Abstract: This thesis reports on a retrospective observational study that examined the complication rate of peripherally inserted central catheters (PICCs) within a regional cancer centre. PICCs are increasingly used for delivery of chemotherapy and other intravenous therapies in oncology patients. A literature review revealed that almost all published research on PICC complications reported on silicone (Groshong(TM)) catheter use, rather than the polyurethane (Arrow(TM)) PICCs used at Christchurch Hospital. Also, much literature referred to PICCs being inserted by non-nurses, whereas the Christchurch service uses specially-trained nurses to insert them. The purpose of the study was to identify the nature, incidence and rates of polyurethane (Arrow(TM)) PICC complications in an adult oncology cohort. Ethics Committee approval was gained to retrospectively follow all PICCs inserted in adult oncology patients at Christchurch Hospital over a 13-month period from 1st March 2006 until 31st March 2007. Data collected were analysed utilising the statistical computer package SPSS. One hundred and sixty-four PICCs were inserted into 156 individual oncology patients over this period. The median dwell time was 68 days for a total of 14,276 catheter-days. Complications occurred in 25 (15%) out of 164 PICC lines, in 22 (15%) of the 156 patients for an overall complication rate of 1.75 per 1000 catheter-days. However, only 16 of the 25 PICCs with complications required early removal (9.75% of the cohort) for a favourably low serious complication rate of 1.12 per 1000 catheter-days. The three commonest complications were infection at 4.3% (7/164) or 0.49 infection complications/1000 PICC-days, PICC migration at 3% (5/164) or 0.35/1000 catheter days, and thrombosis at 2.4% (4/164) or 0.28/1000 catheter days. The median time to complication was 41 days. Those with complications were more likely to have a gastro-intestinal or an ovarian cancer diagnosis, and less likely to have colorectal cancer. These findings provide support for the safe and effective use of polyurethane (Arrow(TM)) PICCs for venous access within the adult oncology context. Furthermore, it suggests that cost effective nurse-led (Arrow(TM)) PICC insertions can contribute to a low complication rate.

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: ABSTRACT
BACKGROUND: Emergency nursing is a specialty concerned with the care of people of all ages, with either perceived or actual unwellness presenting to the emergency department(ED) for assessment, resuscitation, investigation, treatment and review of their illness or injury. Emergency nurses apply specialty knowledge and expertise in the provision, delivery and evaluation of emergency nursing care. Over recent decades social, political and professional changes have affected nursing care delivery and nursing education. In particular the 21st century has witnessed the development of state funded postgraduate nursing education programmes, developing nurses specialty or advanced nursing knowledge, quality patient/client care and nursing practice within the tertiary education system.
AIM: The aim of this study is to investigate emergency nurses? perceptions of the impact of postgraduate education on their practice in New Zealand (NZ).
METHODS: This study utilises critical social theory as the overarching framework, informed by the writing of Jürgen Habermas (b.1929- ). It is the three phases of
Habermas?s practical intent of critical social theory; namely enlightenment, empowerment and emancipation, that this study is concerned with. This descriptive research study employs both quantitative and qualitative methods and is therefore known as mixed-methods research. Data collection took place over 12 weeks, from August to November 2006, using a survey questionnaire obtained with permission from Ms Dianne Pelletier, Sydney, Australia. The sample included 105 emergency nurses from District Health Board (DHB) emergency departments in NZ, 10 respondents from this sample self-selected to be interviewed by telephone. Ethical approval for this study was obtained from the University of Otago Ethics Committee for research involving human participants. Data was analysed using the Statistical Package for Social Sciences (SPSS).
RESULTS: Two main themes arose from the thematic analysis; these being positive and negative, these themes were further divided into 10 sub-themes. The results indicate that postgraduate study (PGS) has increased nurses? perception of their knowledge; leadership and understanding on the quality of patient care delivered, increased their academic and research skills and increased their confidence/self-esteem and recognition by their colleagues and team. Therefore the majority of respondents perceive postgraduate education has been an instrument of liberation and a process of empowerment and emancipation. A smaller percentage of respondents perceived that PGS had no effect on various aspects of patient care and another significantly smaller percentage of respondents reported negative results from PGS. This research identified similarities between this study and that of Pelletier and colleagues? (2003; , 2005; , 1998a; , 1998b) Australian study.
CONCLUSION: This study adds to the existing literature on postgraduate studies undertaken by nurses. No known study has previously investigated solely emergency nurses?perceptions of the effects of PGS, either nationally or internationally. The results of this study offer enlightening information regarding emergency nurses? perceptions of their PGS within NZ and offers a platform from which other studies may be undertaken. It also has the potential to inform nurses contemplating PGS and educators facilitating these programmes,as well as provide implications for policy development by the Nursing Council of NZ, NZ Universities, DHBs and the Ministry of Health.

Abstract: Professional development is an ongoing requirement of nurses as a result of the Health Practitioners Competence Assurance Act. The Act?s principal purpose is to protect the health and safety of the public by ensuring health practitioners are fit and competent to practise. This survey was designed to explore the avenues nurses have taken, and would prefer to take, for their professional development. The questionnaire was sent to a random sample of the New Zealand Nurses Organisation's registered and enrolled nurse members. Nurses overwhelmingly favoured professional development in the workplace. More than half the respondents reported a conflict with other time commitments, while a number of respondents wrote of their desire for work-life balance. The cost of fees, ability to take time off work, and time and travelling distance were all hurdles to professional development. Nurses cited information technology, conflict resolution, managing challenging behaviour, and dealing with rostered & rotating shifts as aspects of their current work for which their nursing education (pre and post) had not adequately prepared them. Nurses also indicated that their pre-registration education in health systems and political processes was inadequate for their current work. As nurses aged, their interest in professional development increased, though many still preferred workplace options. The authors conclude that, in order for professional development opportunities to be accessible and relevant, resources and time must be made available. This is vital to achieve ongoing education of nurses and improved patient outcomes. Management support, combined with effective assessment of learning needs guiding professional development opportunities, are fundamental to ensuring nurse competence.

Abstract: A dissertation submitted in partial fulfillment of the requirements for the degree of Master of Nursing.

Abstract: Describes an exploratory study of Registered Nurses (RNs) within a local District Health Board which pursued the question of 'if' and 'how' professional practice frameworks assisted nurses in their individual professional practice, specifically self-assessment and performance appraisal. Utilises a qualitative descriptive framework to explore the experiences of RNs in inpatient settings, via questionnaire. Identifies 8 themes related to self-assessment, performance appraisal, and professional practice.

Abstract: Presents a qualitative exploration of factors that influence eight newly-graduated nurses as they endeavour to practice ethical mental health nursing. Gathers data from in-depth interviews with the participants, analysed using a thematic analysis method. Considers aspects of the social and political context within which the participants are situated.

Abstract: This research takes an autoethnographical approach to exploring the connections between being a nurse, doing nursing work, and experiencing a mental illness. Data is comprised of autoethnographical stories from 18 nurses. Drawing on Lyotard's (1988) postmodern philosophy of 'regimes of phrases' and 'genres of discourse,' the nurses' stories yielded three motifs: Nursing, Tangata Whaiora (people seeking wellness) and Bullying. Interpretation of the motifs was undertaken by identifying and exploring connected or dissenting aspects within and between the motifs.