maori and Pacific children. It focuses on what happens once these children are discharged. Its aims were to find out what the expressed needs of parents were, as they cared for their child, once home. Whilst there has been a small amount of international research undertaken in this area, there is little known about expressed parent need in the New Zealand context. This exploratory descriptive study involved parents of under five year old children, who had been admitted to a hospital, with one of five acute illnesses. Eighteen parents were surveyed over the telephone. This study found the parents expressed a need for reassurance and advice once home, and that they worried about their child getting sick again. It highlighted gaps in discharge planning and support. None of the parents had received a written discharge plan for their child. Only five parents had received either a contact number for advice or a referral back to their primary care provider. This study found that whilst some parents considered their discharge needs had been met, others considered that they had not. Four local discharge practice opportunities to support these families were recommended, these included, providing parents and caregivers with an individualised written discharge plan, giving a contact number for advice after discharge, offering a follow-up phone call in the first 48 hours, and ensuring that all children have a referral back to their primary health care provider. Areas for further research were highlighted, including the need for a larger study to explore and compare the needs of rural and urban parents, and Maori and Pacific parents.

Abstract: A paper presenting the findings of a small research project involving a group of self-selected senior nurses of Wellington Hospital to explore the nature of nursing practice in the care and management of hospitalised patients and to formalise the language that would acknowledge its significance in the current effort of hospitals to define patient care pathways. The nature of hospital nursing practice was described in themes of a generic process of nurse-patient care that articulates a distinct specialism of hospital nursing, whatever the hospital department in which nurses hold positions.