Abstract: This paper explores the benefits of using education as one means to advance palliative care competence for nurses. A literature search was conducted revealing numerous educational initiatives and approaches have been developed to improve palliative care. Benefits include improved nursing knowledge, confidence and competence which directly correlate with improved patient outcomes. Accompanying the shift of palliative care from hospices to varied health care providers globally, are disparities in care provision. The literature suggests that reasons for such disparities include insufficient specialised palliative care knowledge and skills of nurses to effectively deliver this care within generalist health settings and lack of information for caregivers. In response, approaches aimed at improving palliative care include reviewing, redefining and implementing nursing roles, education courses, and theoretical frameworks to inform practice and improve outcomes. This paper focuses on the benefits of offering tailored palliative care education in work settings to improve patient care. One entrepreneurial education initiative aimed at advancing palliative nursing and which is currently being implemented in aged care contexts is shared. Careful strategic planning and working more collaboratively between all stakeholders, is strongly recommended in order to manage current and future challenges. Advancing palliative nursing care using appropriate education is achievable and beneficial but is fraught with complexities.

Abstract: The aims of this study were to illuminate the joint constructions of exemplary nurses and their lived experiences of being and becoming one. Inherent in being 'exemplary' was the notion of 'becoming', which involved the integration of knowledge and experiences through reflecting on the day-to-day of 'being a nurse'. Being exemplary was not about perfection but learning from every experience and integrating these into becoming. The author developed a creative qualitative and participatory method. Ten exemplary nurses were recruited and interviewed three times. They also provided supplementary data such as photos, poetry and writings. Analysis occurred through first and second level categorising and the use of writing as method. Writing became a way of knowing – assisting discovery and allowing reflection on the data in order to connect the categories and themes together in a coherent and workable whole. The author reports that the above method led to the following emergent findings. The pivotal construct was Authentic Being, through living a reflective life, surrounded by the major constructs of Love of Nursing, Making a Difference, Critical Friends, Walking the Talk and Backpack patients. These constructs directed a specific and comprehensive review of both the philosophical and nursing literature. This review was not used to expand or enlarge the findings but to enlighten, illuminate and clarify. Significant philosophical ideas were extended, developed and synthesised with the findings. The author suggests that the new knowledge that emerged from this research has profound implications for everyday nursing practice, undergraduate and post graduate nursing education, and for Charge Nurses and Senior Nurses, who are of vital importance as role models, mentors and critical friends. The results are significant and are important for nurses and the nursing profession and contribute to, and advance, nursing knowledge.

Abstract: The intention of this heuristic study was to explore and discover the essence of the positive influence of the natural environment on the human spirit. The study quest was identified as a central concern that evolved from the author's personal experience of spiritual awakening in the natural environment and an interest in the concept of connectedness in nursing care and practice. The study also focused on the self of the nurse and the qualities of holistic nursing care. Guided by heuristic methodology developed by Moustakas (1990) the thesis traces a journey of discovery. Using conversational interviews, six nurses were asked to describe their experiences of their spirit being positively influenced in the natural environment. These nurses were also asked if these beneficial experiences had any flow-on effect to their nursing practice. From these interviews various commonalities of experience were identified as well as some experiences unique to the individual participants. The participant knowing was articulated using Reed's (1992) dimensions of relatedness in spirituality as a framework. Reed describes these dimensions as being able to be experienced intrapersonally, interpersonally and transpersonally. A substantive body of nursing and non-nursing literature was explored to support the participant knowing and provide strength to the discussion. The study discovered that the human spirit is positively influenced in the natural environment. The three actions of personal healing and wellbeing in the natural environment, knowing self – knowing others and sustaining self in nursing practice were valued by the participants as contributing to the quality of their nursing care. In bringing together spirituality, the natural environment and nursing, holism was discovered to be the significant and connecting constituent. The study has some implications for the discipline of nursing that are also discussed by the author.

Abstract: The aim of this research was to explore patients' educational experiences and the usefulness and benefits of this health education in the rehabilitation period, when undertaking a total joint replacement. An exploratory, qualitative descriptive study method was used to describing patients' experiences of health education. Five participants, convenience sampled, were interviewed eight to twelve weeks post surgery following unilateral total joint replacement in a tertiary hospital. Participants valued the education they received pre operatively, which included written material, video and individual interaction with varied health professionals. Although this was provided in a timely manner, evidence showed limited post operative reinforcement and follow up of given education and preparation for discharge. Three 'partnership' themes were identified from data, Communicative, Subservient and Knowledge. 'Communicative Partnership' conceptualised the participants' experiences of the nurse-patient relationship, whilst 'Subservient Partnership' captured the participants' experiences of 'being' patients. 'Knowledge Partnership' combined the participants' ideas about knowledge and their retention of this knowledge to assist with their rehabilitation post surgery. The needs and experiences of patients after total joint replacement reflect on transitional change – changes in roles, behaviour, abilities and relationships. Educational contents need to reflect a realistic recovery process to assist with this transitional period, delivered by health care professionals in a manner best suited for patients.

