Abstract: Eighteen months after the first of many large earthquakes, Christchurch-based home health care provider Nurse Maude surveyed staff to identify the impact on the well-being of their mainly elderly clients. Responses from 168 staff identified five key issues. These were: mental health, anxiety, and depression, symptoms similar to post-traumatic stress disorder (PTSD); unsafe environments; loneliness and isolation; difficulty coping with change; and poor access to services. To meet the needs of clients in this challenging environment, staff felt they needed more time to care, including listening to stories, calming clients and dealing with clients who had become slower and more cautious. Damaged and blocked roads, and the fact that many clients moved house without warning, added to the time it took to deliver care in the home. This survey has helped Nurse Maude build on its initial post-earthquake responses to better meet the needs of clients and support health-care workers in this stressful environment.

Abstract: The aim of this research was to ascertain the opinions of ward nurses (registered and enrolled nurses) on a critical care outreach (CCO) service and the early warning score (EWS) tool and how CCO helps them care for ward patients whose condition is deteriorating. An 18-item Likert scale questionnaire was adapted to gain opinions on three aspects of the service: The usability of the EWS tool and the escalation protocol; the role and usefulness of the critical care outreach nurse (CCON); and education and sharing of critical care skills. The research was conducted in a 270-bed New Zealand hospital with a nurse-led outreach team. The survey was distributed to adult general wards. It found 45 percent of ward nurses found EWS useful in identifying patients whose condition was deteriorating, 58 percent found EWS easy to use and 82 percent found EWS helped them prioritise workloads. On the role and usefulness of the CCON, 41 percent of surveyed nurses found the post-ICU review helpful, 65 said CCONs were approachable, 71 percent found the CCON shift time of 3pm-11pm was useful, 69 percent said the CCON demonstrated sound clinical knowledge, and 54 percent rated CCONs teaching as sufficient for their needs. When CCO was present, nurses were able to formulate an effective management plan for potentially deteriorating patients and acquired critical care skills needed to manage such patients. The results are comparable with other research which sought nurse opinion of CCO. It indicates nurses believe CCO to be instrumental in increasing critical care skills to prevent deterioration in the clinical area.

Abstract: This research aims to design and test the feasibility of an intervention promoting smoking cessation, and reducing smoking relapse, among Māori nurses who smoke. It is being conducted in two phases. Phase one, a national web-based survey, conducted in December 2012, explored the views of Māori nurses (smokers, ex-smokers and non-smokers) regarding smoking. This paper reports on the analysis of qualitative responses from 410 nurses and nursing students identifying as Māori who completed an online survey. Five themes were identified: beliefs about smoking; ?for our tamariki?; personal stories of quitting; dissatisfaction with current approaches; and plans for future strategies. The findings confirm that nurses who smoke may experience feelings of conflict, and regard their behaviour as inconsistent with their role as nurses and health promoters. Nurses who smoke must be supported to become, and to stay, smokefree. Tailored Māori-specific cessation initiatives are needed.

Abstract: As has been the case internationally, deinstitutionalisation of dual diagnosis (intellectual disability and mental illness) services has also occurred in New Zealand. Inpatient services have been redefined to respond to the more acute focus that has arisen out of this deinstitutionalisation process and nurses are having to redefine their roles in response. This study was undertaken to explore and describe the culture of nursing practice in a dual diagnosis inpatient unit in one psychiatric hospital. A focused ethnographic approach was used to triangulate data gathered from fieldwork observations, review of documents and semi-structured interviews. Schein's (1985) levels of culture model, was used to identify and explore the artifacts, values and assumptions evident in this nursing practice. Analysis presents three key themes categorised as 'communication', 'assessment' and 'safety'. While these key themes are shown to be evident in the everyday practice of the nurses, how these relate to the notion of 'dual diagnosis nursing' is not clear. Therefore, the author describes the major finding of this study as revealing a nursing culture holding tight to traditional psychiatric and psychopaedic nursing practices and struggling to develop a distinctive culture in the absence of a defined dual diagnosis knowledge base. The author concludes that these findings suggest an urgent need to provide nurses with support in gaining contemporary knowledge regarding dual diagnosis nursing. Support for nurses in advancing these areas then impacts on support for the patients. It is suggested that additional research is undertaken to assess the learning needs of the nurses in order to develop clinical practice guidelines for this area. Further recommendations are made to address system issues which are contributing to the gap in knowledge.

Abstract: This research explores the issues and experiences of mental health nurses who experience or have experienced mental illness. This project was prompted by the author's concern for colleagues and friends in this situation. The research topic was approached using a mix of critical ethnography and action research principles. Five mental health nurses who all work for the same district health board were interviewed about their experiences of being mental health professionals with mental illness and the issues that arose from this. The themes that emerged from this research are: the reactions of nurse colleagues, the effects on participants' own mental health treatment, employer responses, professional experiences and issues and strategies for coping. Discussion and recommendations focus on the need for improvements to the responses that mental health nurses with experience of mental illness encounter in their workplace. Recommendations from this research encompass suggestions for both individual and organisational education, action and change.

Abstract: This thesis reviews the role of primary health care nurses, who have an opportunity to play a unique role in teaching, touching and empowering families with newly discharged pre-term babies. Birth of a baby earlier than 37 weeks gestation ushers in a period of uncertainty and stress for parents. Uncertainties may centre on whether their infant will survive and what ongoing growth and developmental issues their infant will face.

Abstract: This research aims to clarify the knowing and wisdom that inform clinical nurse educators' responses through unpredictable situations. The author referred to philosophical literature on the notions of tacit knowledge, practical wisdom, smooth activity and the Unready-to-Hand experience. She created an explanatory framework and utilised this in a thought experiment by reflecting on personal experiences. To add clarity to these reflections, two layers of interviewing with nurse educators teaching in practice were carried out. The first layer was an interview with eight clinical nurse educators who in their role experienced Unready-to-Hand situations. The second layer consisted of four clinical nurse educators who volunteered to be involved in more in-depth interviews. An interpretive analysis of these clinical nurse educators stories illuminated the “Unready-to Hand as Adventure”, highlighting the uncertainty and energy associated with opening in the adventure, not knowing what will unfold, yet committed to remaining engaged and doing the best they can. Through the process of attuning to difference, accessing and deciphering knowing, nurse educators create meanings of situational complexities. By preserving the ideals of good practice and engaged caring, nurse educators salvage learning by creating opportunities for learning and teaching.