Abstract: The aim of this paper is to detail the practical application of the Delphi technique as a culturally and clinically valid means of accessing expert opinion on the importance of clinical criteria. Reference is made to a bicultural New Zealand mental health nursing clinical indicator study that employed a three-round reactive Delphi survey. Equal proportions of Maori and non-Maori nurses (n = 20) and consumers (n = 10) rated the importance of 91 clinical indicator statements for the achievement of professional practice standards. Additional statements (n = 21) suggested by Delphi participants in round 1 were included in subsequent rounds. In round 2, participants explained the rating they applied to statements that had not reached consensus in round 1, and summarised responses were provided to participants in round 3. Consensus was considered to have been achieved if 85% of round 3 ratings lay within a 2-point bracket on the 5-point Likert-scale overall, or in one of the Maori nurse, non-Maori nurse, or consumer groups. A mean rating of 4.5 after round 3 was set as the importance threshold. Consensus occurred overall on 75 statements, and within groups on another 24. Most statements (n = 86) reached the importance benchmark. The authors conclude that when rigorous methods of participant selection, group composition, participant feedback, and determination of consensus and importance are employed, the Delphi technique is a reliable, cost-effective means of obtaining and prioritising experts' judgements.

Abstract: The aims of the study were to provide a deconstructive analysis of the concepts of risk and risk management, and to explore the historical context of mental disorder and the concept of risk, the clinical context of risk assessment and management, the cultural, political and economic context of risk, and the impact on mental health nursing and consumers of mental health services. This is undertaken by providing a critical review of the history of mental illness and its relationship to risk, examination of government policy on clinical risk management, analysis of a risk assessment model and a discussion of the political and economic factors that have influenced the use of risk assessment and management in clinical practice. The concept of risk and its assessment and management have been employed in the delivery of mental health services as a form of contemporary governance. One consequence of this has been the positioning of social concerns over clinical judgement. The process employed to assess and manage risk could be regarded as a process of codification, commodification and aggregation. In the mental health care setting this can mean attempting to control the actions and behaviours of consumers and clinicians to best meet the fiscal needs of the organisation. The authors conclude that the mental health nursing profession needs to examine carefully its socially mandated role as guardians of those who pose a risk to others to ensure that its practice represents its espoused therapeutic responsibilities.

Abstract: The aim of this study was to evaluate whether the services that community mental health nurses provide are meeting the needs of consumers in the community. This was a joint project between nurses and consumers. It was a service-specific descriptive research project utilising qualitative methods of data collection and analysis that provides a model for working in partnership. The results of this research identify collaboration in planning care and sharing information as two areas of concern but generally the consumers were very satisfied with the care provided by community mental health nurses. The analysis of the data suggests that consumers value nursing care because nurses provide support in their own home; they help consumers develop strategies for coping with their illness and their life; they provide practical assistance when it is required; they are vigilant about any deterioration or improvement; and they are available and accessible. The results of this study have demonstrated that nurses will remain critical to the success of community-based care because of their ability and willingness to be flexible to the demands of their own organisation and the users of services.

Abstract: This article outlines a model for the nursing role in the chronic health care context of renal replacement therapy. Materials from several streams of literature are used to conceptualise the potential for nursing work in the renal setting as negotiated care. In order to present the role of the renal nurse in this way it is contextualised by viewing the renal setting as a specialised social context constituted by a dominant professional discourse and a contrasting client discourse. While performing specific therapeutic activities in accord with the dominant discourse, renal nurses can develop a relationship with the person living on dialysis, based on responsiveness to their subjective experience reflecting the renal client discourse. In contrast to the language of noncompliance prevalent in the renal setting, nurses can, through their relationship with renal clients, facilitate their attempts to negotiate the requirements of the therapeutic regime into their own personal life situation. Nurses can mediate between the dominant and client discourses for the person living on dialysis. Care describes the quality that nurses actively seek to create in their relationships with clients, through negotiation, in order to support them to live as fully as possible while using renal replacement therapy. The author concludes that within chronic health care contexts, shaped by the acute curative paradigm of biomedicine, the model of nursing work as negotiated care has the potential to humanise contemporary medical technologies by responding to clients' experiences of illness and therapy.

Abstract: This article discusses a child/adolescent-centred primary nocturnal enuresis program and service that is administered by a group of public health nurses in South Auckland. Enuresis is the involuntary passing of urine. Many children and adolescents who are nocturnal enuretics exhibit behaviours such as low self-esteem, withdrawal, less ambition and increased anxiety. These children are often low achievers within the school system and become a problem for their family and school.

Abstract: This research sought to explore the nature of comfort within the context of three New Zealand nursing homes and examine how nursing and other actions contribute to residents' comfort. A critical ethnographic approach was used and fieldwork included 90 days of participant observation, interviews with 27 residents and 28 staff and extensive document examination. Comfort was multidimensional, idiosyncratic, dynamic and context dependent, rather than merely the absence of discomfort. This multidimensional nature meant residents could be 'betwixt and between' comfort and discomfort simultaneously. The constraints of one-size-fits-all care delivery practices and the tensions inherent in communal living compounded residents' discomfort. The findings show that individualised care, based on comprehensive and accurate nursing assessment, is fundamental to the comfort of residents.

Abstract: The aim of this research is to provide an analysis of the scope of nursing practice and inter-professional role responsibility for ventilatory decision-making in Australian and New Zealand intensive care units (ICU). Self-administered questionnaires were sent to nurse managers of eligible ICUs within Australia and New Zealand. Survey responses were available from 54/180 ICUs. The majority (71%) were located within metropolitan areas and categorised as a tertiary level ICU (50%). The mean number of nurses employed per ICU bed was 4.7 in Australia and 4.2 in New Zealand, with 69% (IQR: 47-80%) of nurses holding a postgraduate specialty qualification. All units reported a 1:1 nurse-to-patient ratio for ventilated patients with 71% reporting a 1:2 nurse-to-patient ratio for non- ventilated patients. Key ventilator decisions, including assessment of weaning and extubation readiness, were reported as predominantly made by nurses and doctors in collaboration. Overall, nurses described high levels of autonomy and influence in ventilator decision-making. Decisions to change ventilator settings, including FiO(2) (91%, 95% CI: 80-97), ventilator rate (65%, 95% CI: 51-77) and pressure support adjustment (57%, 95% CI: 43-71), were made independently by nurses. The authors conclude that the results of the survey suggest that, within the Australian and New Zealand context, nurses participate actively in ventilation and weaning decisions. In addition, they suggest, the results support an association between the education profile and skill-mix of nurses and the level of collaborative practice in ICU.

Abstract: The purpose of this article is twofold. The first is to clarify some of the challenges experienced while conducting collaborative research and describe the steps taken to ensure consistency between the purpose of the research and the phenomenological research design used to explore the learning that nursing students acquire in their final clinical practicum. Second, it was thought that by illuminating this learning, registered nurses working as preceptors and those supporting new graduates could gain insight into the complexities of learning the skills of safe and competent practice from the student's perspective. This insight is essential in creating a strategy between education and practice to minimise the duplication of learning opportunities and lessen the cost of supporting newly registered nurses, which may be at the expense of investment in the professional development of experienced registered nurses.