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: 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 article reports one aspect of a phenomenological study that described the lived experience of mothering a child hospitalised with acute illness or injury. The significance for mothers that nurses do the 'little things' emerged in considering the implications of this study's findings for nurses in practice. Seven mothers whose child had been hospitalised in the 12 months prior to the first interview agreed to share their stories. The resulting data were analysed and interpreted using van Manen's interpretation of phenomenology. This description of mothering in a context of crisis is useful in the potential contribution it makes to nurses' understanding of mothers' experience of the hospitalisation of their children. It supports the philosophy of family-centred care and highlights the ability of individual nurses to make a positive difference to a very stressful experience by acknowledging and doing 'little things', because it is the little things that matter to the mothers of children in hospital.

Abstract: An ethnographic study which attempts to understand what initial employment means to graduates from a comprehensive nursing course. The researcher participated in the first 3-4 months of the nurses' employment in general hospital settings. Five major themes emerge from the study indicating that the rhetoric practice of the school of nursing is different from the rhetoric and practice within general hospital settings. The reality of initial employment for the new graduated conflicts with the values and ideals of nursing promulgated by the comprehensive nursing course. The educational program stressed patient centred nursing, where nurses accepted responsibility for the continuing care of individuals. In contrast the hospital settings stress nursing as management of tasks across different patients. This conflict was a major source of frustration for the 'beginning' nurses. Ultimately they accept the reality of nursing as the management of tasks, but not without some personal cost. Orientation programs and the early employment period focus on 'fitting in to the system'. A significant determinant of the practice of new graduates are context effects such the time of their shift and the availability of experienced nurses. A number of management practices foster and maintain a beginning level of practice and new graduates have no opportunity to practice as autonomous nurses within a multi disciplinary health care team. Beginning practice is identified in new graduates through their difficulties in coping with unplanned or unexpected events. The initial employment period is dominated by shift work, resulting tiredness and adjustment to social activities.It is argued that management practices which support the ideals of comprehensive nursing courses and totally qualified nursing workforce have yet to occur. There are implications in this study for nursing education and nursing practice

Abstract: A system of staffing is described which can be used to distribute existing staff equitably throughout wards according to patient numbers and the degree of patient/ nurse dependency

Abstract: An exploratory qualitative study was investigated to further identify nurses'' attitudes to the care of people with human immunodeficiency virus (HIV) and acquired immunodefiency syndrome (AIDS). This follows as a sequel to a study using questionnaire. Data collected from nine focus groups attended by a total of 29 nurses at a hospital within a new Zealand regional health authority. The principal findings suggest that nurses' attitudes to this patient group are varied and depend on social influences, personal experiences and the extent of knowledge regarding HIV/AIDS. Other concerns raised included nurses' rights to choose to care for HIV-positive patients and the issue of universal precautions. Theses findings may have implications for further educational initiatives and information of hospital policy

Abstract: This paper is a report of a study to determine the construction of male nurses as gay, and to describe how this discourse impacts on a group of New Zealand male nurses. This social constructionist study drew on data collected from existing texts on men, nursing and masculinity and interviews with 18 New Zealand men conducted in 2003-2004. Discourse analysis, informed by masculinity theory and queer theory, was used to analyse the data. Despite the participants' beliefs that the majority of male nurses are heterosexual, the stereotype persists. A paradox emerged between the 'homosexual' general nurse and the 'heterosexual' pyschiatric nurse. The stigma associated with homosexuality exposes male nurses to homophobia in the workplace. The heterosexual men employed strategies to avoid the presumption of homosexuality; these included: avoiding contact with gay colleagues and overt expression of their heterosexuality. These stigmatising discourses create a barrier to caring and, aligned with the presence of homophobia in the workplace, deter men's entry into the profession and may be important issues with respect to their retention.

Abstract: Sense-Making, a qualitative research method, was used to obtain and analyse data from interviews with 10 registered nurses, in order to study reflective thinking in actual nursing practice. Ten non-routine nursing situations were analysed for the presence of reflective thinking. Reflective thinking was extensively manifest, especially in moments of doubt and perplexity, and consisted of such cognitive activities as comparing and contrasting phenomena, recognising patterns, categorising perceptions, framing, and self-questioning in order to create meaning and understanding. Self-questioning was identified as a significant process within reflective thinking. By exploring and analysing the type of questions respondents were asking themselves, the study uncovered three hierarchical levels of reflective thinking, focussed on action, evaluation and critical enquiry. The findings of this study resulted in the development of a model of reflective thinking, which is discussed in terms of the implications for learning in nursing practice.