Abstract: Current New Zealand health policy encourages collaborative health promotion in all sectors of health service delivery. The integrated approach to the acute management of coronary heart disease in a coronary care unit, combining medical therapy and lifestyle change, supports clinical health promotion. The aim of this study was to use the grounded theory approach to discover the main concerns of nurses' promoting health in an acute coronary care setting and to explain the processes that nurses used to integrate health promotional activities into their practice. Seventeen registered nurses from three coronary care units within a large metropolitan city in New Zealand were interviewed. Data were constantly compared and analysed using Glaser's emergent approach to grounded theory.The main concern for nurses promoting health within coronary care was ritualistic practice. In this study, ritualistic practice concerns the medically-based protocols, routines, language and technology that drives nursing practice in coronary care. This concern was resolved via the socio-cultural process of attitudinal shifting that occurs over time involving three stages. The three conceptual categories, environmental pressures, practice reality and responsive action are the main components of the theory of attitudinal shifting. In environmental pressures, nurses experience a tension between specialist medically-dominated nursing practice and the generalist nursing role of promoting health. In practice reality, nurses become aware that the individual needs of patients are not being met. This causes role conflict until the nurse observes colleagues who role model possibilities for practice, working with patients to promote health. Responsive action sees the nurse engaging in self-development, also focusing on the nurse-patient relationship, thereby enabling active patient involvement in individual health-promoting decisions. The author suggests that the findings from this research have implications for nursing practice and education. With the increasing specialisation in nursing practice, these findings may be of interest to nurses working in delegated medical roles where the reality of everyday practice precludes nurses from undertaking their essential nursing role. Health care facilities also need to ensure that there are opportunities for the personal and professional development of nursing staff. The place of health promotion within nursing undergraduate curricula needs to be examined, as many nurses found that they were ill prepared for undertaking health promotional activities.

Abstract: This study aims to examine the concept of 'inappropriate' emergency department attendances in relation to the emergency department at Christchurch Hospital. It specifically seeks to determine whether there is a consensus opinion among healthcare providers regarding a definition of 'inappropriate'. An exploratory survey of health professionals involved with the referral, assessment, transport, and treatment of emergency department patients in Christchurch was carried out. A range of health professionals, including ambulance personnel, general practitioners, emergency department physicians, emergency nurses, and hospital managers were approached. A series of questions relating to definition and response to 'inappropriate' patients was asked, with an additional open-ended question relating to the definition of 'appropriateness'. The researchers found significant differences in the attitudes and perceptions of key health professionals involved in the referral, treatment, and admission of patients to the emergency department. This has implications for any interventions aimed at addressing emergency department 'overcrowding' that assume the presence of a consensus understanding of this concept.

Abstract: The incidence of postoperative complications is reduced with early identification of at risk patients and improved postoperative monitoring. This study describes the development and effect of a nursing preoperative assessment tool to identify patients at risk of postoperative complications and to reduce the number of acute admissions to ICU/HDU. All surgical patients admitted to a surgical ward for an elective surgical procedure (n=7832) over a 23-month period were concurrently scored on admission using the preoperative assessment tool. During the time period studied, acute admissions to ICU/HDU reduced from 40.37 to 19.11%. Only 24.04% of patients who had a PAS >4 were identified by the surgeon and/or anesthetist as being at risk of a postoperative complication, or if identified, no provision was made for improved postoperative monitoring. This study supports the involvement of nurses in identifying preoperatively patients at risk of a postoperative complication and in need of improved postoperative monitoring. The postoperative monitoring requirements for the PAS >4 patients were relatively low technology interventions.

Abstract: Reports on a local multi-component initiative to improve local Human Papillomavirus (HPV) vaccination coverage among Maori male students aged 13-17 years in a rural location in Aotearoa New Zealand. Backgrounds the initiative co-designed by the rural health nurse from a community clinic of the Hauora (Maori health provider) and the principal of the local area school, in order to improve health literacy and provide an environment to support student consent to vaccination. Undertakes an evaluation of the initiative in 2018, comprising 10 key informant interviews and a group discussion with eight male students. Identifies the factors associated with the success of the initiative.

Abstract: Explores and describes experiences of older women who live alone in the community, and who are often perceived by both society and health professionals as frail and dependent. Employs a qualitative descriptive methodology to underpin a survey of 5 older women living alone in their own homes, and analyses the data using a general inductive approach. Identifies 3 themes that emerge from the data.

Abstract: In 2004, Plunket nurses from eight areas around New Zealand participated in collecting data for a research project on health needs assessment practices. This project aimed to examine risk factors identified by Plunket nurses, what areas of health need considered to be priorities; grading of health needs; and how closely the results of health need assessment aligned with the individual clients' deprivation score. The researchers examine the assessment of health needs against the use of the Deprivation Index, which indicates a specific population in a specific area, as a funding model. This study appeared to show there are two distinct groups of clients assessed as high needs: those with risk factors such as family violence and severe parental mental illness, and who may live in an area of 1-7 deprivation; and those with multiple risk factors which include poverty, low education, and/or reluctance to access services and support, and who usually live in dep 8-10 areas. This research supports the anecdotal evidence that significant health needs exist outside the lower deprivation areas.

Abstract: This dissertation explores the assessment of nurses' clinical competence in the adult ICU setting. Specifically, methods for the assessment of competence are critiqued for their practical application to the novice nurse with less than six months experience in ICU. The assessment methods considered are continuous clinical assessment, self-assessment, peer review, objective structured clinical examination (OSCE), portfolio and computer assisted assessment. Several criteria are applied to the methods including the ability of each method to assess skills, knowledge and attitudes or values. Each method is critiqued for its implications in terms of cost and staffing resource, benefits and barriers to implementation. In addition, reliability and validity issues are considered for each method. The outcome of this exploration is the recommendation of a combination of methods; namely, portfolio and OSCE, for the assessment of competence in the ICU novice. The author concludes that this finding enhances current understanding within the ICU specialty of the multidimensional nature of competence assessment.

Abstract: Seeks to give voice to migrant nurses, using case-study methodology to highlight their experience of the competence assessment process. Distributes a questionnaire to a group of 22 newly-arrived IQNs, and conducts interviews with 10 IQNs who had been working in NZ for several years. Uncovers the motivations among the first group and reflections on the Competence Assessment Programme (CAP) among the second. Makes recommendations for CAP training based on the results of the study.