Abstract: This dissertation is a review of evidence underpinning the recommendations for pressure ulcer prevention from four national guidelines frequently used as a foundation for best practice. The focus is on grade-1 pressure ulcer prevention for “at risk” patients, in the acute environment. Rationale: Prevention is better than cure. While preventive strategies maybe effective are they supported by evidence? Results: The strongest evidence for best practice appears to be limited to an established fact that standard hospital mattresses should at least be replaced by high specification foam, pressure reducing mattresses for patients “at risk” or vulnerable to pressure ulcer development. Repositioning, skin assessment, skin protection and maintenance, traditionally the basis of pressure ulcer prevention, appear to have a paucity of strong supportive evidence. Further evidence is emerging on clinically important areas such as erythema and mattresses. Implications for Nursing: The organisational or ministerial support for education of the multidisciplinary team, especially nurses in risk assessment and prevention strategies. This support is required both in release time and finances for education and in adequate funding for preventive strategies. The author concludes that strong evidence to support the recommendations of the guidelines appears to remain limited, particularly in the acute environment. Expert opinion would appear to remain the basis for current best practice for pressure ulcer prevention. The volume and consistency of this evidence worldwide is substantial and adds validity to the recommendations. Best practice includes firstly risk assessment, skin assessment, maintenance of skin temperature, moisture, and condition, and the importance of repositioning, in conjunction with an appropriate support surface. However gaps remain in the supportive evidence in many of these fields. Advances in practice include pressure relief or reduction considerations for all surfaces the patients encounter. There appears to be no gold standard for prevention of pressure ulcer development.

Abstract: This qualitative study investigated surgical nurses' perceptions of patient-controlled analgesia as a strategy for managing acute pain in a tertiary care hospital. Patient-controlled analgesia is commonly used and nurses play an essential role in caring for patients prescribed it. The study was divided into two parts. First, audiotaped semi-structured interviews were conducted with 10 nurses. The interviews were followed by a postal questionnaire to 336 nurses with 171 returned. Thematic analysis was the chosen methodology. The audiotaped transcripts and questionnaires surfaced five themes, with the dominant one being `I think PCA is great, but . . .'. The paper outlines and explores these themes and addresses the implications arising from the research for both clinical practice and education.

Abstract: The purpose of this research has been to trace the development of the nurse practitioner role in New Zealand. Using a discourse analytical approach informed by the work of Michel Foucault, the study foregrounds the discourses that have constructed the nurse practitioner role within the New Zealand social and political context. The author suggests that discourses of nursing and of medicine have established systems of disciplinary practices that produce nurses and physicians within defined role boundaries, not because of legislation, but because discourse has constructed certain rules. The nurse practitioner role transcends those boundaries and offers the possibility of a new and potentially more liberating identity for nurses and nursing. A plural approach of both textuality and discursivity was used to guide the analysis of texts chosen from published literature and from nine interviews conducted with individuals who have been influential in the unfolding of the nurse practitioner role. Both professionally and industrially and in academic and regulatory terms dating back to the Nurses Registration Act, 1901, the political discourses and disciplinary practices serving to position nurses in the health care sector and to represent nursing are examined. The play of these forces has created an interstice from which the nurse practitioner role in New Zealand could emerge. In combination with a new state regime of primary health care, the notion of an autonomous nursing profession in both practice and regulation has challenged medicine's traditional right to surveillance of nursing practice. Through a kind of regulated freedom, the availability of assessment, diagnostic and prescribing practices within a nursing discourse signals a radical shift in how nursing can be represented. The author concludes that the nurse practitioner polemic has revolutionised the nursing subject, and may in turn lead to a qualitatively different health service.

Abstract: New graduate nurses, particularly in the first year of clinical practice, face challenges with making clinical decisions about patient care. A review of the literature revealed no studies that reported using fundamental qualitative descriptive methodology to investigate new graduate nurses' clinical decision making. Aspects of decision making by new graduates have been studied using observational and interview methods, the findings from which have been interpreted using various theoretical decision making models. There has been little research outside of the context of critical care or intensive care units, but anecdotal reports in 2006 from the New Zealand Nursing Entry to Practice Programme (NetP) coordinators network suggest that new graduates are seldom employed in critical care or intensive care units in New Zealand. Nursing educators involved in undergraduate nurse training and NetP programmes need to understand how new graduates perceive, experience and manage decision making in clinical practice, in order to assist them to develop and refine those skills. There is a need for studies utilising fundamental qualitative descriptive methodology in order to explore the experiences of new graduates' decision making in clinical practice. The author notes that the topic is particularly relevant in light of the introduction of the national NetP programmes framework in New Zealand, and to her role as a NetP programme coordinator. This dissertation examines the relevant literature about decision making by new graduates and the research methods that were used, and concludes that fundamental qualitative descriptive method is a highly appropriate method by which to study new graduates' decision making.

Abstract: This research is informed by the interpretive phenomenology of van Manen, and explores the lived experience of nursing from the perspective of nurses who provide care for people with a co-existing intellectual disability and mental health problem. Although nursing research is commonly informed by phenomenology, there is a dearth of literature of any description written from the perspective of nurses who provide care for people with intellectual disabilities and mental health problems. As a result of the closure of many large institutions in New Zealand there are not many nurses who work with people who have intellectual disabilities and co-existing mental health problems. The study participants were four nurses purposefully selected because they provided care for people with intellectual disabilities and mental health problems. Data was collected using semi-structured interviews, and the researcher identified and wrote about the recurring themes in the transcribed interview data, which best captured the lived experience of the participants. The themes were: criticism of services, holistic caring, working with the client, issues of status, need for specialist knowledge, enduring relationships, diagnostic issues, advocating, modelling good practice; and working alongside. After further analysis the themes were encompassed within the larger interrelated themes of “Status and positioning” and “Advocating practices”, and finally within a single theme of: “The status and positioning of the nurse and the client leads to advocating practices.” These themes were found to be consistent with the nursing literature and with the researcher's own lived experience as a nurse who works in a specialist mental health intellectual disability service. The findings of this research have implications for a number of groups in New Zealand. Among the author's conclusions are that input is required from the Nursing Council of New Zealand, the nursing profession, nurse educators and the government to raise the status of clients with co-existing intellectual disabilities and mental health problems and the nurses who work with this client group. In addition, the roles for nurses who work with this client group are emerging and are likely to be diverse and there is a need for further research to capture the different experiences of these nurses.

Abstract: The author reviews the national and international literature on medical errors and adverse events. Contributing factors are identified, such as organisational culture, the myth of infallibility, and a one size fits all approach to health care. Conflict and communication difficulties between different health professionals is discussed in detail, as is the issue of disruptive behaviour, which includes intimidation, humiliation, undermining, domination and bullying. Some strategies for addressing these issues are proposed, such as promoting a no-blame culture, and addressing conflict between health professionals.

Abstract: In this review, the author illustrates the connection between diabetes, stress and barriers to care, and the impact these have on Maori who have type 2 diabetes. A literature review, which focused mainly on indigenous peoples, and more specifically on Maori was undertaken. The connections between all the factors involved are explored, and combined with reflections from the author's own clinical practice experience. She argues that stress, diet, exercise and barriers to care place a heavy burden on the lives of Maori who live in Aotearoa/New Zealand, suffering from the disease of diabetes. By empowering them to face their situation and see this from a wellness rather than an illness perspective, they can take control of their diabetes and so will live a healthy, longer life, ensuring quality time with their mokopuna/grandchildren.