Abstract: This dissertation is a review of evidence underpinning the recommendations for pressure ulcer prevention from four national guidelines frequently used as a foundation for best practice. The focus is on grade-1 pressure ulcer prevention for “at risk” patients, in the acute environment. Rationale: Prevention is better than cure. While preventive strategies maybe effective are they supported by evidence? Results: The strongest evidence for best practice appears to be limited to an established fact that standard hospital mattresses should at least be replaced by high specification foam, pressure reducing mattresses for patients “at risk” or vulnerable to pressure ulcer development. Repositioning, skin assessment, skin protection and maintenance, traditionally the basis of pressure ulcer prevention, appear to have a paucity of strong supportive evidence. Further evidence is emerging on clinically important areas such as erythema and mattresses. Implications for Nursing: The organisational or ministerial support for education of the multidisciplinary team, especially nurses in risk assessment and prevention strategies. This support is required both in release time and finances for education and in adequate funding for preventive strategies. The author concludes that strong evidence to support the recommendations of the guidelines appears to remain limited, particularly in the acute environment. Expert opinion would appear to remain the basis for current best practice for pressure ulcer prevention. The volume and consistency of this evidence worldwide is substantial and adds validity to the recommendations. Best practice includes firstly risk assessment, skin assessment, maintenance of skin temperature, moisture, and condition, and the importance of repositioning, in conjunction with an appropriate support surface. However gaps remain in the supportive evidence in many of these fields. Advances in practice include pressure relief or reduction considerations for all surfaces the patients encounter. There appears to be no gold standard for prevention of pressure ulcer development.

Abstract: This dissertation explores the nurse's role in addressing the sexual health needs of a rural adolescent community in New Zealand. The increasing incidence of adolescent sexual activity is widely recognised and it is acknowledged that youth face unique barriers to health care. These barriers are particularly apparent in access to contraception with a resulting increase in the rates of sexually transmitted infections, unintended pregnancies and termination of pregnancies. These deteriorating adolescent sexual health statistics are of particular concern within New Zealand's health sector. A review of national and international literature examined the potential nursing role in adolescent sexual health. Results provide strong evidence that experienced nurses can competently and confidently assist in meeting the needs of this population group, especially in rural areas. Literature consistently concluded that nurses could provide care that is as effective as that provided by a doctor. School-based health clinics are identified as a viable way to improve access to adolescent sexual health services. In conclusion, the author suggests that nurses are in a key position to provide an alternative model of health care delivery that can improve adolescent sexual health.

Abstract: This article explores some of the functions of psychiatric diagnosis and the implications this has for mental health nursing care. It critiques the psychiatric diagnosis as a categorisation process that maintains oppressive power relations within society, by establishing and enforcing normality through gender, culture and class biases. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders is used to illustrate some of the inherent biases in the diagnostic process. The author argues that mental health nursing practice needs to demonstrate an awareness of the power relations inherent in any diagnostic process and make attempts to redress these at both the individual and sociopolitical levels. To create a true patient-centred partnership in mental health nursing, the nursing focus should be on the patient's experience rather than the psychiatric diagnosis with which the experience is attributed. NB this is a reprint of article first published in Journal of Advanced Nursing, 2000 Mar; 31(3), 583-9.

Abstract: The aim of this qualitative study was to evaluate the usefulness of formal reflection in the context of undergraduate nursing education during the teaching of a disability module. Reflection is defined as examination and exploration of an issue of concern to help create or clarify meaning.Twelve reflection assignments written by second-year nursing students were analysed. The analysis indicated that students' reflection focused less on their experience of working with people with disabilities and more on their overall learning experience and coping with clinical practice. A central theme, Coping with Clinical Practice, and four sub-themes were identified. Students acknowledged reflection as beneficial to their learning and linked to their clinical practice.

Abstract: This paper reports a study that examined the factors that assisted or hindered the transition of a group of enrolled nurses to registration/degree programmes, via a flexible course developed by a North Island tertiary institution. The study follows ten enrolled nurses, primarily Maori and working in rural settings, as they continued to work while studying at a small satellite campus. The study was exploratory and descriptive, and utilised focus group interviews. Two major categories emerged from comparative analysis of the data. One category entitled 'relearning how to learn', demonstrated the cognitive and behavioural adaptations made and is the focus of this paper. The other category 'barriers and catapults', demonstrated the physical and environmental factors that influenced the students' transition but is outside the scope of this paper. Recent changes in New Zealand nursing education have witnessed the clarification of scopes of nursing practice and the controversial development of a new Certificate in Health Science (Nurse Assistant). Currently enrolled nurses are again facing threats to employment and it is envisaged that many will be seeking to undertake transition to registered nurse in the near future.

Abstract: A study of the life histories of five self-identified lesbian women in nursing is reported. A metastory of “In/Visibility” captured the essence of lesbians being the focus of intense scrutiny while at the same time feeling the pressure to keep their lifestyle and identity hidden from others. Seven story themes were elaborated: closeting of lesbianism in nursing, isolating and hiding from self and others, living a double-life, self-loathing and shame, experiencing discrimination from others, keeping safe, and threatening others who are closeted.