Abstract: This article reports findings from an audit of post-tonsillectomy haemorrhage among patients at South Auckland Health from October 1998 to April 1999. All patients who underwent tonsillectomy or adenotonsillectomy were contacted by telephone, after the 14th day and before the 21st day following surgery.

Abstract: Hospice nurses in New Zealand provide supportive care to patients of settings. In doing so, the hospice nurse and team are likely to have an ideal of a “good death” that guides their practice.A 'good death“ is one where symptons are well controlled without over medicalisation, where there is an acceptance of death by the patient and loved ones and where appropriatepreparation and completion of unfinished business has occurred. The death itself is peaceful and the loved ones are present. However, patients or their families do not always accept the treatment or care that the nurses offer to facilitate the best quality of life and a ”good death“ for the patient. This may leave the nurses involved feeling distressed and confused, as they are confronted with the conflict between the patients' path and the nurses' ideals.This study employs critical incident technique to explore how nurses respond and feel when the patients decline the treatment or care the nurse feels will improve their quality of life and eventually lead to a ”good death“. The findings illustrate a broad range of treatment or care that is declined by either patients or their families in the first instance. This study uncovers a number of action responses nurses use in these situations, which demonstrate acceptance of patient choice but also need to help the patient experience a ”good death". In addition it demonstrates that nurses experience a gamut of emotional responses to such situations, some of which are painful for the nurse and have the potential to cause stress. Recommendations are made which may assist nurses limit the distress they experience when patients of their families decline the treatment or care, and empower nurses with further strategies to use in such situations

Abstract: Describes the behavioural and psychological symptoms associated with dementia, including depression, agitation, psychosis, hallucinations, delusions and apathy. Employs an integrative review to investigate why care-givers resort to anti-psychotic medication in the first instance instead of non-pharmacological interventions to manage such symptoms. Identifies three themes: low staff-to-patient ratios, insufficient specialised staff; inadequate understanding of the manifestations of dementia.

Abstract: Research into the effects of dialysis treatment on Maori patients living in rural Northland has already brought changes to practice just one year after the research was completed. Li-Chin Shih completed a thesis entitled “Impact of Dialysis on Rurally Based Mäori Clients and Their Whänau” in partial fulfilment of the requirements for the degree of Master of Nursing, The University of Auckland, 2009. This article in Kai Tiaki is based on this research.

Abstract: The primary aim of this research paper is to draw on the literature to offer some insight into end of life care in the acute hospital setting. The secondary purpose is to provide an understanding of the integrated clinical pathway (ICP) for the care of the dying, consider its influence related to some of the challenges shaping end of life care and the positive effect it can generate on the quality of care experienced. There are significant challenges that impact on both the delivery and receipt of care for dying patients and their families. Six key influential barriers are considered within the context of the acute setting. Communication and the acute environment are two areas that significantly impact on the quality of care delivered, and are explored in more depth. Narratives from nursing and medical staff convey the realities encountered and difficulties experienced when they are unable to provide the care to which they aspire. Stories are shared by patients and families, which reflect on their experience of end of life care in the acute setting, and offer heath professionals some insight into the lives of the people nurses care for. The literature in relation to the development and implementation of the Liverpool Care of the Dying Pathway, and an overview of the Pathway document is presented. The strengths and limitations of its use are considered, alongside its influence beyond the documentation of clinical care. It is not possible to transfer the hospice service into the hospital setting, however the author suggests that through the implementation of the clinical pathway there is an opportunity to transfer best practice guidelines and positively influence the palliative culture in the acute setting.

Abstract: Questionnaires were completed by participants who had had a colleague die. Participants reported that some were still having difficulty with the loss of a work collogue. Participants wanted managers to provide both managerial and emotional support during their time of grieving

Abstract: The aim of the study was to determine the practice of nurses employed in integrated care projects in New Zealand from late 1999 to early 2001. Integrated care was a major health reform strategy that emphasised primary health care as a means to improve service provision between the health sectors. An investigation of nurses' practice sought to determine the extent to which primary health care principles had been adopted in practice, as a comprehensive primary health care approach has been advocated globally in the management of chronic conditions; the leading cause of disability throughout the world and the most expensive problems faced by health care systems. The philosophical basis of the research was postpositivism. The study employed a quantitative non-experimental survey design because it allowed numeric descriptions of the characteristics of integrated care projects to be gained for the purpose of identifying nurses' practice. The unit of inquiry was the integrated care project, and 80 comprised the study population. Data were obtained on projects from expert informants (n=27) by telephone survey using a structured interview questionnaire developed by the researcher. Data obtained from interviews were statistically analysed in two stages. First, data were produced to comprehensively describe the characteristics of integrated care projects and nurses practice. The 'Public health interventions model' was used as a framework to analyses the interventions (activities) and levels of population-based practice of nurses. Following this, the social values embedded in nurses' practice were determined using 'Beattie's model of health promotion' as a framework for analysis. A strong association was found between nurses' practice in projects and strategies used in integrated care, such as information sharing, guideline development and promotion, and case management, and projects with an ethnic focus, low income focus, chronic condition focus, and well-health focus. Whilst nurses undertook interventions most frequently at the individual practice level they were also strongly associated with the small proportion of interventions that were undertaken at the community level. The majority of interventions by nurses reflected the health promotion value of health persuasion, indicating a paternalist and individual-oriented philosophy. Nurses were engaged in two interventions that indicated a collective-oriented philosophy – coalition building and community development, the latter reflecting health promotion values of negotiation, partnership and empowerment. The study demonstrated that nurses' practice in projects was predominantly centred on individual-focused population-based practice suggesting the need for a framework to assist nurses to transition their practice to include more activity at the community and systems levels. Without a reorientation of practice, nurses will remain limited in their ability to achieve health gains for populations. In response to this conclusion, and drawing on research results and reviewed literature, a new model, The 'Primary Health Care interventions model' was constructed. Recommendations include advocacy for the acceptance of the model by the health funder, professional nursing bodies, health organisations, educational institutions, nurses, communities, and individuals.