Abstract: A paper presenting the findings of a small research project involving a group of self-selected senior nurses of Wellington Hospital to explore the nature of nursing practice in the care and management of hospitalised patients and to formalise the language that would acknowledge its significance in the current effort of hospitals to define patient care pathways. The nature of hospital nursing practice was described in themes of a generic process of nurse-patient care that articulates a distinct specialism of hospital nursing, whatever the hospital department in which nurses hold positions.

Abstract: High stress and staff turnover in a multi-specialty paediatric area prompted this study that aimed to :1) measure the burnout level of nurses in a multi-specialty paediatric area2) identify and validate causes of stress3) identify new ways of preventing stress on the wardFifty four percent (n=14) of the paediatric nurses completed the questionnaire booklet that included demographic data, the Maslach Burnout Inventory, the Nursing Situations Questionnaire the Hopkins Symptom Checklist-21 the Ways of Coping Checklist and open ended questions about sources of stress and satisfaction at work. Results indicated levelsof burnout and distress comparable with larger studies. Conflict with doctors was the major source of stress followed by workload, inadequate preparation in dealing with the emotional needs of patients and their families and death and dying. Conflict with doctors has not previously been identified as the major source of stress. However workload and death and dying are commonly identified as sources in the literature. Suggestions for further research and the low response rate are discussed

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