Abstract: Nursing shortages, technology, advances in genetics and the knowledge explosion are trends that have an influence on the nursing profession in the future. This article will examine these trends and give an overview of what it may be like to nurse in an acute-care hospital in the year 2020. The impact of leadership, management and political influences will also be discussed. The American concept of 'Magnet' hospitals will be described as one possible solution to the issues that affect the nursing profession in New Zealand.

Abstract: Mobile computing is rapidly becoming a reality in New Zealand health care settings. Personal Digital Assistants (PDAs) are the most frequently used of these mobile technologies, giving nurses access to clinical learning resources, including drug references, medical encyclopaedias and diagnostic information. The implementation of mobile computing at Waikato Institute of Technology (Wintec) will ensure graduates of our Bachelor of Nursing Programme are able to meet health care service demands for knowledge in contemporary information technologies as well as the information technology requirements defined by the Nursing Council of New Zealand and the Health Practitioners Competency Assurance Act 2003 for registration as a nurse in New Zealand. This paper presents strategies for the implementation of mobile computing as a core element of the curriculum for the Bachelor of Nursing Programme at Wintec in Hamilton.

Abstract: This paper explores the benefits of using education as one means to advance palliative care competence for nurses. A literature search was conducted revealing numerous educational initiatives and approaches have been developed to improve palliative care. Benefits include improved nursing knowledge, confidence and competence which directly correlate with improved patient outcomes. Accompanying the shift of palliative care from hospices to varied health care providers globally, are disparities in care provision. The literature suggests that reasons for such disparities include insufficient specialised palliative care knowledge and skills of nurses to effectively deliver this care within generalist health settings and lack of information for caregivers. In response, approaches aimed at improving palliative care include reviewing, redefining and implementing nursing roles, education courses, and theoretical frameworks to inform practice and improve outcomes. This paper focuses on the benefits of offering tailored palliative care education in work settings to improve patient care. One entrepreneurial education initiative aimed at advancing palliative nursing and which is currently being implemented in aged care contexts is shared. Careful strategic planning and working more collaboratively between all stakeholders, is strongly recommended in order to manage current and future challenges. Advancing palliative nursing care using appropriate education is achievable and beneficial but is fraught with complexities.

Abstract: This thesis uncovers a personal journey of reflective practice, focusing on the author's emerging role as a nurse facilitating transitions using a dialectical approach in the context of a private nursing practice. Transitions encompass: life changes, loss, and adjustment to changes in function. Dialectical nurse facilitation of transition (DNFT) is a way of exploring self in the transitional space between “the no longer and the not yet”. In this facilitated process people potentially discover paradoxes, tensions, and creative energy, as they search for a way forward. The research design details a dialectical heuristic quest through journaling and reflecting on practice supervision and peer review, over a two year period. Exemplars written after reflecting on case notes reveal the lived experiences of participants. These case reviews show the complexity of patterns for people undergoing transitions and nurse facilitation. A relational pattern for DNFT encompasses compassionate engagement, catalytic mirroring, and interconnectedness. An exploration of literature encompasses nursing theories, facilitation, dialogue, loss, grief, spirituality and transition. This thesis provides a basis for evaluative research on the effectiveness of DNFT in health care settings in the future. Discussions regarding the expansion of these reflective and praxis genres are included which may be of interest to nursing education and practice contexts.

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: The objectives of this study were to explore the concept of the 'health-promoting school' in a specific New Zealand context; to develop and use appropriate research methods to assess a single low decile school in relation to World Health Organization health-promoting school components and checkpoints; to work with the school community to identify health issues; and, to record external and internal changes that could impact on school health over a finite time period. Case study was selected as the most appropriate method to collect both quantitative and qualitative evidence with the aim of providing a clear understanding of the particular case. Results confirmed that the school was working appropriately within the scope of their educational practice to provide a health-promoting school environment for the school community. Gaps and issues identified included an element of talking past each other between the cultures of the education organisation and the nominated health service provider respectively that contributed to a lack of appropriate and accessible health service delivery for the school population. Teaching staff considered that they had insufficient access to health knowledge, and input from health service staff did not meet health education requirements for the school. Staff preference for increased school nurse involvement was not realised. The consequence was that two outside agencies (KiwiCan and Life Education Trust) delivered the bulk of the Health and Physical Education curriculum which resulted in a degree of fragmentation of health education for students. The issues that were identified demonstrated that health services in the area were not satisfactorily meeting the needs of the community and were not addressing the health inequities for the predominantly Pacific Island and Maori students and of their families that formed the school community. The researcher concluded that a full-service school approach should be considered by the school and the local district health board as one way to overcome the current lack of access to health services for the school community. Assertions included the potential integration of locally available services by a school-based nurse coordinator supported by health professionals (nurse practitioner and Pacific Island Community Health Worker) and social workers. The vision included professionals working within their professional scopes of practice as part of a Primary Health Organisation with the aim of appropriately addressing the health inequities experienced by the school population.

Abstract: Critical Comparative Nursing Assessment (CCNA) is a theory about how the competence of completing Bachelor of Nursing students in New Zealand is determined. Semi-structured, audio-taped interviews and field notes were used to collect data from twenty-seven nurses with experience in undertaking competency assessment. A Glaserian grounded theory approach was used to guide the data collection and analysis. This utilised the processes of constant comparative analysis, theoretical sampling and saturation to generate a middle range substantive grounded theory. This is presented as a model consisting of four emergent categories that explain how nurses formulate professional judgements about competence. These are a) gathering, which describes the processes used to collect evidence of practice to inform decisions; b) weighing up, which explains how evidence is analysed using the processes of benchmarking and comparative analysis; c) judging brings into focus the tensions inherent in making professional judgements about competence and how nurses formulated these, and d) moderating, which describes the processes nurses use to validate decisions and ensure that professional responsibilities and public safety are upheld. The basic social psychological process of comparing integrates these categories to explain how nurses resolve the tensions associated with making decisions about competence. This research presents a new way of viewing and understanding how nurses assess competence. It identifies where the challengers and tensions related to the assessment of competence lie and suggests strategies that if implemented, the author suggests could further enhance the validity and reliability of assessment outcomes.

Abstract: This study focuses on power themes in the nurse-patient relationship. The study is a critical reflection of the author's practice using a humanistic perspective from Hartrick Doane and Varcoe's (2005) model of relational family practice. It reviews the literature relating to power relationships in communication between nurses and patients and compares the ability to provide relational care in the home with hospital care. Practice examples demonstrate the shift in power relationships that the author had noticed since changing roles from hospital based to home care nursing. This is related to cultural, socio-environmental, historical and traditional influences on power in communication. The study is based on her reflection of the paradigm shift in her practice. Her practice moved from a problem solving approach to an empowerment, strengths based approach within partnership. The ethical challenges of discussing her practice in relation to clients has been managed by scrambling patient data so that it is not related to a single person and is focused on the author's nursing practice.