Abstract: This dissertation explores the issues affecting the exposure of isolated rural nurses working in New Zealand to violence from members of the local community, including the visiting public. Discussion on the collaborative role with the New Zealand Police is thematic in the issues presented. Challenges presented include the unique community dynamics of the Stewart Island nursing practice on the Island, with scope of practice, isolation and practice issues included. Role definition, present-day health-care delivery, the potential for violence including causation and reporting are presented. Incident management and risk strategies, including de-escalation are rationalised and described. Evidence for the nurse-police inter-service relationship along with issues including confidentiality and legislation are reviewed. Recommendations and conclusion are provided. The thread and theme of the dissertation is to encourage discussion within nursing circles on the provision of satisfactory safety standards for nurses working in remote isolated parts of New Zealand.

Abstract: In November 2005, the Oxford Community Health Centre (OCHC) introduced an innovative way of delivering primary health care to the residents of Oxford. This was in response to the difficulty with recruitment and retention of medical staff for the solo General Practitioner (GP) at OCHC. Primary health care services are now the shared responsibility of the Rural Nurse Specialists (RNS) and the GPs. This initiative is underpinned by a collaborative approach in sharing patient care between the GPs and RNSs to improve access to primary health care and foster staff retention. The team at OCHC is keen to consolidate and enhance the success of collaboration. Therefore, this dissertation has reviewed a range of literature in order to identify lessons that can be learned for the future. Two key factors that have implications for OCHC are the structural effects of the organisation and the interpersonal relationships between the GPs and RNSs. The structural effects include: the structure and philosophy at OCHC, and the social, cultural, and educational influences within the organisation. It is the nature of the interpersonal relationships that can affect the development and success of collaboration through a willingness to collaborate and the existence of mutual respect, trust, and effective communication between the RNSs and GPs. Strategies to foster collaboration at OCHC in the future include: staff participation in making collaboration visible within the philosophy at OCHC, a workshop for staff to further define roles and differentiate activities according to skill-mix; and the involvement of a nurse in decision-making at the organisational level. The author suggests that these strategies could also be beneficial to other rural practices that are striving to maintain a sustainable primary health care service.

Abstract: Death education encompasses many complex realities, for both the students and lecturers involved. This quantitative research explored the experiential and didactic preparation of nursing students through a content analysis, of one New Zealand, three year Bachelor of Nursing programme, in relation to death education. The Otago Polytechnic Bachelor of Nursing programme incorporates compulsory and optional courses, with the courses taught as an integrated programme with a progressive, sequential approach. This approach builds on content, deepening understanding from year to year, as well as providing opportunities for experiential learning and broadening of understanding. The literature review discusses three dominant themes of undergraduate death education: education, death, and transition. The data collection tool incorporates eighteen key terms, ten teaching methods and ten assessment methods. The programme and individual course documents, which define course content, teaching and assessment were scanned and analysed. The findings initially showed limited evidence of death education in course documents, however deeper analysis of the documents showed further evidence over the three year programme. The existence of death education is implied rather than overt throughout many course documents, through the use of broad practice statements. Content analysis is one way of shedding light on programme content in relation to death education. Limitations of the content analysis approach mean measuring experiential and didactic learning is not fully achievable from documentation analysis only. Further development of Bachelor of Nursing death education is an ongoing challenge, with current programmes very full and possibly lacking the capacity to increase content. Bachelor of Nursing programmes are discussed, highlighting the need for student focused learning with emphasis on acquiring and processing information, rather than mastery of content.

Abstract: The aim of this dissertation is to assess the preventability or reduction of adverse events in the intensive care unit (ICU) through a literature review. Research shows the ICU is at high risk for errors, nevertheless there is a huge gap between knowing something should be done and applying this knowledge to practice. That being the case, this dissertation identifies and discusses several proven and transferable quality improvement proposals. These include: instituting anonymous error reporting; documentation of a daily goal-of-care; a nurse as ICU team co-ordinator; conflict resolution processes and communication training for all ICU staff. NThe author concludes that nurse-doctor collaboration requires the support of medicine, with recognition of the unique contribution nurses make to patient safety.

