Abstract: An essential part of nursing practice for the nurse on the surgical floor is to relieve the discomfort of post operative pain for patients in their care. Post operative pain management encompasses a series of processes from assessing pain, providing relief, assessment of measures used to relieve pain through to documentation in the patient record. Yet literature, both internationally and from Australia and New Zealand, suggests that post operative pain continues to be poorly managed despite having the means to provide more than adequate relief. Events leading up to the commencement of this study indicated that locally, post operative pain assessment, including documentation in the patient record may be substandard. The objective of this study was to develop and test an audit tool; undertake a retrospective audit of nursing records, including nursing notes and the nursing care plan, in respect of what postoperative pain assessments nurses document in the patient record; evaluate data and make recommendations for practice. Methodology: A five part, 23 question Likert scale audit tool, designed specifically for this study was used to collect data over a period of two months. In total 40 patient records that met the inclusion criteria were audited.The results indicate that local practice reflects poor documentation standards found in other studies. The most complete recordings were those entered on specifically designed charts such as the Patient Controlled Analgesia and Epidural charts (N 28) but this did not carry over into the patient record. Despite that fact that the patient's self reports of pain is said to be the single most reliable indicator of pain, there was only four occasions when the patient's verbal response to pain was recorded. None of those responses were according to any type of pain rating scale. Evidence of evaluation following measures used to relieve pain was more likely to be recorded if pain was poorly controlled or when side effects such as nausea were experienced by the patient. The author concludes that overall the audit has highlighted many gaps in what is or is not recorded in the patient record in respect of post operative pain assessment and has highlighted the need to develop standards of practice that will improve post operative pain management practices.

Abstract: The author's interest in this study came from working as a mental health nurse with mainly older women with depression and developed from her concern that depression for older people is frequently misdiagnosed, not recognised or is under-treated. To date, research has rarely paid attention to the voices of people who have actually experienced depression and even less is known from the perspective of older women. This hermeneutic phenomenological study, informed by Martin Heidegger and Max van Manen, describes what it is like for four older women to live with depression. Multiple interviews were conducted with the participants. Heidegger's philosophical concepts of Being-in-the-world and Being-with-others structured the analysis. Depression was found to have a significant effect on the participants' Being-in-the-world. The themes that emerged were: something is wrong; the search for reasons; self-loathing; being overwhelmed by the feelings; hiding from the world; loss of self; loss of meaning; the struggle of everyday life; and living circumspectly. Being-with-others was difficult for the participants and the themes that emerged were: maintaining relationships when well; Being-alone; misinterpreting self and other people; the stigma of mental illness – society and self; and seeking understanding from other people. The author suggests that the findings have implications for nurses and other health professionals.

Abstract: Practice nurses are primarily responsible for the administration of vaccinations in New Zealand, although many other health professionals contribute to the success of the National Immunisation Schedule by providing vaccination information and advice to parents. Vaccination uptake remains relatively low, indicating many parents choose not to vaccinate their children. A literature review was undertaken to gain an understanding of factors which may influence parents when they are making decisions about childhood vaccinations. Four key themes were identified within the literature: Perceived risk; Vaccine safety and efficacy; Child characteristics; and the Influence of health professionals/supporting vaccination structures. Increased knowledge and awareness about influential factors creates opportunities for health professionals and policy makers to develop strategies to increase vaccination uptake. Implications and recommendations are made for practice, with particular emphasis on the role of the primary healthcare nurse.

Abstract: The Guthrie Test has become the standard screening test for early detection of congenital metabolic disorders for newborn babies in New Zealand and is an accepted part of neonatal care. In neonatal care, decisions are made on behalf of babies usually by their parents and, for the Guthrie Test there is a requirement that health professionals obtain informed consent. This qualitative research utilised focus group methodology to discover what neonatal nurses in clinical practice consider when obtaining informed consent from parents for newborn screening, the Guthrie Test. The convenience sample consisted of seven registered nurses who volunteered to participate in the study. They all practice in the Neonatal Intensive Care Unit at Dunedin Public Hospital that provides Level 3 intensive care to neonates in the Otago/Southland regions. There are proven benefits of the current newborn screening programme and in the experience of this focus group not many parents choose to refuse. These neonatal nurses identified the rights of parents to have that choice and to make an informed decision. The findings from this research indicate the importance neonatal nurses place on patients' rights and the information provided to ensure that their rights are respected. However, the results indicated that there is a need for clarification of the purpose and process of informed consent for the Guthrie Test in the Neonatal Intensive Care Unit. Therefore providing sufficient, relevant information at an appropriate time and manner is considered necessary. The findings will be used to inform discussion related to the provision of best practice.

