Abstract: As the healthcare system moves toward a consumer-driven paradigm, visiting hours for family and significant others of the intensive care unit patient have become a topic of interest and discussion. Research since the 1970s has generated controversy and speculation over the ideal visiting practices in the adult intensive care unit. The aim of this dissertation was to examine the benefits for the patient, family members and nurses of appropriate visiting practices within intensive care areas in order to establish if open visiting is the best regime for patients in the adult intensive care unit (ICU). This dissertation explores visiting practices in adult critical care unit settings. Specifically, the benefits of visiting for patients, and the factors that may impede or facilitate visiting practices within the ICU were critically discussed. These factors included the benefits and disadvantages of open visiting, and the nurse as an influential factor in visiting. These areas linked together to form the basis for consideration of visiting in the ICU. Review of existing literature pertaining to visiting in the ICU indicated that patients wanted open visiting hours yet also indicated that they would like some visiting restrictions. Nurses appeared to value family input into care and were aware of patient and family needs, even though they may restrict visiting to suit their own work practices. Family members can provide the patient with psychological support, provide important historical data, assist the nurse with selected aspects of physical care, and actively encourage the patient's efforts to recover. The outcome of this exploration is the recommendation of an open visiting policy tailored to individual patients, as, the author suggests, this would foster nursing practice and ultimately benefit patients and their families.

Abstract: Use of health assessment skills is undeniably part of everyday nursing practice, guiding nursing decisions and a part of facilitating patient outcomes. Undergraduate nursing education in New Zealand includes the use of health assessment skills within the context of nursing practice. The registered nurse working in their first year of practice is required to use effective assessment skills to identify potential risks to a patient's health, while learning to adjust to the many other demands of practice, but little research has explored these experiences. The purpose of this research study was to describe the experience of using health assessment skills within the first year of practice as a registered nurse. Using a qualitative descriptive method, informed by phenomenology, interviews were conducted with six newly graduated registered nurses working within a New Zealand setting. Findings of this study revealed that graduates endeavour to incorporate the skills of health assessment taught at undergraduate level into their practice. Six main themes of health assessment philosophy; tuning in; mobilising health assessment skills; recognition; anxiety; and identification and facilitation of outcomes can be aligned with Benner's (1984) model of skill acquisition. The author suggests that these research findings are useful to inform nursing education, clinical practice and further research. An awareness of these graduate experiences provides opportunities for nurses in both clinical practice and education to facilitate and support graduate nurses' of health assessment within their nursing practice.

Abstract: Healthcare systems in New Zealand and the western world are grappling with changes with an aging population; increased use of technology resulting in shorter inpatient stays, increasing chronic illness rates and people with complex health needs. Supporting people through the health system and meeting their needs is an aim of all services. Trying to support seamless transition and manage complex care requirements has become important for community health services. In the district health board, where the author works, the role of Liaison Nurse/Complex Coordinator was established to support this. This role has become important in reviewing what the best model of care for Community Health Services is and how to describe the current practices in this context in an appropriate way. The first section of the report reviews the literature and current practice in relation to liaison nursing. This section explores how to make the role clear and identify its clinical and organisational effectiveness, drawing out the key elements and aspects for this role that will contribute to a model of care. The second section progresses onto the clinical work related to managing patients with chronic illness and complex needs. Utilising literature to inform current practice when supporting patients through health transitions to achieve seamless care and identifying key aspects required to manage this and adding these aspects to the model of care. Following this, a review of current care models available and in use in the health care systems is undertaken. There are some elements and aspects similar in these models and those explicated in the previous sections. Finally a model of care is developed bringing all the key aspects and elements together. This model describes the practice of Liaison/Complex Coordination role in community health service in New Zealand and identifies the need for care, provision of care, outcomes of care provided and impact for the service and organisation. The author suggests that this model is relevant for any liaison or complex coordination role and could be a basis for other models of care to expand upon the specific needs for their services.

Abstract: This dissertation explores the issues affecting the exposure of isolated rural nurses working in New Zealand to violence from members of the local community, including the visiting public. Discussion on the collaborative role with the New Zealand Police is thematic in the issues presented. Challenges presented include the unique community dynamics of the Stewart Island nursing practice on the Island, with scope of practice, isolation and practice issues included. Role definition, present-day health-care delivery, the potential for violence including causation and reporting are presented. Incident management and risk strategies, including de-escalation are rationalised and described. Evidence for the nurse-police inter-service relationship along with issues including confidentiality and legislation are reviewed. Recommendations and conclusion are provided. The thread and theme of the dissertation is to encourage discussion within nursing circles on the provision of satisfactory safety standards for nurses working in remote isolated parts of New Zealand.

