Abstract: The author notes that learning nurses require real clinical experiences in order to apply learnt theory to actual practice. Clinical learning environments have consistently been found to function variably and sub-optimally for both learners and teachers. In order to improve the quality of the clinical learning environment it is necessary to first evaluate how effectively a clinical learning environment is functioning. A number of different methodologies have been used to evaluate clinical learning environments, a recent and successful method being the use of questionnaires or clinical learning environment evaluation tools. The objective of the present study was to develop clinical learning environment evaluation tools for use in a New Zealand hospital health service. Four tools appropriate to evaluate the clinical learning environment from the different perspectives of any type of clinical learner, clinical teacher, clinical manager and programme co-ordinator or nurse lecturer were developed. Six newly graduated nurses, three senior nurses, and the researcher were involved in the development of the evaluation tools over a five month period. A participatory action research methodology was employed. The resultant tools had a unique local focus and were suitably similar to other internationally developed tools. After testing the clinical learning environment evaluation tools, it is hoped that the implementation of the tools will support all stakeholders to understand and consequently optimise the functionality of their clinical learning environment.

Abstract: The author presents a case study of a joint appointment between a nurse lecturer and a staff nurse in an acute forensic psychiatry unit. He explores the advantages, disadvantages and reasons for success in relation to the findings of a survey of the literature on joint appointments. This technique is seen as a means of narrowing the gap between theory and practice which resulted when nurse training was transferred from hospitals to polytechnics. He highlights the need to develop research methodology to clarify potential benefits of this approach.

Abstract: This thesis is a study of the experiences of four cultural safety lecturers in nursing education in Aotearoa / New Zealand. A review of literature reveals the recent and turbulent evolution of cultural safety. The media which documented this journey in a negative light in the 1990s prompted ministerial inquiries and the publication of the Nursing Council of New Zealand's guidelines for cultural safety in nursing and midwifery education (1996). Action research methods enabled the participants to implement change in their practice and gain positive personal involvement in the study. Reflective diaries provided the major tool in this process as participants were able to achieve at least one action research cycle by identifying issues, planning action, observing the action and reflecting. The findings of the research revealed that the participants not only coped with every day stressors of teaching but they were also required to formulate knowledge of cultural safety. For the Maori participants their stress was confounded with recruiting and retaining Maori students and macro issues such as commitments to iwi. Lack of support to teach cultural safety was identified to be a key theme for all participants. An analysis of this theme revealed that it was organisational in nature and out of their immediate control. Action research provided a change strategy for participants to have a sense of control of issues within their practice. Recommendations have been made which focus on supporting cultural safety educators to dialogue on a regular basis through attendance at related hui; the introduction of nurse educator programmes; paid leave provisions for cultural safety educators to conduct and publish research so that a body of knowledge can be developed; and that Maori cultural safety educators be recognised for their professional and cultural strengths so that they do not fall victim to burn out.

Abstract: This reports an audit of the assessment practices at Christchurch Hospital, compared to international guidelines. The clinical notes of all patients who were re- admitted acutely with chest pain within six months of PCI procedures performed between 1/4/05 and 30/9/05 were audited. Ethics approval was granted and an audit tool was designed based on the 2000 ACC/AHA Guidelines for the management of patients with unstable angina. The purpose of the audit was to determine to what extent best practice guidelines were followed in the assessment of patients re-admitted with chest pain and to determine if there were any indicators (lesional, procedural or risk factors for restenosis) that predicted a normal or abnormal repeat coronary angiogram. 448 consecutive patients had PCI procedures, 36 patients represented acutely with chest pain and had repeat coronary angiography. In 18 patients the coronary angiogram was unchanged, 11 patients demonstrated instent restenosis, one patient demonstrated thrombus and six patients developed new lesions. The authors concluded that at Christchurch Hospital assessment practices are consistent with international guidelines. Of the patients who had repeat angiography, 50% had no coronary obstruction for the cause of pain. There was a relatively low incidence of acute representation with chest pain. These results suggest a revision of the guidelines for repeat angiography following PCI is warranted.

Abstract: Within New Zealand nursing education there appears to be a widespread acceptance of problem-based learning and an assumption that the strategies it uses are unproblematic. A review of the literature however, reveals that problem-based learning has drawbacks that may inhibit the achievement of desired graduate outcomes. It seems timely for nurse educators to exercise caution in uncritically accepting problem-based learning approaches and using them as the predominant approach to teaching and learning. To this end, a two-part critique of this teaching and learning method is presented. Part one critiques the methods of problem-based learning, discussing self-directed learning, the group process, self-assessment, and content knowledge. Part two explores the philosophical underpinnings of problem-based learning, and the so-called 'fit' within nursing.