Abstract: The transition of patients from intensive care to the ward environment is a regular occurrence in intensive care. Today patients are often transferred earlier and sicker due to the demands for intensive care beds. This results in patients with higher acuity being cared for in the wards. Here ward nurses have to meet the ongoing complex demands of caring for higher acuity patients, alongside managing high patient-to-nurse ratios, staffing concerns, and varying levels of experienced nurses. This research explored the experiences of ward nurses receiving patients transferred from intensive care. The aims were to identify any areas of concern, highlight specific problems that occur on transition and to address what information is pertinent to ward nurses when receiving patients from intensive care. A qualitative descriptive methodology using focus groups was utilised to gather information about these experiences. Three focus groups were held with ward nurses from various wards within the study setting hospital. All participants had considerable contact with intensive care and were familiar with the processes of transferring patients. Five themes emerged from the focus groups – Patients as intensive care staff say they are; Time to prepare the biggest thing; Documentation as a continuation of patient care; They forget what its like; and Families, a need to know about them. The theme Patients as intensive care staff say they are relates to reliable information sharing focused on the patient, their needs and condition. Participants expressed their concern that patients were not always in the condition that the intensive care staff stated they were on the referral. Having adequate time to prepare was considered important for the majority of ward nurses receiving patients from intensive care. Documentation was highlighted in the theme Documentation as a continuation of patient care particularly in relation to fluid balances and vital sign history. The theme They forget what its like suggests there is a perception that intensive care nurses have a lack of understanding of what the ward staff can actually manage. Decreased staffing levels during certain shift patterns and a lack of appropriately experienced staff on the wards is a common concern for ward nurses. Ward nurses also recognised that caring for families was part of their role. Patients and families may respond differently to the transfer process and their inclusion in transfer planning was seen as essential. Communication was a reoccurring element throughout all themes.The author concludes that communication is the paramount factor that impacts on a 'smooth transition' for ward nurses. A 'smooth transition' refers to the transfer of patients from intensive care to the next level of care. Subsequently, nurses' perceptions need to change, whereby transfer planning from ICU should be the focus rather than discharge planning. Transfer planning and education for all nursing staff is vital if the transfer process is to be improved. Consequently, transitional care within the context of ICU aims to ensure minimal disruption and optimal continuity of care for the patient. The knowledge gained from this research may provide better understanding of the multifaceted issues linked with transitional care that may be adapted for a wider range of patients in various clinical environments.

Abstract: In this project the author reveals how she is observing and thinking as she cares for people who are dying. She records her reflections and insights and reveals that there is life right up to the moment of death, having observed terminally ill patients choosing the precise moment to die. She describes her observations of these moments by using poetry and stories, and explores the implications for her practice as a result. The author presents her reflections using an individualistic, reflective and exploratory perspective which is informed by the work of nursing scholars. This paper is framed using the metaphors of a journey and a window to indicate the reflective process that the author used to journal her observations in practice over time.

Abstract: In this research, three female registered nurses relived their experiences of being caregiver to a family member who was ill, elderly or had an enduring illness and explored whether they chose, or felt obligated, to assume the role of caregiver because they were nurses. This research was an exploratory descriptive study utilising narrative as inquiry and the method of story-telling. It is women-centered, taking into account the unpaid role of caregiving within families most often fulfilled by women. Four main themes were identified and renamed to highlight research findings – these were the culture of nursing, silence of the nurses, emotional cloudiness, and the natural role of the nurse. Through this study it is hoped that nurses will be more aware of the impact their caregiving roles have had on their lives. The importance in acknowledging the effects of caregiving, relevance of informing employers to promote supportiveness, implications for workforce development and recognising the loss of objectivity in caring when emotions are involved, are identified in this research. The author suggests that further indepth research about these concepts would be a valuable contribution to the nursing profession and ideas for future research have been identified.