Abstract: As carers of patients who are clinical research participants, nurses' contribution to the success of clinical trials is acknowledged in the literature. Ethical dilemmas and challenges that clinical trials may present for nurses are also recognised. Although there is some discussion regarding these issues, few studies explore and identify the perceptions of intensive care nurses regarding clinical trials and how they may impact on nursing practice. This thesis explores and describes the viewpoints and experiences of sixty intensive care nurses from a tertiary level referral centre in New Zealand engaged in clinical research activities. The descriptive study utilised a self-administered questionnaire to gather information regarding nurses' roles in clinical trials, associated issues encountered and contributory factors, and the impact of issues on nursing practice, stress and satisfaction levels. Suggestions for potential strategies to minimise the impact of issues on nurses' practice were also sought. Descriptive statistical and content data analyses identified three key areas in which nurses' encounter issues associated with clinical trials and their practice: nurses' workload; ethical concerns; educational preparation and support. The findings indicate that, when issues exist in these areas, routine patient care can be delayed, the enactment of nurses' patient advocacy role can be affected, and nurses' stress and satisfaction levels can be negatively impacted upon. The perceptions of a group of intensive care nurses who are enveloped in the daily balance of patient care, the need for clinical research, and their professional obligations are discussed in this thesis. While the study's findings are reflective of one group of nurses in a distinct practice setting, their experiences can prompt other nurses, research teams and clinical leaders to reflect upon their own clinical research environment.

Abstract: Clinical practice is an essential and integral component of nursing education. The decision-making process involved in student selection of clinical placements is influenced by a range of factors which are internal or external to students. As there was little research that explored these factors and the influence they have on student decisions, the author sought to investigate this further. A mixed-method approach was used, using a questionnaire and focus group interview, to give breadth and depth to the research. This study found that students are particularly influenced by previous positive experiences, or an interest in a particular area of practice. Their personality will also influence their placement decisions. Nurse preceptors and clinical lecturers also provide a key support role to students in the clinical environment.

Abstract: The focus of this study is the management of unsafe nursing students within the tertiary education context. The moral dilemmas experienced by nurse educators, specifically linked to the issue of accountability for public safety, are explored. The theoretical framework for the thesis is informed by the two moral voices of justice and care identified by Gilligan and further developed using the work of Hekman and Lyotard. Case study methodology was used and data were collected from three schools of nursing and their respective educational organisations. Interviews were conducted with nurse educators and education administrators who had managed unsafe nursing students. Interviews were also conducted with representatives from the Nursing Council of New Zealand and the New Zealand Nurses Organisation to gain professional perspectives regarding public safety, nurse education and unsafe students. Transcripts were analysed using the strategies of categorical aggregation and direct interpretation. Issues identified in each of the three case studies were examined using philosophical and theoretical analyses. This thesis explores how students come to be identified as unsafe and the challenges this posed within three educational contexts. The justice and care moral voices of nurse educators and administrators and the ways in which these produced different ways of caring are made visible. Different competing and conflicting discourses of nursing and education are revealed, including the discourse of safety – one of the language games of nursing. The way in which participants positioned themselves and positioned others within these discourses are identified. Overall, education administrators considered accountability for public safety to be a specific professional, nursing responsibility and not a concern of education per se. This thesis provides an account of how nurse educators attempted to make the educational world safe for patients, students, and themselves. Participants experienced different tensions and moral dilemmas in the management of unsafe students, depending upon the moral language games they employed and the dominant discourse of the educational organisation. Nurse educators were expected to use the discourses of education to make their case and manage unsafe students. However, the discourses of nursing and education were found to be incommensurable and so the moral dilemmas experienced by nurse educators were detected as differends. This study bears witness to these differends.