Abstract: Although it is accepted in rural nursing literature that the context shapes nursing practice there is limited opportunity to gain an understanding of how this occurs. This dissertation addresses this issue. Firstly, by employing a social geographical lens to define and examine the dynamic, evolving rural context and secondly, by considering the nursing concepts that arise from those contextual factors that relate directly to rural societal health needs. Defining 'rural' is essential when describing or debating rural nursing practice in context. However, there remains no universally accepted definition of 'rural'. Despite this and even though each location is individually specific, there are socio-cultural, occupational, ecological and health aspects that are common and bespeak rural society. These aspects have been developed into a Rural Framework Wheel as a visual reference to demonstrate the substantial influences which impact on nursing practice within the rural context. The framework encapsulates the distinctive dimensions that are hallmarks of rural nursing practice. Nurses can therefore use the framework to express concisely their individualised practice and competence by employing the two broad themes that have emerged from the literature; that of 'nursing per se' and 'partnership'. The Rural Framework Wheel is recommended as a paradigm to critique the practice of rural nurses from an educational, employment, research and political perspective. It is advocated that this framework be used by rural nurses to describe their practice and therefore to express the distinctiveness of the rural nursing identity.

Abstract: The purpose of this dissertation is to consider the potential role of nurse practitioners within the Family Planning Association using the “participatory, evidence-based, patient focused process for advanced practice nursing” framework. The existing model of care meets the needs of most Family Planning Association clients well in family planning and sexual and reproductive health care. Some population groups, for example, Maori, Pacific Island people and males are currently underserved particularly in areas of sexual and reproductive health. Consideration is given to how the Family Planning Association could incorporate nurse practitioner expertise to complement existing care and utilising innovative and cost effective ways of reaching some underserved population groups. The integration of the nurse practitioner role into the current staffing mix has the potential to enhance the current model of care, freeing medical officers to deal with more complex medical issues and providing a clinical career path for Family Planning Association nurses.

Abstract: This dissertation was written to promote the author's understanding of the development of drug calculation competency in the undergraduate student nurse. It explores and critiques the literature surrounding the topic and examines the differing teaching methods that are currently used to promote this competency. Findings from the literature were compared to her experience of teaching drug dosage calculation competency to second year undergraduate nursing degree students. This dissertation suggests that drug dosage calculation may be an ongoing problem for nursing students not only during their course of study but also post registration. It appears that age and educational background may be factors in determining whether or not the student will truly master the concept. Although highly debated, it does appear that the use of a calculator assisted the nursing students within the author's class with their arithmetic operation. However, problems associated with conceptual understanding remain notable. The recommendations from this dissertation include the use of varied methods of instruction, integration of both the theory and practical components and the possible use of the dimensional analysis method in the teaching of drug dosage calculation. The author suggests that further research is required both locally within the School of Nursing where she is employed and nationally to fully examine the extent of this issue. Research which is not only focused on the student's calculation ability and its progression over the course of their study but which also allows the School to collate data on age, educational background, culture and learning style would allow lecturers to gain greater insight into student competency, progress and learning needs. She goes on to say that the continued ongoing exploration of her own practice utilising action research is also required as this would assist her in meeting the needs of students and lead to an overall improvement in her practice.

Abstract: Palliative care is a growing specialty in New Zealand with many well-established hospices and palliative care services around the country. However palliative care is not confined to specialist units and is in fact an element of all health services. The aged care sector is one of those services where patients with palliative care needs are prevalent and this is now beginning to be recognised. In these settings care assistants, most of whom have no training, make up a large component of the workforce providing care for residents with increasingly complex needs. In 2005, Hospice New Zealand responded to the recommendations made by the New Zealand Palliative Care Strategy (Ministry of Health, 2001) by developing an eight-hour palliative care course for care assistants employed in residential aged care facilities. The main objective of the course was to increase care assistants' ability to deliver a high standard of palliative care to their residents within their scope of practice.This qualitative study uses descriptive, semi-structured interviews to explore the impact that attending the course had on care assistants and their practice by inviting them to share stories of their experiences caring for dying residents. Factors influencing the implementation of learning in the workplace were identified. The results showed that while attending the course had a positive impact on participants, they were restricted in the extent to which they were able to apply new learning in the workplace, which was largely due to factors that were out of their control. As a result, recommendations are made to enhance workforce development in the aged care sector and to minimise the barriers to the implementation of learning.