Abstract: This research is informed by the interpretive phenomenology of van Manen, and explores the lived experience of nursing from the perspective of nurses who provide care for people with a co-existing intellectual disability and mental health problem. Although nursing research is commonly informed by phenomenology, there is a dearth of literature of any description written from the perspective of nurses who provide care for people with intellectual disabilities and mental health problems. As a result of the closure of many large institutions in New Zealand there are not many nurses who work with people who have intellectual disabilities and co-existing mental health problems. The study participants were four nurses purposefully selected because they provided care for people with intellectual disabilities and mental health problems. Data was collected using semi-structured interviews, and the researcher identified and wrote about the recurring themes in the transcribed interview data, which best captured the lived experience of the participants. The themes were: criticism of services, holistic caring, working with the client, issues of status, need for specialist knowledge, enduring relationships, diagnostic issues, advocating, modelling good practice; and working alongside. After further analysis the themes were encompassed within the larger interrelated themes of “Status and positioning” and “Advocating practices”, and finally within a single theme of: “The status and positioning of the nurse and the client leads to advocating practices.” These themes were found to be consistent with the nursing literature and with the researcher's own lived experience as a nurse who works in a specialist mental health intellectual disability service. The findings of this research have implications for a number of groups in New Zealand. Among the author's conclusions are that input is required from the Nursing Council of New Zealand, the nursing profession, nurse educators and the government to raise the status of clients with co-existing intellectual disabilities and mental health problems and the nurses who work with this client group. In addition, the roles for nurses who work with this client group are emerging and are likely to be diverse and there is a need for further research to capture the different experiences of these nurses.

Abstract: The transition of patients from intensive care to the ward environment is a regular occurrence in intensive care. Today patients are often transferred earlier and sicker due to the demands for intensive care beds. This results in patients with higher acuity being cared for in the wards. Here ward nurses have to meet the ongoing complex demands of caring for higher acuity patients, alongside managing high patient-to-nurse ratios, staffing concerns, and varying levels of experienced nurses. This research explored the experiences of ward nurses receiving patients transferred from intensive care. The aims were to identify any areas of concern, highlight specific problems that occur on transition and to address what information is pertinent to ward nurses when receiving patients from intensive care. A qualitative descriptive methodology using focus groups was utilised to gather information about these experiences. Three focus groups were held with ward nurses from various wards within the study setting hospital. All participants had considerable contact with intensive care and were familiar with the processes of transferring patients. Five themes emerged from the focus groups – Patients as intensive care staff say they are; Time to prepare the biggest thing; Documentation as a continuation of patient care; They forget what its like; and Families, a need to know about them. The theme Patients as intensive care staff say they are relates to reliable information sharing focused on the patient, their needs and condition. Participants expressed their concern that patients were not always in the condition that the intensive care staff stated they were on the referral. Having adequate time to prepare was considered important for the majority of ward nurses receiving patients from intensive care. Documentation was highlighted in the theme Documentation as a continuation of patient care particularly in relation to fluid balances and vital sign history. The theme They forget what its like suggests there is a perception that intensive care nurses have a lack of understanding of what the ward staff can actually manage. Decreased staffing levels during certain shift patterns and a lack of appropriately experienced staff on the wards is a common concern for ward nurses. Ward nurses also recognised that caring for families was part of their role. Patients and families may respond differently to the transfer process and their inclusion in transfer planning was seen as essential. Communication was a reoccurring element throughout all themes.The author concludes that communication is the paramount factor that impacts on a 'smooth transition' for ward nurses. A 'smooth transition' refers to the transfer of patients from intensive care to the next level of care. Subsequently, nurses' perceptions need to change, whereby transfer planning from ICU should be the focus rather than discharge planning. Transfer planning and education for all nursing staff is vital if the transfer process is to be improved. Consequently, transitional care within the context of ICU aims to ensure minimal disruption and optimal continuity of care for the patient. The knowledge gained from this research may provide better understanding of the multifaceted issues linked with transitional care that may be adapted for a wider range of patients in various clinical environments.

Abstract: This thesis presents an explorative study of the place of caring in bioethics. Through the examination of various sources of literature from the disciplines of nursing, feminist theory and ethics, and bioethics, a case is developed that argues for a valid respected place for caring, as an ethic of care in bioethical decision-making. The case is built by providing evidence to support the fundamental importance of caring to human life, health, relationships, and survival at the broad societal level. This is presented from the feminist and nursing perspectives, along with a critique of the negative aspects of caring practices. The next stage of the case presents a layout of the discipline of bioethics, using an historical perspective to illuminate the influences of bioethics' deep past, as it still affects the discipline in the present. The development of contemporary bioethics' current status is presented along with critiques from bioethicists themselves, and nursing and feminist theory and ethics. In the case at this point, from a bioethical perspective, two major predicaments appear to prevent an ethic of care obtaining a valid place in ethical decision-making in bioethics. These are the justice/care duality, and the conflict between different conceptions of care and autonomy. The bioethical objections and arguments put forward regarding these predicaments are examined and refuted, and the author suggests a case is established for the inclusion of an ethic of care in bioethical decision-making.