Abstract: This action research project explored the factors that helped or hindered student nurse clinical learning from the perspective of nurse educators, practitioners and students. Participant analysis of their own discussions identified both common and disparate views regarding the student's learning experience. Researcher analysis identified five practical and three organizational issues that influenced the development of more effective partnerships between these three stakeholder groups that would facilitate student clinical learning. The practical issues were how to deal with the 'problem' people in the learning process, how to clarify and develop the various roles in the learning context, how to generate more effective communication, how to respond more effectively to the impact of the changing environment, and how to maximize 'moments of learning'. The organizational issues were identified as the schisms between the disparate personal and organizational cultures that direct the way educators, practitioners and students, perceive, think, feel and act

Abstract: This feminist study is an exploration of the subjectivity of women working as nurses within the gynaecological ward. Gynaecology has a long history as a unique area of concern to the health practitioners of any given period. However, the author suggests, recently with the development of modern gynaecology, this specialty has become based on male knowledge and male texts, women either as patients or nurses appear voiceless within this canon. Major tests within nursing mirror a medical construction of gynaecology, with the women involved in the discourse again absent from the literature. To explore the nurses' reality within the gynaecological ward, the author has undertaken a feminist interpretive study. To contribute to this debate the author drew on certain specific notions from feminist and postmodern epistemologies. These notions of the Other, difference, the body and discourse provided a unique way of viewing the practice of the nurses in this gynaecological setting. These epistemological concepts were then interwoven with feminist strategies to undertake the research. Through the process of feminist praxis, which included the author working alongside the nurses and conducting in-depth interviews, three areas of general concern to the nurses emerged. Firstly the relationships, that is their relationships with each other as nurses and with their women patients. Secondly, the difficulties inherent in nurses' practice in this setting due to the nature of the experiences of the women they were nursing. These difficulties arose in relation to two particular situations, nursing women experiencing a mid-trimester termination and nursing women with cancer. Thirdly, the relationship with/in the medical discourse and individual doctors which, according to nurses, had a major impact on their work. This study contributes to nursing knowledge by providing a forum for the voices of women as nurses, who nurse women in the gynaecological ward, to be heard. The author concludes that nursing and feminism have much to offer each other and share an emancipatory goal of positive action to support and assist people in their lives.

Abstract: Respiratory nursing has, as a core clinical concern, the alleviation of distress and suffering associated with respiratory disease. This research describes the ways in which experienced New Zealand respiratory nurses understand, assess, manage and support patients suffering from chronic breathlessness. It reviews the professional context in which these nurses practice, and examines the experiences and beliefs that have lead them to, and maintain them in, this area of practice. This study has been stimulated by the realisation that the skills, understandings and practice wisdom exhibited by experienced Respiratory Nurses is poorly described in the published research literature. This qualitative, grounded theory research is based upon data gathered from in-depth interviews with six experienced New Zealand respiratory nurses. A constructivist research position is adopted. Analysis of these interviews revealed distinct phases of developing respiratory nurse practice including preparing and entering respiratory nursing practice, comprehension of the phenomena of chronic breathlessness and the effect upon the patient and the seeking of possibilities which may alleviate and modify the debilitating effects of chronic breathlessness. Consistent values and beliefs are identified, which are captured in the concepts of professional caring and the movement towards developing expertise in practice. The unifying concept of journeying is employed to draw together these conceptual elements and develop a substantive model describing the work of experienced respiratory nurses with patients with chronic breathlessness. Implications for practice and the health system, and suggestions for further research, are discussed.

Abstract: This research paper reports on the findings of a literature review conducted to establish and analyse the international magnitude, context and effectiveness of nurse-led heart failure initiatives. The research revealed that the underlying philosophy in establishing nurse-led disease management programmes of care is that, by treating chronic heart failure as a continuum, it is possible to decrease exacerbations and improve patient outcomes. Regardless of the type of heart failure management programme, critical components of care include a collaborative supportive approach that educates and empowers the patient (including family/whanau) to recognise the early indicators of exacerbation, access expedient care, and to adhere to evidence based treatments. The author points to significant evidence to support the establishment of nurse-led heart failure programmes. The positive outcomes associated with this model of care delivery include decreased readmissions, reduction in mortality, and cost efficiencies. However, the organisational model of care, or programme components that are the most effective in optimising patient outcomes, need to be selected on the basis of local healthcare infrastructure, services and resources. The author suggests that New Zealand has a unique opportunity to encompass the recent emergence of the Nurse Practitioner role in facilitating, coordinating and monitoring of heart failure programmes across the continuum of care. The delivery of evidence-based, cost effective, heart failure programmes is a prerequisite to improving the delivery of optimal treatment and ensuring that heart failure patients have the opportunity to attain quality care outcomes.