Abstract: An emergent theoretical perspective in the nursing literature relates to nursing as a human science and the application of critical social science and feminist frameworks to nursing research. This research adds to the discipline's knowledge base in that it is at the leading edge of exploring how critical case study illuminates critical issues in the practice of nursing.My interest in the research question came from hearing colleagues espouse the view that other than a legal one, there were no differences in practice between enrolled and registered nurses. How accurate was this perception? Without answers to this question, members of the nursing profession in New Zealand were likely to make some major decisions about the future of enrolled nursing which history will show were ill founded. Since I “walk the talk” of both the world of practice and the corridors of nursing power relationships, I sought answers by incorporating the viewpoints of both groups into the research design.Five registered nurses who had previously been enrolled nurses were asked to consider what was different about their present practice compared to their experiences as an enrolled nurse.Through critically reflexive discourse and journalling, Liz, Emma, Kathy, Helen and myself came to reflect on our nursing worlds in order to transform them.Writing about these transformations in a way that kept our voices alive was more difficult. The cases were written as stories, using storytelling as a legitimate academic activity to link the methodology with the theoretical perspectives. This ensured our individual voices were heard rather than silenced by the research process. It also left a clear decision trail for the reader to follow related to issues of rigor. Paradoxically, the identification of patterns across the case studies was facilitated.Two main patterns emerged in answer to the question “what's different in your practice now from when you were an enrolled nurse?” The differences were explicated in the pattern “Becoming a registered nurse” while “She was one of us” exposed the underlying power and control issues. This study found that the enrolled nurse controls practice at the bedside.The nursing profession's stance on the future of enrolled nurses was also explored through case study. Key nursing stakeholders were interviewed using a proposed legislative change to the Nurses' Act, 1977, that would lead to the demise of the enrolled nurses as a category of nurse, as a focus point. These different perspectives expose for critique the socio-political forces that silence the voice of enrolled nurses in determining their own future. At a legislative level, the stakeholders' voices are dominant. The future of enrolled nurses looks increasingly bleak in New Zealand as the nursing profession positions itself legislatively for the 21st century

Abstract: Introduction Critically ill patients cannot clean their own teeth. A variety of methods are used but as the best method is unknown we performed a prospective randomised double-blind controlled trial of three methods.Method Of 359 consecutive admissions to the Department of Critical Care Medicine between 31/01/97 and 25/05/97, 222 were excluded (62 edentulous, 6 unexaminable, 142 transferred alive and 12 dead or dying at 24 hours). The remaining 137 patients had quantitative (picture-linked, ordinal score) assessment of caries, peridontal status and plaque (in 12 segments of teeth) before randomisation (to the use of either toothbrush, jumbo swab or sonic toothbrush) by pre-assigned sealed envelopes. All teeth were cleaned (prescribed four hourly) with 0.2% chlorhexidine solution. Daily plaque scores were obtained (by an assessor (SC) blind to treatment allocation) until withdrawal, death or transfer.Results Toothbrush Jumboswab SonicPatients assigned 50 48 39Withdrawn within 24hrs. 9 3 5Patients remaining 41 45 34Percentage of teeth segments thatare pristine: pre treatment 45 50 51 after 2 days 74 57 90 F(2.63) = 5.00 p = 0.0097 More withdrawals for patient noncompliance after randomisation occurred in the sonic group (5/34 versus 3/86). Conclusion. By the second day the sonic toothbrush was the most effective in plaque removal with the toothbrush the next most effective method

Abstract: A study to examine the effects of pre- information ( what a Nurse learns about a patient before they meet) on clinical inference and Nursing actions, in a simulated Nurse- Patient situation. It was hypothesized that the nature of the pre-information will influence the way the patient is perceived and the resulting Nursing actions. The research was conducted in an obstetrical setting. There were 55 subjects within three groups. Two groups comprised student midwives and the third group was of second year comprehensive Nursing students near completion of clinical experience in maternal and child health nursing. A 5 minute videotape sequence of a role played post natal patient was made for use in the research. All subjects were given the same initial pre-information, viewed the videotape and gave written description of what they saw on the videotape and their response ( as the Nurse in the situation). This data provided a base line for each subject. Subject were then given additional pre-information concerning the patient's physical condition, her baby's condition or formed part of the control group ( receiving no additional information) The procedure was repeated. These responses were then compared with the base line for each subject. Responses were coded by means of content analysis. Group data was analysed using multivariate one way analysis of variance graphical display. The results indicated support of the hypothesis that the nature of the pre-information does influence the way in which a Nurse perceives a patient and resulting Nursing actions. Implications of these findings for Nurses are discussed

Abstract: Using the life history approach this study investigates the consequences of difference within the context of nursing. Life story interviews were conducted with 26 women nurses of varying racial, cultural and sexual identity backgrounds in the USA and New Zealand.The questions framing the interviews focused on the women's experience of difference and fairness in their lives and specifically within nursing.The creation of life story 'snippets' in the first level of analysis reflected the unique aspects of each woman's story and became the first step in the process of creating a thematic analysis or meta-story. The meta-story that emerged from the juxtaposition of the women's stories was “not fitting in to nursing”.The findings of this study suggest that in spite of the change in location of nursing education and its recent attention to the implications of client diversity, the continued imposition of traditional definitions of 'the nurse' by nursing institutions, renders difference amongst nurses invisible. This limits the ability of nurses to be authentic in their practice and also limits the extent to which they can implement the new policies recognizing difference amongst their client populations