Abstract: This article examines a growing number of cases in New Zealand in which parents and guardians are required to make life and death ethical decisions on behalf of their seriously ill child. Increasingly, nurses and other practitioners are expected to more closely inform, involve and support the rights of parents or guardians in such situations. Differing moral and ethical values between the medical team and parents or guardians can lead to difficult decision making situations. The article analyses the moral parameters, processes, outcomes and ethical responses that must be considered when life and death ethical decisions involving children are made. It concludes with a recommendation that nurses should be recognised as perhaps the most suitable of all health care personnel when careful mediation is needed to produce an acceptable moral outcome in difficult ethical situations.

Abstract: This article provides a brief overview of the findings of a hermeneutic study that explored the experience of nursing people from cultures other than one's own. The notions prejudice, paradox, and possibility are argued to describe this phenomenon. Nurses in New Zealand are being challenged to recognise and address racism in their practice. Yet, the implementation of cultural safety in nursing education has created tension within the profession and between nursing and the wider community. As nurses negotiate the conflicts essential for ongoing development of their practice, the play of prejudice, paradox, and possibility is evident at intrapersonal and interpersonal levels as well as in relation to professional and other discourses. Nurses are challenged to continue their efforts to understand and move beyond the prejudices that otherwise preclude the exploration of new possibilities.

Abstract: In 1973, two trial pre-registration nursing education programmes were piloted in New Zealand polytechnics. These represented an alternative to traditional hospital-sited schools of nursing. The establishment of nursing education in the tertiary sector marked a radical challenge to the cultural heritage of apprenticeship-style nursing training associated with paternal and medically-dominated health institutions. This thesis offers a Foucauldian and feminist poststructuralist analysis of discourses employed by fifteen senior nursing educators in the comprehensive registration programmes between 1973 and 1992. The women employed to teach in the comprehensive programmes faced unique challenges in establishing departments of nursing, in developing curricula that would promote a reorientation of nursing and in supporting candidates to attain their nursing registration. Through semi-structured interviews and discourse analysis methods, a set of unique characteristics shared by this group of early leading comprehensive nursing educators has emerged. The women's narratives were underpinned by discourses that centre around the valuing of education as a vehicle for emancipation and an upholding of a legitimacy of difference in nursing educators' work. The participants upheld the importance of clinical practice skills and drew on their own student nursing experiences as incentives for reforming nursing education. These nursing educators conceptualised an idealised type of graduate, and commonly employed an heroic metaphor to describe their experiences as senior comprehensive educators. Their engagement with such discourses and their shared characteristics demonstrate unique re-constitutions of power, knowledge and relations with their colleagues and clients throughout the education and health care sectors. The author proposes that these traits characterise the women as strategic and astute professionals who successfully negotiated the construction of comprehensive nursing programmes as a legitimate and transformative preparation for nursing registration.

Abstract: This is the second of a series of research projects undertaken to present the contemporary picture of the nurse workforce and their work in rural settings to inform policy for development of rural healthcare. The document presents the findings of telephone interviews with nurses in different work rural work settings around the country discussing their practice. The analysis identified a framework of four models of nursing practice: two traditional models defined by the institutions employing nurses, and two emerging models defined by the new positions requiring nurses to respond directly to health need.

Abstract: Using nursing and associated literature, the relevance of nutrition in the care of children and families is highlighted in this article. The role of a nurse in providing nutrition advice and interventions is examined, in the context of social and economic pressures on the provision of a healthy diet. Relevant examples of the provision of such advice is provided, along with competencies required to achieve this in practice.

Abstract: The research on which this thesis is based involves both a private narrative and a public narrative, with the story of cultural safety, and the history, theory and the future direction gathered into one qualitative work. The work is divided into three sections. The first is entitled, Ko Wai Matou? The Private Narrative. This section seeks to explore the historical, social, educational, physical, emotional, political and moral influences and ephiphanies which brought about the personality which introduced cultural safety ideas into nursing and midwifery. Early nursing practice is investigated and examples from practice are used to illustrate learning and consolidation of the ideas which led to Cultural Safety Theory. The second section is entitled He Huarahi Hou: A New Pathway. This section explains the progress of the theory and its relationship to education pedagogy and to nursing practice. Comparison between the work of Madeline Leininger and the Transcultural Theory of Nursing and the New Zealand concept of cultural safety is undertaken. The role and application of the Treaty of Waitangi to the theory of cultural safety is explored in this section. The third section, entitled He Whakawhanuitanga: The Public Narrative, looks at the introduction of cultural safety into the nursing education system and its implementation. The public and media reaction to the inclusion of cultural safety in the national examination for nursing registration and the subsequent parliamentary response are noted. The interviews with nursing and midwifery leadership, Maori and pakeha key players in the process and consumer views of the ideas are documented and pertinent excerpts have been included. The work concludes with a discussion on the likely future of cultural safety as a theory and in practice and outlines several issues which represent a challenge to the viability of the concept in nursing and midwifery education. The author notes that the story of cultural safety is a personal story, but also a very public one. It is set in neo-colonial New Zealand, but has implications for indigenous people throughout the world. It is about human samenesses and human differences, but is also a story about all interactions between nurses and patients because all are power laden. Finally, she points out that, although it is about nursing, it is also relevant to all encounters, all exchanges between health care workers and patients.

Abstract: The aim of this study was to test the hypothesis that triaging certain emergency department patients through a rapid assessment clinic (RAC) improves the waiting times, and times in the department, for all patients presenting to the emergency department. For ten weeks an additional nurse and doctor were rostered. On the odd weeks, these two staff ran a RAC and on even weeks, they did not, but simply joined the other medical and nursing staff, managing patients in the traditional way. During the five weeks of the RAC clinic a total of 2263 patients attended the emergency department, and 361 of these were referred to the RAC clinic. During the five control weeks a total of 2204 patients attended the emergency department. There was no significant difference in the distribution across triage categories between the RAC and non-RAC periods. The researchers found that the rapid management of patients with problems which do not require prolonged assessment or decision making, is beneficial not only to those patients, but also to other patients sharing the same, limited resources.