Abstract: This paper explores the creative opportunities children might have to attend to their emotions and feelings following the death of a parent, grandparent or close friend. It presents the position that often children are left out of the process of caring for an adult when they are terminally ill and that has long term psychological implications. It also suggests that this has antecedents for the white New Zealand culture that were noted historically. In this research the author describes a personal journey that has shaped her current work as a hospice practice manager. The writer explores literature in psychological aspects of removing children from the dying room, creative therapies and the importance of sacred memories for the living child. The need to create memory that will embrace the child as a cloak enfolds them in their crisis stimulated the writer to offer a text in the personal narrative form. This text is presented in this form to enable other clinicians to access their own memories as survivors of grief in their own families. It is suggested that by enabling children and family to explore the importance of relating in the palliative phase of a person's life journey, good memories are created for the survivors.

Abstract: This study investigated issues surrounding the high numbers of preventable admissions of young children with acute illnesses, particularly amongst Maori and Pacific children. It focuses on what happens once these children are discharged. Its aims were to find out what the expressed needs of parents were, as they cared for their child, once home. Whilst there has been a small amount of international research undertaken in this area, there is little known about expressed parent need in the New Zealand context. This exploratory descriptive study involved parents of under five year old children, who had been admitted to a hospital, with one of five acute illnesses. Eighteen parents were surveyed over the telephone. This study found the parents expressed a need for reassurance and advice once home, and that they worried about their child getting sick again. It highlighted gaps in discharge planning and support. None of the parents had received a written discharge plan for their child. Only five parents had received either a contact number for advice or a referral back to their primary care provider. This study found that whilst some parents considered their discharge needs had been met, others considered that they had not. Four local discharge practice opportunities to support these families were recommended, these included, providing parents and caregivers with an individualised written discharge plan, giving a contact number for advice after discharge, offering a follow-up phone call in the first 48 hours, and ensuring that all children have a referral back to their primary health care provider. Areas for further research were highlighted, including the need for a larger study to explore and compare the needs of rural and urban parents, and Maori and Pacific parents.

Abstract: This study explored what some New Zealand families believe constitutes the successful management of unsupervised childcare. It was designed to increase social understanding and practitioner knowledge of the issue by exploring families' beliefs, practices and perspectives. The researcher was concerned with the professional role nurses may play with this group of children. A qualitative descriptive approach was used to obtain a straight description of successful unsupervised childcare, using the everyday language of the participating families. Data was collected in semi structured interviews with five family groups, and subjected to content and thematic analysis. Findings suggest unsupervised childcare is both choice and solution, though parents are fearful of the legal and social consequences of using it. Context of the care is important, with the child's preference, community context and availability of adults through distal supervision critical components of its success. Trust between parent and child, the use of rules and boundaries to regulate child behaviour, the teaching of skills and strategies to build child competency, and parental support of children while unsupervised are identified by parents as factors linked to success. Parents identify increasing child independence and self responsibility as positive outcomes from the successful use of unsupervised childcare. This study has helped to identify positive factors resulting in good outcomes from which successful interventions could be developed, provides information that will be of particular interest to practitioners and policy makers, and provides a platform to launch larger studies into the issue of unsupervised children.

Abstract: This descriptive case study was undertaken to provide an account of chemotherapy practice in a nurse-led clinic located within a rural New Zealand area. The researcher, an oncology nurse specialist, worked alongside colleagues for thirteen months to enable practice development. This clinic developed out of a need to have services closer to rural patients in order to address issues of equity, access, care integration and the fiscal and social constraints associated with the cancer burden of care. Capturing the range of data applicable to this case; the ability to conceptualise it as a service within its context was possible using case study research methods. Four nurses involved in the chemotherapy clinic were participants in this study. The findings of this study reveal that what could be perceived as barriers to outcomes and practice can in essence be turned into opportunities to develop new ways of caring for the patient and supporting nursing practice. These nurses view their practice as safe within the clinic despite resource constraints. They work in many ways to support each other and to cushion the patient from the impact of situational and contextual influences. Nursing practice was shown to evolve as a direct result of internal and external influences which were the impetus for nurses taking responsibility for their own competency. This study also explored what it meant to be an experienced nurse but novice in a speciality practice. It challenges previously held assumptions that, to deliver chemotherapy successfully, a nurse needs to be operating from a previously held body of oncology nursing knowledge. Many challenges are faced on a day to day basis in a rural practice environment to just maintain consistent care and promote good patient outcomes. The nurses are well aware of their role in contributing to patients' quality of life and the roles they take to meet the growing needs of the patient as a consumer. This study delves into the multifarious nature of this nurse-led clinic and discusses the processes and relationships that are forged to deliver care.

