Abstract: Problem based learning (PBL) has been used in a Bachelor of Nursing course since 1996 and several modifications to this delivery have been made. These changes were in response to concerns from students and tutors that students knowledge level was not appropriate and they were unable to apply this knowledge to their practice. The pure PBL process has been adapted to gradually move from tutor direction to self-direction. This has enabled students to develop critical thinking, problem solving, information retrieval and evaluation skills and group work skills over an 18-week period.However, no rigorous evaluation of these changes had been undertaken and so the purpose of this study was to evaluate how the current format of PBL was meeting students learning needs. An action research method was chosen as most relevant to the context and the questions posed, namely: How useful are the classroom activities in developing students understanding and integration of knowledge? How well do the students perceive they are learning compared to traditional teacher-centred methods?Two cycles of the action research method (Cardno and Piggot-Irvine, 1994) were used, involving four tutors and 17 students. Data was collected both quantitatively and qualitatively. Findings indicated the importance of: explaining the purpose and process of PBL; communicating in detail the role of both students and tutors; keeping communication open between students and tutors; addressing timetabling issues and valuing this method of learning for nursing practice. Implications for nursing education are addressed

Abstract: This article presents the findings of a search for evidence to support the 45-60 degree angle of insertion for intramuscular injection of vaccine which is recommended in New Zealand. With the objective of discovering the evidence base for an intramuscular injection angle which differs from that recommended by the World Health Organisation and the accepted practice experienced by the author in the UK, Canada, Malawi and the USA, a comprehensive library and internet literature search was undertaken. Information was also sought by personal correspondence and contact with a range of immunisation specialists. Both the literature specifically on needle angle and that which includes needle angle within a wider investigation of technique is included. Overwhelmingly the evidence supports a 90 degree angle of needle insertion for intramuscular injection as being most effective in terms of patient comfort, safety and efficacy of vaccine.

Abstract: This dissertation is an exploration of what underpins and informs clinical nursing practice by telephone in mental health emergency settings. A critical review of the literature provides the foundation for discussion. Points of reflection explore links between the literature and the author's own experience and thoughts about clinical practice. Findings are presented within three main sections. 'Historical Context' considers the development and function of mental health emergency service telephone work. Practical aspects are discussed under `Service Provision Context.' 'Nursing Context' explores the fundamental skills involved in clinical reasoning and the preparation of staff for telephone work. Whilst 'Best practice' in the area of nursing by telephone is yet to be well defined, this work aims to provide a foundation for further inquiry, research and dialogue.

Abstract: Oral history accounts of the care of the hospitalised child in the context of family are used to argue that current practice paradoxes in family-centred care are historically ingrained. The article looks at the post-war period, the intervening years, and current practice, centred on the changing concept of motherhood throughout that time. The conflict between clinical expediency versus family and child needs is explored.

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.