Abstract: This qualitative study investigated surgical nurses' perceptions of patient-controlled analgesia as a strategy for managing acute pain in a tertiary care hospital. Patient-controlled analgesia is commonly used and nurses play an essential role in caring for patients prescribed it. The study was divided into two parts. First, audiotaped semi-structured interviews were conducted with 10 nurses. The interviews were followed by a postal questionnaire to 336 nurses with 171 returned. Thematic analysis was the chosen methodology. The audiotaped transcripts and questionnaires surfaced five themes, with the dominant one being `I think PCA is great, but . . .'. The paper outlines and explores these themes and addresses the implications arising from the research for both clinical practice and education.

Abstract: This study examines the communication strategies used by nurses on the ward in one aspect of the job, namely the ways that they describe health procedures to patients. The data used in this project was collected by nurses on a busy hospital ward as part of Victoria University's Language in the Workplace Project. Three nurses carried minidisc recorders as they went about their normal working day, recording their conversations with patients, visitors, and other staff. The data was collected in a women's hospital ward. All patients, nurses, cleaners and ward clerks were female; two doctors were female and two were male. Twenty three instances where nurses described procedures to patients were identified in the data set. The analysis identified several typical components; indicated there was no fixed order of components; and demonstrated that all except the core component of describing the procedure were optional rather than obligatory elements. The researchers note this is qualitative and exploratory research. The findings demonstrate the benefit of discourse analysis within a sociolinguistic framework for the analysis of nurse-patient interaction. The results indicate that health discourse is not one-sided, nor is it as straightforward as many nursing textbooks suggest.

Abstract: This study looks at the effect of implementing the Tidal Model at Rangipapa, a regional secure mental health forensic unit. A phenomenological study was undertaken to obtain reflective description of the nursing care experience from the perspective's of four registered nurses and four “special patients”. Five major themes were identified that appeared to capture the experiences of the participants. The themes show changes to the unit's unique culture and values following implementation of the model. These changes engendered a sense of hope, where nurses felt they were making a difference and patients were able to communicate in their own words their feelings of hope and optimism. Levelling was experienced as an effect emerging from individual and group processes whereby a shift in power enhanced a sense of self and connectedness in their relationships. These interpersonal transactions were noted by the special patients as being positive for their recovery. This enabled effective nurse-patient collaboration expressed simply as working together. The participants reported a feeling of humanity, so that there was a human face to a potentially objectifying forensic setting. Implications arising from this study are that the use of the model enables a synergistic interpersonal process wherein nurses are professionally satisfied and patients are validated in their experience supporting their recovery.

Abstract: This paper outlines the project outcomes, benefits, impact and constraints of introducing the named nurse concept to a neuro-services department. The concept of the named nurse was first introduced in the UK, in 1992, with the aim of supporting the partnership in care between the patient and the nurse. The evidence for the effectiveness of introducing the named nurse concept is largely anecdotal. In line with the hospital wide policy of implementing the named nurse concept at Auckland Hospital, a six-month pilot study was undertaken within the Neuro-services Department. The aims of the study were to foster a partnership in care with patients / whanau and the multidisciplinary team, to improve the efficiency and effectiveness of delivery of nursing care, and to contribute to continuous quality improvement. The results highlighted that, in theory, the named nurse concept would be effective in providing quality co-ordinated care, however factors were identified that hindered the effectiveness of its implementation. Therefore, further development of the concept was required.

Abstract: The aim of this study is to analyse the discourses drawn upon by community paediatric nurses in relation to children's rights to health. The philosophy of Michel Foucault has been used to underpin the analysis of the interviews and exemplars of five experienced community nurses, revealing conflicting power relationships and discourses. Rights are formalised morality and so from a children's rights perspective, discourses reflect both the moral and ethical positions of the nurses. Children are constructed as developing human beings whose moral status gradually changes and who, through a lack of developmental autonomy, entrust their decision-making to their representatives (parents and caregivers) as their trustees. Rights are correlative with the obligations and duties toward children by both families and society. Society constructs legislative and politically organised structures to govern raising children because children are an intrinsic social concern. Whilst representing society's interest in children's rights to health, nurses in the home act as a conduit for multiple governing structures. The nurses in this study construct their “truths” and knowledge about children's health rights from nursing, medicine, law, education, and social policy. However, the values of individual parents can conflict with universal values for children's health and wellbeing. Therefore representing society positions nurses as “agents of the state”, a role that potentially holds power over parents and children and leads to the epithet of “the health police”. Within the institution of the family, and in the privacy of the home, there are also mechanisms of power that can resist the mechanisms of the state and its representatives. Therefore the discourse “it takes a village to raise a child” competes with the “my home is my castle” discourse. Nurses negotiate a fine balance between these power relations. Nurses are challenged with using power productively to promote children's rights whilst respecting the role of parents and families. The author argues that children's rights are central to the moral and ethical work of nurses but that such work is often obscured and invisible. She proposes that children's community nurses are excellent at negotiating networking and connecting at a micro level, but need to create a more sophisticated and cohesive entity at a macro level to become fully political children's rights advocates.

Abstract: This study compared the perceptions that registered psychiatric nurses have of their roles with their actual practice. Following the closure of large scale psychiatric institutions in New Zealand, there was was an increased demand for limited beds in acute inpatient facilities for acutely mentally ill patients. This change in location and downsizing of acute inpatient beds challenged traditional roles of mental health nursing, resulting in confusion over what roles mental health nurses should now perform in the new context of care. This qualitative descriptive exploratory study observed nursing practice on three selected wards and used focus group interviews to establish from registered nurses what they perceived their roles to be. A key finding of this study was that many of the nursing roles related to delivering care from a crisis management perspective, which covers aspects such as assessment, stabilisation of symptoms and discharge planning. Participants also believed that the therapeutic relationship was a fundamental role in inpatient care. Nurses used any opportunity to make it a reality such as kitchen organisation, medications, or dealing with a challenging patient. This study highlighted the complexity of the roles that nurses performed and went some way to give voice to what at times seems an invisible practice.

Abstract: Postnatal depression is a term used loosely to describe disorders of mood and distressing symptoms for women in the postpartum, yet it has its own distinct symptoms. It is thought to affect between 10 and 20 percent of new mothers in New Zealand. In order to deliver effective nursing care that has a positive impact on the health of women who experience postnatal depression, nurses need knowledge and theory to underpin practice. This study explores the experience of four women who experienced postnatal depression and the care they received from a nurse. A postmodern feminist position informed the research project. Women became actively involved in a focus group to explore their experiences. A thematic analysis of the focus group transcripts revealed the women's experiences of care from nurses and health professionals as not always helpful. The themes that arose from the analysis were knowledge, perception, care and self. Knowledge examined the women's and significant others' knowledge of postnatal depression as well as women's own knowledge of themselves. Perception identified the women's beliefs of and views on mental illness, as well as their expectations of motherhood. Care as a concept was examined as to how it was provided by nurses. This encompassed a lack of care and, in contrast, supportive care as impacting on the women's individual experiences. Self described the experiences of a loss of self as women experienced their distress in the postpartum, and that a regaining of self was identified by women as difficult, and this is where they required support. The themes are discussed and critiqued with literature that identifies the nursing role with women who experience postnatal depression. There are recommendations for ongoing research and development of the nursing role in order to promote the health and wellbeing of women in the postpartum.