Abstract: In November 2005, the Oxford Community Health Centre (OCHC) introduced an innovative way of delivering primary health care to the residents of Oxford. This was in response to the difficulty with recruitment and retention of medical staff for the solo General Practitioner (GP) at OCHC. Primary health care services are now the shared responsibility of the Rural Nurse Specialists (RNS) and the GPs. This initiative is underpinned by a collaborative approach in sharing patient care between the GPs and RNSs to improve access to primary health care and foster staff retention. The team at OCHC is keen to consolidate and enhance the success of collaboration. Therefore, this dissertation has reviewed a range of literature in order to identify lessons that can be learned for the future. Two key factors that have implications for OCHC are the structural effects of the organisation and the interpersonal relationships between the GPs and RNSs. The structural effects include: the structure and philosophy at OCHC, and the social, cultural, and educational influences within the organisation. It is the nature of the interpersonal relationships that can affect the development and success of collaboration through a willingness to collaborate and the existence of mutual respect, trust, and effective communication between the RNSs and GPs. Strategies to foster collaboration at OCHC in the future include: staff participation in making collaboration visible within the philosophy at OCHC, a workshop for staff to further define roles and differentiate activities according to skill-mix; and the involvement of a nurse in decision-making at the organisational level. The author suggests that these strategies could also be beneficial to other rural practices that are striving to maintain a sustainable primary health care service.

Abstract: The prevalence of allergic disease has increased significantly in western countries over the last decade. However, the author points to the availability of specialist allergy services in New Zealand being limited to the large cities, resulting in a lack of, or fragmentation of, the allergy-related services in smaller regions. As a public health nurse in Otago working with a rising number of families with severely food allergic children, the author had become aware of the challenges many parents face in accessing accurate information about their child's allergy and the negative impact this has had on them and their child. The purpose of this dissertation is to explore how an Allergy Nurse Specialist (ANS) led service could improve the experiences and health outcomes of the families and children with severe food allergies living in Otago. A critical analysis of the literature on allergy nursing, advanced nursing roles, and related food allergy issues was conducted and applied to the Otago region. Drawing on the 'Nurse with a Special Interest in Allergy' model of nurse-led allergy care outlined by Cross (2005) and the existing Otago District Health Board's (2004) clinical nurse specialist role, the author proposes that an ANS-led model of care, incorporating advanced nursing practice, primary care access and multidisciplinary collaboration could complement the existing allergy related services in Otago. The focus of the ANS's care will be on facilitating timely access to accurate assessment and advice for families regarding the management of their child's food allergies.

Abstract: The low numbers of nurses attracted to work in mental health is a concern particularly with the increased demand for mental health services. Strategies are required to increase recruitment to this less popular area of nursing to ensure that a high quality of care is provided for people suffering from mental illness. The World Health Organisation is aware that this area of health has been neglected and that it is time to promote mental health. This study aimed to examine the influences involved in nurses choosing to work in this area. A descriptive survey using a questionnaire was given to seven groups of new graduates enrolled in the New Graduate Mental Health Nursing programme through five educational institutes. At the time of writing there were no published studies around this topic in New Zealand. This study will attempt to inform nurses, the Nursing Council of New Zealand, tertiary institutions and the government of New Zealand that there is evidence of a need to develop and change practices to address the predicted workforce decline.

Abstract: Death education encompasses many complex realities, for both the students and lecturers involved. This quantitative research explored the experiential and didactic preparation of nursing students through a content analysis, of one New Zealand, three year Bachelor of Nursing programme, in relation to death education. The Otago Polytechnic Bachelor of Nursing programme incorporates compulsory and optional courses, with the courses taught as an integrated programme with a progressive, sequential approach. This approach builds on content, deepening understanding from year to year, as well as providing opportunities for experiential learning and broadening of understanding. The literature review discusses three dominant themes of undergraduate death education: education, death, and transition. The data collection tool incorporates eighteen key terms, ten teaching methods and ten assessment methods. The programme and individual course documents, which define course content, teaching and assessment were scanned and analysed. The findings initially showed limited evidence of death education in course documents, however deeper analysis of the documents showed further evidence over the three year programme. The existence of death education is implied rather than overt throughout many course documents, through the use of broad practice statements. Content analysis is one way of shedding light on programme content in relation to death education. Limitations of the content analysis approach mean measuring experiential and didactic learning is not fully achievable from documentation analysis only. Further development of Bachelor of Nursing death education is an ongoing challenge, with current programmes very full and possibly lacking the capacity to increase content. Bachelor of Nursing programmes are discussed, highlighting the need for student focused learning with emphasis on acquiring and processing information, rather than mastery of content.