Abstract: Explores what NZ Emergency Department (ED) nurses perceive as the biggest challenges to nursing care and staff safety during an influenza pandemic, in order to provide information on how to ensure the engagement of these nurses at the frontline of the pandemic response. Uses a qualitative descriptive design to allow an examination of the first-hand perspectives of ED nurses, gaining meaningful insights into a phenomenon little explored. Interviews 16 ED nurses about future pandemic planning at ED, DHB and government level.

Abstract: The aim of this research was to describe what factors contribute to people re-presenting to the emergency department (ED) within one week of a previous visit for intentional self-harm. Objectives identified were to describe the people using demographic and clinical features; describe and evaluate ED management; and identify possible personal or system reasons as to why people re-present to ED within one week. A retrospective observational design was selected for a period of one year. The data was collected from electronic clinical case notes. The sample consisted of 48 people with 73 presentations and re-presentations. Missing data limited the number of inferential analyses. Outcome measures were divided into information regarding the person and the presentation. This study made several discoveries: many representations (55%) occurred within one day; the exact number of people who represented many times to ED is unknown, but is far higher than reported in other studies; fewer support people were present for the second presentation; the documentation of triage and assessments by ED staff was often minimal, though frequently portrayed immense distress of this population; cultural input for Maori was missing; physical health complaints and psychosis were found with some intentional self-harm presentations; challenging behaviours occurred in at least a quarter of presentations; and the medical and mental health inpatient admission rates were approximately 50% higher for second presentations. Recommendations in regard to the use of a triage assessment tool, the practice of reviewing peoples' past presentations and the need for a mental health consultation liaison nurse in ED are made. Staff education, collaboration between services with consumer involvement and further research of this group are required. This study supports the need for holistic and expert care for people who present at emergency departments with intentional self-harm.

Abstract: On call emergency health services are becoming routinely provided by some rural nurses, predominantly within the South Island. Rural nurses have been advancing their practice to accommodate the limited availability of general practitioners in rural communities. Although this is becoming routine practice, the author has been providing a service such as this for the past 12 years. This dissertation describes this practice in relationship to the present social-political context, advancing nurse competencies and her experience of rural nursing in a rural town within the South Island. Particular significance for the rural nurse is the required independent practice and overall responsibility when remote from traditional medical oversight. Providing on call emergency care with the possibility of a broad spectrum of emergency situations while maintaining competence for the unpredictable frequency (or lack of frequency) of the rural emergency is the focus of this dissertation. The professional and personal risks are high for rural nurses when placed in situations they are not prepared for or unable to remain competent to manage. Implications resulting from the critique of the health service literature on this subject are identified. Firstly, rural nurses need to be insightful of their own emergency on call expertise and limitations. Secondly, rural nurses require ongoing education and thirdly that appropriate education is available and accessible to rural nurses. Lastly, rural nurses require maintenance of competency so these emergency skills are not lost. This dissertation and the resulting recommendations embrace Nursing Council of New Zealand Nurse Practitioner Competencies. The resulting outcomes fulfilling the rural nurse's need for maintenance of competency for emergency on call care, the community's need for safe appropriate emergency care and national legislation requirements.

Abstract: Pain management practices within emergency departments require a more patient focused approach due to extended waiting times for analgesia. This dissertation questions current methods of providing timely and appropriate delivery of analgesia. Nurses represent the biggest resource in emergency departments therefore are in a position to be able to access patients in a timely fashion. A review of the literature pertaining to nurse initiated analgesia protocols has been evaluated and information relating to efficiency and safety utilised to discuss the processes for planning and implementation of a similar protocol. The author finds that the literature provides no evidence that nurse initiated analgesic practices prior to medical assessment compromises patient safety or delays diagnosis. A discussion of the benefits to patients, nurses and the institution has been included to highlight the appropriateness of extending nursing roles.

Abstract: Explores emergency nurses? perspectives and practices about the quality, importance and value of emergency nursing documentation in relation to their personal beliefs, past experiences and preferred systems of documentation; the practical and contextual factors that influence documentation practices within an emergency department (ED); their interests in documentation tools or systems; and their interests in relation to further development of documentation practices and systems. Conducts a qualitative descriptive study in which ten emergency nurses from one ED in New Zealand were interviewed using interactive interview methods, and asked to complete a Likert scale to identify the relevance of internationally- recognised general influences on documentation to their own practices in the context of an ED. Includes recommended routes to development through partnership, participation and process engagement, and strategies including document development, knowledge advancement and support.

Abstract: The aim of this paper is to compare the Emergency Nurse Practitioner role in the UK, Australia and New Zealand. Whilst geographically distant, the role of the Emergency Nurse Practitioner within these three countries shares fundamental similarities, causing the researchers to question, is this a time to implement international standards for the role? The Emergency Nurse Practitioner role in all three countries is gradually establishing itself, yet there are shared concerns over how the role is regulated and deficits in standardisation of scope of practice and educational level. Together these issues generate confusion over what the role embodies. The authors suggest that one method of demystifying the Emergency Nurse Practitioner role would be to progress towards international standards for regulation, education and core components of practice.