Abstract: This study sought to examine the effects that hospital re-engineering may have on adverse patient outcomes and the nursing workforce. In 1993, New Zealand implemented policies aimed at controlling costs in the country's public health care system through market competition, generic management, and managerialism. The study was a retrospective, longitudinal analysis of administrative data. Relationships between adverse outcome rates and nursing workforce characteristics were examined using autoregression analysis. All medical and surgical discharges from New Zealand's public hospitals (n=3.3 million inpatient discharges) from 1989 through 2000 and survey data from the corresponding nursing workforce (n=65,221 nurse responses) from 1993 through 2000 were examined. Measures included the frequency of 11 nurse sensitive patient outcomes, average length of stay, and mortality along with the number of nursing full time equivalents (FTEs), hours worked, and skill mix. After 1993, nursing FTEs and hours decreased 36% and skill mix increased 18%. Average length of stay decreased approximately 20%. Adverse clinical outcome rates increased substantially. Mortality decreased among medical patients and remained stable among surgical patients. The relationship between changes in nursing and adverse outcomes rates over time were consistently statistically significant. The authors conclude that in the chaotic environment created by re-engineering policy, patient care quality declined as nursing FTEs and hours decreased. The study provides insight into the role organisational change plays in patient outcomes, the unintended consequences of health care re-engineering and market approaches in health care, and nursing's unique contribution to quality of care.

Abstract: The introduction of nurse practitioner registration into New Zealand in 2001 was heralded as a move that would open up a wealth of opportunities for registered nurses to extend their practice into more independent roles and to provide a client-centred health service. It was also seen as a way to retain experienced registered nurses in the clinical practice area by providing a credible clinical career pathway. If nurse practitioner's are to meet these expectations, then, the author suggests, it is important to understand the processes that encourage or discourage nurses from advancing their practice. One of the early scopes of practice to be introduced was nurse practitioner with an endorsement in aged care scope of practice. Grounded theory was the method used to generate an explanation of how registered nurses working in aged care were preparing for the introduction of nurse practitioner roles. An analysis of early data highlighted codes around registered nurses in aged care extending and advancing their practice rather than preparing specifically for the nurse practitioner role. The research question for this study was: 'How are registered nurses in aged care advancing their nursing practice?' Semi-structured interviews were used to collect data from ten experienced registered nurses working in aged care clinical practice settings ranging from secondary hospital facilities, to community settings and residential care villages. Dimensional analysis of the data eventually generated three major conceptual categories: 'ownership of nursing', 'extending practice', and 'moving out of a comfort zone'. Of these, 'ownership of nursing' was identified as the core construct that linked the other categories together. The substantive theory that explains how registered nurses in aged care advance their clinical practice is 'developing autonomous ownership'. Nurses who develop autonomous ownership of nursing are more likely than other nurses to move out of a current comfort zone and advance their practice into more independent roles that suit their autonomous ownership of nursing. This study identified important contextual factors and conditions that support the development of an autonomous ownership of nursing and that subsequently facilitate advancing nursing practice. These include creating supportive environments, organisational commitment to advanced nursing practice roles, visible nursing leadership, congruence between organisational and nursing philosophies, interdisciplinary collaboration and participating in postgraduate education. The author suggests that the significance of this study is that it generated a theory about the processes that encourage or discourage nurses from preparing for, and progressing into, advanced nursing practice roles such as nurse practitioner.

Abstract: The author presents an overview of the impact and management of novovirus infections in New Zealand. The impact of this highly contagious virus on hospital settings is serious. With staff shortages already a problem, any outbreak of contagious disease has the potential to result in unsafe staffing, either through low numbers or poor skill mix. A report from New Zealand Environmental Science and Research (ESR) showed 35 reported norovirus outbreaks in New Zealand in the first quarter of 2004, resulting in 890 cases of the disease. Norovirus outbreaks are characterised by a rapid spread of infection, high uptake rate, and a high proportion of cases presenting with projectile vomiting. The author provides a definition of the novovirus, and looks at transmission, the management of hospital outbreaks, and the impact on emergency departments and hospital wards. Procedures include in-patient isolation. She notes there are no simple answers or “quick fixes” to the problem of norovirus outbreaks. While ongoing surveillance, recognition and isolation are key elements, there are wider structural and political implications that need to be acknowledged. These issues include overcrowding and staff shortages.

Abstract: This paper documents a practice development initiative with the aim of formulating a rationale for the professional practice development of a relatively recently conceived nursing initiative; that of a Palliative Care Liaison Nurse (PCLN) role. The project involved conducting an inquiry through a search of the literature with the aim of discovering ways to articulate, then develop, the role to meet the needs of elderly people living in Residential Aged Care Facilities (RACFs), their family and the whanau. The paper initially explores the concept of liaison roles globally, to consider how this role might be located as an interagency position between palliative care and aged care within the context of Aotearoa/New Zealand. The paper then reveals the perceived skills and personal attributes required by a person in the PCLN role that the author, drawing from personal and professional experience of having been appointed to this position, considers are necessary to effectively manage the diverse dimensions of this role. Bridging the gap is a key role discussed which centres on the capacity to organise and present an effective education programme while supporting, encouraging and role modeling for staff providing the day to day nursing care. This role involves practice wisdom and advocating for change and tolerance within everyday practice. An example of this dimension is discussed in depth, because the researcher considers that through staff working together, they can effectively bridge the knowledge-practice gap which exists between specialist palliative and gerontological nursing care.

Abstract: The aim of this research paper is to explore the processes of clinical decision-making in relation to emergency nurses and to examine the educational requirements for the development of clinical decision-making skills. Clinical decision-making is foundational to professional nursing practice. It is the expectation of the profession and the organisations in which nurses work that appropriate clinical decision-making will occur. Patients also rightly expect, when being cared for by nurses, that the clinical decisions pertaining to their care will be optimal.

Abstract: The New Zealand emergency department (ED) nurse is faced daily with the challenge of caring for patients of all ages with a wide variety of presenting complaints. Courses are available for ED specialty work such as trauma and paediatric assessment. However, this thesis argues, it is difficult to access updated and ongoing education in relation to caring for people with mental health problems who present to the emergency department. In addition to this education deficit, are the challenges of providing care in an overcrowded ED environment. The author goes on to say that such factors contribute to a perceived lack of confidence and sometimes ambivalence or frustration on the part of nursing staff in caring for this group. This may result in an inconsistent standard of care for the person with a mental health problem unless such issues are addressed. The aim of this research paper was to explore the education needs of ED nurses when caring for people with mental health problems. A literature review was undertaken to investigate the broad education strategies available to overcome these challenges. Diverse approaches were identified such as workshops, clinical guidelines, and mental health consultation-liaison roles. Research was also identified that examined ED nursing attitudes and their learning needs in relation to mental health. This paper concludes with a discussion of recommendations for the New Zealand setting with the intention of developing a more confident and competent nursing workforce, who are better prepared to care for the person with a mental health problem.

Abstract: Travels to Australia, Canada, the US and the UK to investigate various methods of procedural sedation for 0-5-year-olds in paediatric Emergency Departments. Describes the types of sedation used and the recovery periods. Transcribes the interviews he conducted with Emergency Department staff in each country. Part of the Margaret May Blackwell Scholarship Reports series.