Abstract: This study draws upon Gadamer's philosophical hermeneutics to explore the understandings that four men have had of their past suicidal experiences. The interpretations developed in this study, as far as possible, make explicit use of the author's own particular horizon of meaning as researcher and mental health nurse. In addition, by consciously bringing an anti-essentialist perspective of masculinity to this process, he explores the way in which gender impacts on men's suicidality. The primary source of information for this study is in-depth, open-ended conversations with four men of European descent in their middle adult years who were asked to talk about their past experiences of suicidality. The interpretations developed here show that for these men, the hermeneutic fusion of history, language, and sociocultural context, provided limited possibilities with which they were able to construe themselves as 'fitting in' with normative standards. These constraints, that are otherwise taken-for-granted and invisible, became explicit through their experience of ongoing victimisation. Furthermore, early understandings of these experiences became a potent horizon of meaning from which they then came to understand later difficult experiences. Victimisation became constitutive of an understanding of self as fundamentally different and (hierarchically)'less-than' other men. Ultimately, suicidality emerged out of a background of ever-present psychological pain accompanying a construction of self as being unable to see themselves as ever 'fitting in'. These men did not regard themselves as having recovered from suicidality, but remain in a process of recovering. This process did not mean figuring out how to 'fit in', or become 'normal' men, but rather, to live meaningfully as men in spite of not 'fitting in' with the sociocultural ideal. Recovering was a continual and idiosyncratic process, rather than an outcome of a specific technique or knowledge. The position taken in this study is that mental health nursing seeks to engage with people and work with them in collaborative, respectful, human relationships. It is argued that mental health nurses work with an individual's situated understandings rather than delivering prescribed treatment determined by diagnosis. Hence, viewing suicidality as socioculturally situated and historically emergent suggests mental health nurses must closely attend to the way in which we bring ourselves into relationships with our clients so that we are then able to create opportunities for change.

Abstract: This nursing study seeks to understand the experience of one group of people with chronic renal failure using renal replacement therapy, Pakeha men living on home haemodialysis. It is based on the assumptions that people living on dialysis have distinctive experiences that are characterised by common concerns reflecting their shared position as subjects of renal illness and therapy. In order to understand the experience of people living on dialysis, this study develops a critical interpretive approach, seeking the participant's own interpretation of their individual experiences. The experiences are then reinterpreted them from a critical standpoint, recognising that they can only be adequately understood by contextualising them. This enables the researcher to discern the common perspective underlying them in contrast to the dominant professional viewpoint in the renal setting. The concerns identified include symptoms from chronic renal failure and dialysis, limitations resulting from the negotiation of the therapeutic regime into their lifestyle, their sense of ongoingness and uncertainty of living on dialysis, and the altered interrelationship between autonomy and dependence inherent in living on dialysis. The study suggests that the individual accounts can be understood as resulting from the interaction of the various dimensions of their own personal social locations, including their gender and ethnicity, with the concerns of client discourse, reflecting their common position as people living on dialysis. The author concludes that one implication of this understanding is that the role of nursing in the renal setting can be articulated as a response to the experience of the person living on dialysis. The nurse can support the renal client in seeking to integrate the requirements of the therapeutic regime into their personal situation.

Abstract: A retrospective descriptive design was used to examine the records of all presentations to the emergency department of patients with COPD over a 3-month period to determine whether there is a subset group of people who present with hypercarbia. There were 114 presentations, amongst those there were 71 individuals, a number presenting more than once within the three months. 80% of the 71 individuals had a smoking history of which 53% were female. Of the 114 presentations, 76 had arterial blood gases taken during their emergency department presentation. Of these 76 presentations 30 had hypercarbia and 46 were non-hypercarbia. These 76 presentations involved 58 individuals, with some individuals presenting five times over the three-month period. Three groups emerged, some who were only hypercarbia (n= 18), some in the non-hypercarbia group (n=35) and 5 individuals who had presentations in both the hypercarbia and non-hypercarbia groups. Data showed that there was no definable subset group of hypercarbia patients within acute exacerbations of COPD presenting to the emergency department according to the variables. However the sample of presentations (with a blood gas) found within the study suffering hypercarbia was much higher (31.1%) than anticipated. Further analysis showed that the hypercarbia group had a significant lower forced expiratory volume in one second (FEV1) and a combination diagnosis of emphysema or asthma and congestive heart failure. An implication to the clinician is that identification of hypercarbia within COPD exacerbation is problematically difficult until the late signs are shown with the individual. By that time effective treatment patterns may have changed from the initial presenting problem. The author concludes that future areas of research within this field needs to lie within the community, and look at when these people start the exacerbation, what leads them to progression presentation to the emergency department, and whether these people are chronic sufferers of hypercarbia or presenting after a period of days exacerbation within their own home.