Abstract: New Zealand's ageing population is predicted to have increasing degenerative musculoskeletal changes affecting both mobility and morbidity. In response, the New Zealand government is supporting a one hundred per cent increase in the number of elective joint replacements performed across the country from 2004 to 2008. However, like other specialties, orthopaedic nursing is experiencing shortages. In order to improve the recruitment and retention of orthopaedic nurses, as with other nursing specialties, childcare is offered as a strategy for consideration. In 2005, New Zealand parents indicated in an online survey, that in order for them to work, they needed affordable, quality and conveniently located childcare. Nurses have similarly indicated the importance of childcare when considering and managing a balance between their work and home lives. This paper explores contextual work and home life balance dialogues in relationship to nursing recruitment and retention issues and New Zealand nursing. Childcare as a recruitment and retention strategy, is explored in the context of New Zealand nursing and compared with the childcare strategies employed for nurses by Britain and Australia – New Zealand's major competitors for New Zealand nurses. The author concludes that, in light of the international shortage of nurses, childcare is an important recruitment and retention strategy which is currently absent in many of New Zealand's district health boards. Recommendations are offered to support the balance between work and home life for nurses and reconcile orthopaedic nurses to the clinical setting in order to provide the quality and efficient care that is needed for New Zealand's ageing society.

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 primary aim of this research paper is to draw on the literature to offer some insight into end of life care in the acute hospital setting. The secondary purpose is to provide an understanding of the integrated clinical pathway (ICP) for the care of the dying, consider its influence related to some of the challenges shaping end of life care and the positive effect it can generate on the quality of care experienced. There are significant challenges that impact on both the delivery and receipt of care for dying patients and their families. Six key influential barriers are considered within the context of the acute setting. Communication and the acute environment are two areas that significantly impact on the quality of care delivered, and are explored in more depth. Narratives from nursing and medical staff convey the realities encountered and difficulties experienced when they are unable to provide the care to which they aspire. Stories are shared by patients and families, which reflect on their experience of end of life care in the acute setting, and offer heath professionals some insight into the lives of the people nurses care for. The literature in relation to the development and implementation of the Liverpool Care of the Dying Pathway, and an overview of the Pathway document is presented. The strengths and limitations of its use are considered, alongside its influence beyond the documentation of clinical care. It is not possible to transfer the hospice service into the hospital setting, however the author suggests that through the implementation of the clinical pathway there is an opportunity to transfer best practice guidelines and positively influence the palliative culture in the acute setting.

Abstract: This paper provides an overview of the evolving meaning of 'culture' in New Zealand nursing. Then, drawing upon the findings of research that used hermeneutic phenomenology to explore the experience of nursing people from cultures other than one's own, a description of the constituent parts is of this phenomenon is briefly outlined and followed by an exemplar that describes the coalescent and contradictory nature of the phenomenon as a whole. As New Zealand nurses negotiate the conflicts essential for ongoing development of their practice, interplay of the notions of prejudice, paradox and possibility is evident at intrapersonal and interpersonal levels as well as in relation to professional and other discourses.

Abstract: This research study was designed to identify ways of enhancing patient safety during the administration of medications within the New Zealand context. The researchers employed a multi-method approach that included a survey using the Safety Climate Survey tool, focus groups and three clinical practice development groups. The authors conclude that the outcomes of this study indicate that practice development initiatives, such as the ones outlined in this project, can have a positive effect on nurses' perceptions of organisational safety, which in turn has been demonstrated to have a positive impact on patient safety.

Abstract: The aim of this study was to describe the recruitment strategy and association between facility and staff characteristics and success of resident recruitment for the Promoting Independence in Residential Care (PIRC) trial. A global impression of staff willingness to facilitate research was gauged by research nurses, facility characteristics were measured by staff interview. Forty-one (85%) facilities and 682 (83%) residents participated, median age was 85 years (range 65-101), and 74% were women. Participants had complex health problems. Recruitment rates were associated (but did not increase linearly) with the perceived willingness of staff, and were not associated with facility size. Design effects from the cluster recruitment differed according to outcome. The recruitment strategy was successful in recruiting a large sample of people with complex comorbidities and high levels of functional disability despite perceptions of staff reluctance. Staff willingness was related to recruitment success.

Abstract: The Rating Scale for Aggressive Behaviours in the Elderly (RAGE) is a twenty-one item rating scale, designed specifically to measure aggressive behaviours in the elderly in the psychogeriatric inpatient setting. The purpose of the scale is to qualify the aggressive behaviour, note any changes in the behaviour, and record intervention and/or treatments. This study combines both qualitative and quantitative methods with exploratory and descriptive designs to explore nurses' experiences of using a consistent tool for monitoring, measuring and managing aggressive behaviours. Data gathered over a three month period of implementing RAGE aimed to provide a 'snapshot' of the prevalence, extent and type of aggressive behaviours within the inpatient setting, providing evidence to nurses in developing strategies for the management of aggression. Focus group interviews were used to enable nurses to discuss their experiences of utilising a clinically validated tool in their practice and how this made a difference to their practice. Findings from this research indicate that nurses within the setting found that RAGE is a consistent tool with which nurses can record, measure and monitor aggressive behaviours. Responses from nurses' experiences of utilising RAGE in their practice were varied, with some being unable to articulate how RAGE had made a difference to their practice. Despite this there was an overwhelming positive response for the continued use of RAGE within the setting as a clinically validated tool by which to measure, record and manage aggressive behaviours.

Abstract: In this research, three female registered nurses relived their experiences of being caregiver to a family member who was ill, elderly or had an enduring illness and explored whether they chose, or felt obligated, to assume the role of caregiver because they were nurses. This research was an exploratory descriptive study utilising narrative as inquiry and the method of story-telling. It is women-centered, taking into account the unpaid role of caregiving within families most often fulfilled by women. Four main themes were identified and renamed to highlight research findings – these were the culture of nursing, silence of the nurses, emotional cloudiness, and the natural role of the nurse. Through this study it is hoped that nurses will be more aware of the impact their caregiving roles have had on their lives. The importance in acknowledging the effects of caregiving, relevance of informing employers to promote supportiveness, implications for workforce development and recognising the loss of objectivity in caring when emotions are involved, are identified in this research. The author suggests that further indepth research about these concepts would be a valuable contribution to the nursing profession and ideas for future research have been identified.