Abstract: This thesis contains a collection of stories gifted by four New Zealand Retrieval Team nurses who are experienced in the transport of patients. These nurses are commonly called flight nurses and they assist in the transport of patients via helicopter, fixed-wing aeroplane, large commercial aeroplanes and ambulances. While their practice is not exclusively in the helicopter there is an emphasis on this mode of transport in this thesis. Flight nursing is a scope of nursing practice where the use, and visibility, of nurses' stories is rare. The specific context of this research is positioned in one tertiary intensive care unit in New Zealand but it is anticipated that the stories from four flight nurses and the author's subsequent thoughts on them will resonate with flight nurses in other regions. The stories were collected using a storytelling methodology that has been informed by qualitative and feminist perspectives. The stories were either gathered and shaped using interview and transcription techniques with the storyteller and the researcher, or written by the storyteller. The thesis has been written as a narrative and chronicles the journey to the point of receiving the stories and the lines of inquiry in which they subsequently directed the author. The stories are central to this research and appear in their entirety. The reader is encouraged to create their own meaning from the stories. The stories themselves have several common threads, which are planning, communication, teamwork and the unexpected. The threads underpinning the stories are not unique to flight nursing practice and have been discussed in other scopes of practice. One area the author has chosen to explore in more depth is the impacts of technology, privacy, narrative pedagogy and disenfranchisement on the visibility of flight nurses' stories. The other area she has chosen for discussion is advanced and specialty nursing practice as it relates to flight nurses. As a result of this discussion she proposes her own view for advanced and specialty practice in flight nursing.

Abstract: This thesis used a Heideggerian Hermeneutic approach to explore the experiences of registered nurses who act as preceptors to undergraduate student nurses. The researcher interviewed fifteen volunteer registered nurses twice as preceptors to investigate their experience. The data generated was audio-taped and analysed. Four dominant themes emerged. The first, 'Becoming attuned – the call', related to registered nurses responding to the call to be preceptors to students in their clinical placement. The second, “The emerging identity of being-as preceptor: keeping the student in mind”, related to preceptors cultivating their own identity as preceptors as they worked with students in the world of nursing practice. The third, 'Assessing where the student is at: the preceptor and preceptee working and growing together', related to a constant evaluation by preceptors of students' knowledge, readiness to learn, and the provision of learning opportunities. The fourth, 'Preceptors as builders of nursing practice through teaching reality nursing', facilitated the preceptee's experience of the real world of nursing practice. An overall constitutive theme: 'Preceptors as the safeguarders of the practices of nursing', emerged as the essence of the experience.

Abstract: The aim of this study was to assess intensive care nurses' knowledge of pressure ulcers and the impact of an educational programme on knowledge levels. A knowledge assessment test was developed. A cohort of registered nurses in a tertiary referral hospital in New Zealand had knowledge assessed three times: before an educational programme, within two weeks after the programme, and 20 weeks later. Completion of the educational programme resulted in improved levels of knowledge. Mean scores on the assessment test were 84% at baseline and 89% following the educational programme. The mean baseline score did not differ significantly from the mean 20-week follow-up score of 85%. No association was detected between demographic data and test scores. Content validity and standard setting were verified by using a variety of methods. Levels of knowledge to prevent and manage pressure ulcers were good initially and improved with an educational programme, but soon returned to baseline.

Abstract: The aim of this research is to provide an analysis of the scope of nursing practice and inter-professional role responsibility for ventilatory decision-making in Australian and New Zealand intensive care units (ICU). Self-administered questionnaires were sent to nurse managers of eligible ICUs within Australia and New Zealand. Survey responses were available from 54/180 ICUs. The majority (71%) were located within metropolitan areas and categorised as a tertiary level ICU (50%). The mean number of nurses employed per ICU bed was 4.7 in Australia and 4.2 in New Zealand, with 69% (IQR: 47-80%) of nurses holding a postgraduate specialty qualification. All units reported a 1:1 nurse-to-patient ratio for ventilated patients with 71% reporting a 1:2 nurse-to-patient ratio for non- ventilated patients. Key ventilator decisions, including assessment of weaning and extubation readiness, were reported as predominantly made by nurses and doctors in collaboration. Overall, nurses described high levels of autonomy and influence in ventilator decision-making. Decisions to change ventilator settings, including FiO(2) (91%, 95% CI: 80-97), ventilator rate (65%, 95% CI: 51-77) and pressure support adjustment (57%, 95% CI: 43-71), were made independently by nurses. The authors conclude that the results of the survey suggest that, within the Australian and New Zealand context, nurses participate actively in ventilation and weaning decisions. In addition, they suggest, the results support an association between the education profile and skill-mix of nurses and the level of collaborative practice in ICU.

Abstract: The author presents research on nursing strategies that reduce the psychological effects of critical illness and prevent the intensive care unit (ICU) atmosphere from adversely affecting the nurse-patient relationship. Post-traumatic stress disorder and other phobic anxiety syndromes are noted as a risk among former ICU patients. Four interventions to put in place for discharge are presented: patient-centred nursing, communication, multidisciplinary care, and patient/family education.

Abstract: This article looks at the research on the benefits of massage for alleviating the anxiety of patients in critical care. The author draws on her own experiences with cardiac patients and affirms the lasting psychological benefit of massage. She provides advice on which parts of the body to massage on patients in critical care, which to avoid and how to know when it is contraindicated.

Abstract: The author explores possible approaches to the ethical dilemma confronting nurses of critically ill premature infants with an uncertain or futile outcome despite aggressive neonatal intensive care. A case history illustrates the issues. The morality of nursing decisions based on deontological and utilitarian principles is examined, as are the concepts of beneficence and non-maleficence. A fusion of virtue ethics and the ethic of care is suggested as appropriate for ethical decision-making in the neonatal intensive care environment.