Abstract: Huarahi whakatu describes a pathway for recognising the expertise of nurses working in kaupapa Maori mental health services and recommends a professional development programme that can lead to advancement along the pathway. An emphasis on dual competencies – cultural and clinical – underlies the rationale for regarding kaupapa Maori mental health nursing as a sub-specialty. Eight levels of cultural competencies and twelve levels of clinical competencies are used to differentiate career stages and it is recommended that movement from one level to another should be matched by increased remuneration. The report also contains a recommended professional development programme to support the operationalisation of the career pathway.

Abstract: The author draws on her experience as the 'Paediatric Link Nurse' in an Intensive Care Unit (ICU) within a metropolitan area in New Zealand to examine the proposed changes to ventilation practice. Currently, due to ventilator availability and medical and nursing practice, the usual mode of mechanical ventilation is volume-limited with pressure breath triggering. The author suggests this mode can compromise effective ventilation of paediatric patients, due to air leaks around the uncuffed endotracheal tubes of infants and small children. This air leak makes a guaranteed tidal volume almost impossible and can cause ventilator breath stacking and volutrauma. This can impact on the patient's comfort, sedation requirements and airway security, and affects how these patients are nursed. Thus the ventilation of these paediatric patients by the current volume-limiting mode may be not always be optimal for the infant/child. A new ventilator will be available to the unit, with a pressure-controlled, flow breath-triggering mode available. The author critiques the possibility of using this mode of ventilation, suggesting how this will impact on nursing practice in ICU, and of the education and knowledge that will be required. She suggests this change to ventilation practice may improve comfort and safety for the intubated child/infant, through the delivery of an optimal mode of ventilation.

Abstract: The purpose of this article is to review evidence about nurse workload, staffing, skill mix, turnover, and organisational characteristics' effect on outcomes; discuss methodological considerations in this research; discuss research initiatives currently under way; review policy initiatives in different countries; and make recommendations where more research is needed. Overall, an understanding of the relationships among nurse staffing and organisational climate to patient safety and health outcomes is beginning to emerge in the literature. Little is known about nursing turnover and more evidence is needed with consistent definitions and control of underlying patient characteristics. Research and policy initiatives in Australia, Canada, New Zealand, and the United States are summarised.

Abstract: There has been considerable public debate on the range of complementary health practices throughout the western world, perhaps especially in Australia, United States and Europe. Most often, the research critique of these practices is restricted to quantitative or non-user qualitative research methodologies. Consequently, there is a significant gap in the research profile of complementary health services that need to be addressed particularly in view of the rapid and ongoing increase in the use of complementary services, even in the face of sometimes adverse media publicity. This paper demonstrates the contribution that phenomenologically-based research can make to fill this lacuna by explicating, in detail, the client experience of a complementary health practice. The paper explores patient experience of a ginger compress, as applied by anthroposophically trained nurses, to demonstrate various therapeutic effects. Four key themes emerged including an increase in warmth and internal activity in the major organs of the body, changes in thought-life and sensory perception along with a greater sense of well-being and self-focus with the perception of clearer personal boundaries. These themes, emerging from a patient sample in New Zealand, compared favourably to the Filderklinik Study completed in 1992 in a large German state hospital.

Abstract: Eighteen months after the first of many large earthquakes, Christchurch-based home health care provider Nurse Maude surveyed staff to identify the impact on the well-being of their mainly elderly clients. Responses from 168 staff identified five key issues. These were: mental health, anxiety, and depression, symptoms similar to post-traumatic stress disorder (PTSD); unsafe environments; loneliness and isolation; difficulty coping with change; and poor access to services. To meet the needs of clients in this challenging environment, staff felt they needed more time to care, including listening to stories, calming clients and dealing with clients who had become slower and more cautious. Damaged and blocked roads, and the fact that many clients moved house without warning, added to the time it took to deliver care in the home. This survey has helped Nurse Maude build on its initial post-earthquake responses to better meet the needs of clients and support health-care workers in this stressful environment.

Abstract: The aim of this research was to ascertain the opinions of ward nurses (registered and enrolled nurses) on a critical care outreach (CCO) service and the early warning score (EWS) tool and how CCO helps them care for ward patients whose condition is deteriorating. An 18-item Likert scale questionnaire was adapted to gain opinions on three aspects of the service: The usability of the EWS tool and the escalation protocol; the role and usefulness of the critical care outreach nurse (CCON); and education and sharing of critical care skills. The research was conducted in a 270-bed New Zealand hospital with a nurse-led outreach team. The survey was distributed to adult general wards. It found 45 percent of ward nurses found EWS useful in identifying patients whose condition was deteriorating, 58 percent found EWS easy to use and 82 percent found EWS helped them prioritise workloads. On the role and usefulness of the CCON, 41 percent of surveyed nurses found the post-ICU review helpful, 65 said CCONs were approachable, 71 percent found the CCON shift time of 3pm-11pm was useful, 69 percent said the CCON demonstrated sound clinical knowledge, and 54 percent rated CCONs teaching as sufficient for their needs. When CCO was present, nurses were able to formulate an effective management plan for potentially deteriorating patients and acquired critical care skills needed to manage such patients. The results are comparable with other research which sought nurse opinion of CCO. It indicates nurses believe CCO to be instrumental in increasing critical care skills to prevent deterioration in the clinical area.

Abstract: This research aims to design and test the feasibility of an intervention promoting smoking cessation, and reducing smoking relapse, among Māori nurses who smoke. It is being conducted in two phases. Phase one, a national web-based survey, conducted in December 2012, explored the views of Māori nurses (smokers, ex-smokers and non-smokers) regarding smoking. This paper reports on the analysis of qualitative responses from 410 nurses and nursing students identifying as Māori who completed an online survey. Five themes were identified: beliefs about smoking; ?for our tamariki?; personal stories of quitting; dissatisfaction with current approaches; and plans for future strategies. The findings confirm that nurses who smoke may experience feelings of conflict, and regard their behaviour as inconsistent with their role as nurses and health promoters. Nurses who smoke must be supported to become, and to stay, smokefree. Tailored Māori-specific cessation initiatives are needed.