Abstract: In this article the author discusses the New Zealand legislation aimed at protecting the individual's right to privacy and concludes that practice may place healthcare consumers' rights at risk. While patient privacy should be of concern to all health professionals, the focus here is on the nurse's role in relation to recently formulated competencies published by the Nursing Council of New Zealand, which includes the recommendation that care be seen to exhibit an awareness of healthcare consumers' rights to privacy alongside the expectation that nurses question practices that compromise patient privacy.

Abstract: The authors report a survey of all nurses working in hospitals included in the International Hospital Outcomes Study of staffing and patient outcomes in New Zealand's secondary and tertiary hospitals from 1988-2001. The survey examines the way in which the hospitals have been restructured and analyses patient outcomes. Research has identified links between how nursing is organised in a hospital and that hospital's patient outcomes.

Abstract: The present paper draws on experiences and insights gained by a group of psychiatric nurse practice development facilitators whilst working with consumers, carers, clinicians and managers in the context of a practice development programme in a large metropolitan psychiatric hospital. The paper describes how the practice development facilitators were able to adapt techniques of motivational interviewing, commonly used in drug and alcohol treatment services, to help motivate change in an aged care setting. The lessons embedded within this experience are that people do want change, and that sustained change requires ownership and support. Practice development facilitators can assist in this process though the use of principles and strategies of motivational interviewing, which include increasing awareness of the need for change, supporting self-efficacy and managing resistance to change.

Abstract: Using thematic analysis, this study explored the phenomenon of effective education for critical care nursing practice by asking: What does effective education for critical care nursing practice mean to nurses currently practising in the specialty? Eighty eight critical care nurses from the South Island provided written descriptions of what effective education for critical care nursing practice meant to them. Descriptive statements were analysed to reveal constituents, themes and essences of meaning. Four core themes of personal quality, practice quality, the learning process and learning needs emerged. Appropriateness or relevance for individual learning needs is further identified as an essential theme within the meaning of effective education for critical care nursing practice. Shared experiences of the phenomenon are made explicit and discussed with reference to education and practice development in the specialty. The study results lend support to education that focuses on individual learning needs, and identifies work based learning as a potential strategy for learning and practice development in critical care nursing.

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: This reports on an initiative at Whakatane Hospital, where a Nurse-Led pre-assessment (NLPA) was delivered at an outpatients clinic. NLPA involves taking a comprehensive medical history, a nursing assessment, physical examination, airway assessment, ordering appropriate investigations and carefully documenting the process and results. More valuably, it provides an opportunity for the patient to participate in planning their care. The aim of this initative was to short circuit delays and congestion in existing pre-assessment clinics, streamline the pre-assessment process and reduce the number of patient visits to hospital. Reducing cancellations of surgery (often on the day of surgery) and “did not appear” (DNA) numbers were also objectives. After a small pilot, a six-month trial was funded by the Ministry of Health. Over the six-month trial, 373 patients attended NLPA; 178 patients required anaesthetist review before surgery, and 198 could proceed directly to surgery following NLPA. An anonymous postal survey was made of patients, who indicated satisfaction with the service. Other outcomes are discussed, and the trial was deemed successful. Follow up plans have been disrupted by restructuring at the hospital and the clinic has yet to be implemented.

Abstract: This study sought to examine the effects that hospital re-engineering may have on adverse patient outcomes and the nursing workforce. In 1993, New Zealand implemented policies aimed at controlling costs in the country's public health care system through market competition, generic management, and managerialism. The study was a retrospective, longitudinal analysis of administrative data. Relationships between adverse outcome rates and nursing workforce characteristics were examined using autoregression analysis. All medical and surgical discharges from New Zealand's public hospitals (n=3.3 million inpatient discharges) from 1989 through 2000 and survey data from the corresponding nursing workforce (n=65,221 nurse responses) from 1993 through 2000 were examined. Measures included the frequency of 11 nurse sensitive patient outcomes, average length of stay, and mortality along with the number of nursing full time equivalents (FTEs), hours worked, and skill mix. After 1993, nursing FTEs and hours decreased 36% and skill mix increased 18%. Average length of stay decreased approximately 20%. Adverse clinical outcome rates increased substantially. Mortality decreased among medical patients and remained stable among surgical patients. The relationship between changes in nursing and adverse outcomes rates over time were consistently statistically significant. The authors conclude that in the chaotic environment created by re-engineering policy, patient care quality declined as nursing FTEs and hours decreased. The study provides insight into the role organisational change plays in patient outcomes, the unintended consequences of health care re-engineering and market approaches in health care, and nursing's unique contribution to quality of care.