Abstract: This article describes the move in mental health from institutional care to community arrangements. It draws on international literature and New Zealand health policy, which gives increased emphasis to the role of the primary health care sector in responding to mental health issues. These issues include the need for health promotion, improved detection and treatment of mild to moderate mental illness, and provision of mental health care to some of those with severe mental illness who traditionally receive care in secondary services. These developments challenge specialist mental health nurses to develop new roles which extend their practice into primary health care. In some parts of New Zealand this process has been under way for some time in the form of shared care projects. However developments currently are ad hoc and leave room for considerable development of specialist mental health nursing roles, including roles for nurse practitioners in primary mental health care.

Abstract: The aims of this study were to illuminate the joint constructions of exemplary nurses and their lived experiences of being and becoming one. Inherent in being 'exemplary' was the notion of 'becoming', which involved the integration of knowledge and experiences through reflecting on the day-to-day of 'being a nurse'. Being exemplary was not about perfection but learning from every experience and integrating these into becoming. The author developed a creative qualitative and participatory method. Ten exemplary nurses were recruited and interviewed three times. They also provided supplementary data such as photos, poetry and writings. Analysis occurred through first and second level categorising and the use of writing as method. Writing became a way of knowing – assisting discovery and allowing reflection on the data in order to connect the categories and themes together in a coherent and workable whole. The author reports that the above method led to the following emergent findings. The pivotal construct was Authentic Being, through living a reflective life, surrounded by the major constructs of Love of Nursing, Making a Difference, Critical Friends, Walking the Talk and Backpack patients. These constructs directed a specific and comprehensive review of both the philosophical and nursing literature. This review was not used to expand or enlarge the findings but to enlighten, illuminate and clarify. Significant philosophical ideas were extended, developed and synthesised with the findings. The author suggests that the new knowledge that emerged from this research has profound implications for everyday nursing practice, undergraduate and post graduate nursing education, and for Charge Nurses and Senior Nurses, who are of vital importance as role models, mentors and critical friends. The results are significant and are important for nurses and the nursing profession and contribute to, and advance, nursing knowledge.

Abstract: New Zealand's ageing population is predicted to have increasing degenerative musculoskeletal changes affecting both mobility and morbidity. In response, the New Zealand government is supporting a one hundred per cent increase in the number of elective joint replacements performed across the country from 2004 to 2008. However, like other specialties, orthopaedic nursing is experiencing shortages. In order to improve the recruitment and retention of orthopaedic nurses, as with other nursing specialties, childcare is offered as a strategy for consideration. In 2005, New Zealand parents indicated in an online survey, that in order for them to work, they needed affordable, quality and conveniently located childcare. Nurses have similarly indicated the importance of childcare when considering and managing a balance between their work and home lives. This paper explores contextual work and home life balance dialogues in relationship to nursing recruitment and retention issues and New Zealand nursing. Childcare as a recruitment and retention strategy, is explored in the context of New Zealand nursing and compared with the childcare strategies employed for nurses by Britain and Australia – New Zealand's major competitors for New Zealand nurses. The author concludes that, in light of the international shortage of nurses, childcare is an important recruitment and retention strategy which is currently absent in many of New Zealand's district health boards. Recommendations are offered to support the balance between work and home life for nurses and reconcile orthopaedic nurses to the clinical setting in order to provide the quality and efficient care that is needed for New Zealand's ageing society.

Abstract: This article considers wider organisational issues that impact on the implementation of evidence based practice. It describes the strategies adopted by the Auckland Area Health Board and Unitec New Zealand to implement the principles of evidence based practice in New Zealand. This has resulted in a collaboration with Auckland University and the Joanna Briggs Institute for Evidence Based Nursing and Midwifery to form the Centre for Evidence Based Nursing – Aotearoa. Evidence based nursing is a vital part of nursing education. Unitec New Zealand has developed and incorporated evidence based nursing into all courses in their undergraduate programme. Central to this is the use of evidence based practice in patient care and the integration of technology with evidence based nursing in clinical practice.

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: The objective of this study was to conduct research to inform the development of standards for nurse practitioner education in Australia and New Zealand and to contribute to the international debate on nurse practitioner practice. The research was conducted in all states of Australia where the nurse practitioner is authorised, and in New Zealand. The research was informed by multiple data sources including nurse practitioner programme curricula documents from relevant universities in Australia and New Zealand, interviews with academic convenors of these programmes and interviews with nurse practitioners. Findings include support for masters level of education as preparation for the nurse practitioner. These programs need to have a strong clinical learning component and in-depth education for the sciences of specialty practice. Additionally an important aspect of education for the nurse practitioner is the centrality of student directed and flexible learning models. This approach is well supported by the literature on capability.

Abstract: This article describes the implementation of a nurse-led, dedicated support network and service for children with a diagnosis of retinoblastoma and their families. Nurses with an interest in retinoblastoma at an Auckland Ophthalmology Department realised that the service provided was not meeting the needs of patients and families, particularly since the numbers had increased over the past two years. This article outlines the development of a cost-effective approach that improved the service.

Abstract: This paper looks at the links between nursing roles and health policy in New Zealand. Strategic alliances between key professional leaders in different nursing roles can help the profession by directly influencing policy development and implementation. This form of policy entrepreneurship is an important component of professional leadership.