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: This paper moves away from the prevalent discourse of competence to consider the meaning of the experience of 'being safe' within the context of childbirth. It offers findings from a doctoral study, informed by the philosophies of Heidegger and Gadamer. Following ethical approval, the data was collected in New Zealand by tape-recorded interviews of 5 midwives, 4 obstetricians, 1 general practitioner and 10 women. The method was informed by van Manen. The findings reveal that in seeking the meaning of being safe one needs to be aware that the unsafety may already be present in the situation. Practitioners may be able to do little to rectify the unsafeness. There is, however, a spirit of safe practice, explicated in this paper, that is likely to make practice as safe as it can possibly be. Wise practitioners are ever mindful that a situation may be or become unsafe, and are always aware of their own limitations.

Abstract: The purpose of this literature review is to generate a picture of what is known and what needs to be investigated further about anaesthetic nursing in the perioperative nursing role in New Zealand, and to examine this in relation to international trends. Nurse anaesthetists in the United States are described in American nursing literature, and recognised as one of the four advanced nurse practitioner roles. In New Zealand, recent efforts to provide appropriate post-graduate education for the perioperative nurse have been challenged by other inter-professional interests, thus restricting the development of an expanded role. The author notes that this has caused concern for New Zealand's perioperative nurses who consider anaesthetic nursing is an integral part of perioperative practice. Anaesthetic nursing forms a substantial component of the basic competencies required of a registered nurse working in the operating theatres. Orientation programmes and ongoing education at all levels of professional development incorporate anaesthetic nursing competencies to provide continuity of patient care and support perioperative practice. Care of the patient undergoing anaesthesia is an area where nurses demonstrate their advanced assessment skills and clinical judgement and is included in perioperative specialist or nurse practitioner job descriptions. The Perioperative Nurses Association in New Zealand is concerned to develop postgraduate education in their area of speciality to support their application for 'College' status within the New Zealand Nurses Organisation. For this to happen in a cogent fashion, information and knowledge generated from research, are required to clarify perioperative nursing's current position and determine how practice can be shaped to best care for patients undergoing surgical interventions. Evidence from research supports nurses in the anaesthetic role by demonstrating that the preoperative visits and assessments they undertake can reduce patients' anxieties, decrease the need for pain relief and shorten hospital stays. This review includes literature sources that explore disparities between the development of New Zealand anaesthetic nursing and international models. The author suggests that information and understanding gained from conducting this review will allow future developments in anaesthetic nursing practice to be informed by previous initiatives and projects and identifies areas for further research.

Abstract: Evidence within the literature highlights that staff within the general hospital wards are not necessarily equipped to assess and meet the needs of patients with mental health or behavioural problems. The author notes that this is cause for concern as a number of people requiring admission to the general wards often have a complex, interrelated combination of physical and mental health problems. Within New Zealand there have also been a number of changes to health care policies that have increased general nurses contact with mental health patients over the last decade. The Mental Health Consultation Liaison Nurse is an advanced nurse specialist who can meet this need. Having reviewed the literature and communicated with Mental Health Consultation Liaison Nurses in New Zealand and Australia, the author says it is clear that the availability of a mental health nurse within the district health board general wards would be advantageous to all. The role has been shown to positively influence the care of patients and benefit other health care professionals. It provides an improved system of care that is co-ordinated, integrated and responsive to the needs of patients and health care staff. The implementation of the Mental Health Consultation Liaison Nurse role has the potential to cut costs in relation to decreasing length of stay with untreated mental health issues, and reduce the cost of continued use of 'specialling' unnecessarily. Also of importance is the fact that such a position would assist the district health board to comply with the standards of health care provision as directed by the Mental Health Commission and the Ministry of Health. The author suggests that the introduction of the Mental Health Consultation Liaison Nurse role represents a change in traditional ways of providing general nursing and consequently there are a number of issues that may hinder its success. This dissertation aims to increase the visibility of mental health nursing and provide a resource for others debating the development and implementation of the Mental Health Consultation Liaison Nurse role.

Abstract: This thesis examines the forces influencing the development of contemporary advanced nursing practice in New Zealand. It begins with an historical approach to explore the various meanings of advanced nursing practice from the late 1800s through the first years of the 21st century. Seven historical understandings of the meaning of 'advanced' nursing practice emerge. The author's analysis of the broad scope of New Zealand nursing history, including a case study of the development and implementation of the nurse practitioner, draws on theoretical perspectives from sociology, political science, and nursing. She develops a “framework of critical factors for nursing to take into account when considering how to ensure the profession is able to deliver on its great potential to improve the health of New Zealand communities”. Examining the work of a range of nursing leaders, past and present, and drawing on the work of political scientist, John Kingdon, the author describes the work of several nurses as “policy entrepreneurship.”

Abstract: The last twenty years, particularly the early 1990s, ushered in major mental health sector reforms inclusive of deinstitutionalisation policies and subsequent development of community services. Concurrent changes to student nurses' education left registered nurses as the workforce mainstay on inpatient units. However, the author suggests, an emerging global shortage of nurses and implementation of the Employment Contracts Act (1991) negatively impacted on recruitment and retention of registered nurses. Inpatient nurses either left nursing or moved to community positions for better money and increased job status. The author suggests that, as a consequence, the 'critical mass' of experienced and skilled nurses who traditionally provided nursing leadership disappeared resulting in compromised standards of care for patients. As the manager of an inpatient unit, the author proposed the establishment of advanced nursing practice roles as one initiative to provide nursing leadership in order to attract and retain nurses. This study explored five inpatient nurses' perceptions of advanced practice and whether these roles could assist to provide leadership and improve standards of care. The research was a qualitative exploratory descriptive study using a focus group interview as the data collection method. A thematic analysis of the group discussion transcription revealed three key themes: 1) the 'makeup' of advanced nursing practice, 2) moving forwards: establishing roles, 3) moving sideways: barriers to role development. The themes are critically discussed in relation to selected literature. The thesis includes recommendations that could be used by nurses responsible for planning and implementing advanced practice roles on inpatient units.

Abstract: The author reconsiders the meaning of expert, specialist and advanced practice. She proposes that they are distinctive and complementary aspects of every nursing role and suggests a set of attributes for each. Expertise is discussed in terms of the quality of performance, speciality in relation to particularity of performance, and advanced practice with regard to the level of performance.

Abstract: Reports the audit of a nurse-led dyspepsia clinic at Auckland Hospital. Referrals to the Gastroenterology Department for gastroscopy were assessed in a dyspepsia clinic. Initial evaluation included consultation and a urea breath test (UBT). Patients given eradication treatment prior to initial clinic assessment were excluded. Patients with a positive UBT were given eradication treatment and were reviewed two months later for symptom assessment and follow-up UBT. Patients with a negative UBT were usually referred back to the GP. There were 173 patients with a mean age 38 years. The urea breath test was found to be useful as part of the initial assessment of selected patients who would otherwise have been referred for endoscopy. It is likely that the need for gastroscopy was reduced, but longer follow up will be required to determine whether or not this effect is simply due to delayed referral. This approach is likely to have value only in patients who have a relatively high chance of being H. pylori positive.