Abstract: This paper outlines the project outcomes, benefits, impact and constraints of introducing the named nurse concept to a neuro-services department. The concept of the named nurse was first introduced in the UK, in 1992, with the aim of supporting the partnership in care between the patient and the nurse. The evidence for the effectiveness of introducing the named nurse concept is largely anecdotal. In line with the hospital wide policy of implementing the named nurse concept at Auckland Hospital, a six-month pilot study was undertaken within the Neuro-services Department. The aims of the study were to foster a partnership in care with patients / whanau and the multidisciplinary team, to improve the efficiency and effectiveness of delivery of nursing care, and to contribute to continuous quality improvement. The results highlighted that, in theory, the named nurse concept would be effective in providing quality co-ordinated care, however factors were identified that hindered the effectiveness of its implementation. Therefore, further development of the concept was required.

Abstract: The chapter presents the research findings of the 1992-1993 Wellington Nurse Case Management Scheme Project as a distinct model of nurse case management, which introduced a role and form of practice of a family nurse and a diagram of the service delivery structure required for support and relevant for the New Zealand health system reforms.

Abstract: The author traces the development of rural nursing, which began as an assistant role for general practitioners, to the present role which incorporates advanced nursing practice. She reports the results of two surveys of nurses' roles and skills, from 1996 and 1999-2000. Specific rural competencies are identified, in managing isolation, professionalism in a small community, nurse/patient relationships in a small community, and independence.

Abstract: The objectives of this research were to determine how many registered nurses are working as 'responsible clinicians', under what phases of the legislation they are functioning, and to describe the enabling processes and barriers to nurses undertaking this statutory role. An anonymous descriptive survey was distributed to the 11 nurses who were currently responsible clinicians as well as five senior nurses selected from each of the 21 district health boards and the Auckland Regional Forensic Psychiatry Services (n=121). The response rate was 88.4% (n=107). The survey questioned respondents on statutory roles currently undertaken. Respondents were asked whether the responsible clinician role was a legitimate one for nurses and whether they were motivated to attain it. They were also asked which competencies of the role they believed they met, their perceptions of credentialing processes and the educational requirements needed to achieve the role. Of the approximately 395 responsible clinicians nationally, 11 (2.8%) are nurses. Most nurses viewed the role as legitimate. However, many were unaware of competencies for the role and credentialing processes, and were somewhat ambivalent about achieving the role due to current workload, role conflict and lack of remuneration. Competency deficits were highlighted. The authors conclude that there are grounds to encourage nurses as responsible clinicians given the intent of the legislation. This will require the promulgation of appropriate mental health policy, and a concerted effort by major stakeholders in mental health service delivery.

Abstract: This chapter reviews some effects of the growth of tourism, including adventure tourism and the numbers of tourists over 50, on rural nursing practice. Tourism contributes to socio-cultural change within a community, and health resources that previously met the needs of the local community may not meet the expectations of growing numbers of tourists. The transient visitor includes both the tourist and the seasonal worker, and has become a feature of rural nursing. Major effects on rural nurses include the increased volume of work, the advanced scope of practice required to meet more complex needs of visitors, and challenges to personal and professional safety.

Abstract: The aim of this study was to determine the feasibility of establishing a nurse practitioner-led, family focused, primary health care clinic within a New Zealand primary school environment as a means of addressing the health needs of children and families. A secondary aim was to ascertain whether public health nurses were the most appropriate nurses to lead such a clinic. Utilising a community needs analysis method, data were collected from demographic data, 17 key informant interviews and two focus group interviews. Analysis was exploratory and descriptive. Findings included the identification of a wide range of health issues. These included asthma management and control issues, the need to address poor parenting, and specific problems of the refugee and migrant population. Findings also demonstrated that participant understanding of the role of the public health nurse was less than anticipated and that community expectations were such that for a public health nurse to lead a primary health care clinic it would be likely that further skills would be required. Outcomes from investigating the practicalities of establishing a nurse practitioner-led clinic resulted in the preparation of a community-developed plan that would serve to address the health needs of children and families in the area the study was undertaken. Services that participants identified as being appropriate included health information, health education, health assessment and referral. The authors conclude that the establishment of a nurse practitioner-led, family focused, primary health care clinic in a primary school environment was feasible. While a public health nurse may fulfil the role of the nurse practitioner, it was established that preparation to an advanced level of practice would be required.

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.