Abstract: The purpose of this literature review is to generate a picture of what is known and what needs to be investigated further about anaesthetic nursing in the perioperative nursing role in New Zealand, and to examine this in relation to international trends. Nurse anaesthetists in the United States are described in American nursing literature, and recognised as one of the four advanced nurse practitioner roles. In New Zealand, recent efforts to provide appropriate post-graduate education for the perioperative nurse have been challenged by other inter-professional interests, thus restricting the development of an expanded role. The author notes that this has caused concern for New Zealand's perioperative nurses who consider anaesthetic nursing is an integral part of perioperative practice. Anaesthetic nursing forms a substantial component of the basic competencies required of a registered nurse working in the operating theatres. Orientation programmes and ongoing education at all levels of professional development incorporate anaesthetic nursing competencies to provide continuity of patient care and support perioperative practice. Care of the patient undergoing anaesthesia is an area where nurses demonstrate their advanced assessment skills and clinical judgement and is included in perioperative specialist or nurse practitioner job descriptions. The Perioperative Nurses Association in New Zealand is concerned to develop postgraduate education in their area of speciality to support their application for 'College' status within the New Zealand Nurses Organisation. For this to happen in a cogent fashion, information and knowledge generated from research, are required to clarify perioperative nursing's current position and determine how practice can be shaped to best care for patients undergoing surgical interventions. Evidence from research supports nurses in the anaesthetic role by demonstrating that the preoperative visits and assessments they undertake can reduce patients' anxieties, decrease the need for pain relief and shorten hospital stays. This review includes literature sources that explore disparities between the development of New Zealand anaesthetic nursing and international models. The author suggests that information and understanding gained from conducting this review will allow future developments in anaesthetic nursing practice to be informed by previous initiatives and projects and identifies areas for further research.

Abstract: Nursing literature reflects that nurses have been exploring and experiencing the process of clinical supervision for well over a decade. Nurses in the United States, United Kingdom, Scandinavia, and Australasia have written much over the past fifteen years. However, the author notes that nurses grapple with what clinical supervision is within nursing development and disquiet continues to emerge in the literature. This literature review expands on themes that surround this disquiet. These centre on continued confusion and lack of clear definition; whether psychotherapy is implemented under the guise of clinical supervision, who uses it, and the dearth of empirical evaluation of its effectiveness. The lack of significant empirical evidence of its ability to assist practitioners to deliver improved patient/client care continues despite claims of improved professional and personal development, therapeutic relationship, and occupational stress management. These claims come from both supervisees and supervisors. The manner in which clinical supervision is portrayed in nursing in that it is frequently referred to as a support system, rather than one of learning a complex set of communication skills is also highlighted. The continued debate on what model(s) best suit nurses, or whether line management should provide clinical supervision as a means to ensure quality standards and control over nursing practice and optimal patient care is discussed. Whether nursing should stop borrowing from other fields and develop their own model(s) is also raised. Two emerging stances focus on a process that is practice-based as identified by senior staff and management, or one that continues along the lines of what psychotherapy has developed with practitioner-identified developmental needs. These issues raise many questions for further development in nursing, one being are nurses developed enough in their self-awareness to understand what they are to adopt into their practice? Authentic voices from those nurses experienced in the practice of providing and receiving clinical supervision, are shaping therapeutic practice for nurses in the future, and continue to sharpen the debate. Some reference to unpublished data and local practice in the Wellington area have been included as a stimulus for further incorporation of clinical supervision in local practice development.

Abstract: The Rating Scale for Aggressive Behaviours in the Elderly (RAGE) is a twenty-one item rating scale, designed specifically to measure aggressive behaviours in the elderly in the psychogeriatric inpatient setting. The purpose of the scale is to qualify the aggressive behaviour, note any changes in the behaviour, and record intervention and/or treatments. This study combines both qualitative and quantitative methods with exploratory and descriptive designs to explore nurses' experiences of using a consistent tool for monitoring, measuring and managing aggressive behaviours. Data gathered over a three month period of implementing RAGE aimed to provide a 'snapshot' of the prevalence, extent and type of aggressive behaviours within the inpatient setting, providing evidence to nurses in developing strategies for the management of aggression. Focus group interviews were used to enable nurses to discuss their experiences of utilising a clinically validated tool in their practice and how this made a difference to their practice. Findings from this research indicate that nurses within the setting found that RAGE is a consistent tool with which nurses can record, measure and monitor aggressive behaviours. Responses from nurses' experiences of utilising RAGE in their practice were varied, with some being unable to articulate how RAGE had made a difference to their practice. Despite this there was an overwhelming positive response for the continued use of RAGE within the setting as a clinically validated tool by which to measure, record and manage aggressive behaviours.

Abstract: Parent-infant skin-to-skin care has become an advocated aspect of care in neonatal intensive care units nationally within New Zealand and internationally. However the implementation of this care by nurses can be limited by a number of factors within the practice environment. This dissertation presents a critical analysis of literature alongside reflection on the author's own practice experience to explore factors that may be constraining the use of skin-to-skin care with the very low birth weight infant in the neonatal intensive care unit. These factors are examined through a lens of risk taking behaviour underpinned by the grounded theory work of Dobos (1992). The concept of risk is explored in order to develop an understanding of why, in the author's view, the practice of skin-to-skin care of very low birth weight infants may have declined in recent years. For neonatal nurses skin-to-skin care of the very low birth weight infant presents challenges related to the environment, physiological stability of the infant and changes over the past 10 years in the clinical management of very low birth weight infants. As progress is made toward the design, development and eventual move to a new unit in Dunedin recommendations pertaining to the change in physical space, the introduction of a structured model for nursing care and implications for nursing practice development in relation to skin-to-skin care are described.

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.