Abstract: The author explores possible approaches to the ethical dilemma confronting nurses of critically ill premature infants with an uncertain or futile outcome despite aggressive neonatal intensive care. A case history illustrates the issues. The morality of nursing decisions based on deontological and utilitarian principles is examined, as are the concepts of beneficence and non-maleficence. A fusion of virtue ethics and the ethic of care is suggested as appropriate for ethical decision-making in the neonatal intensive care environment.

Abstract: The author presents her experience investigating the incidence of post-anaesthetic shaking in the recovery room ward, and develops a clinical tool for its treatment. Several theories about post-anaesthetic shaking are examined. The cases of 1296 patients who had major regional or general anaesthetics over four consecutive months in the previous year are studied. The incidence of post-anaesthetic shaking and correlating core body temperature readings with post-anaesthetic shaking are examined. A protocol for reducing/treating post-anaesthetic shaking is developed on the basis of the findings of the study.

Abstract: This article describes a study conducted on the internal medicine, general surgical, and vascular wards of a large metropolitan hospital to assess the impact of a networked monitoring system and portable patient monitors. This pilot study was developed to address the needs of hospital patients who require continuous non-invasive vital signs monitoring (including heart rate, non-invasive blood pressure, pulse oximetry, cardiac waveform monitoring) with the addition of surveillance from a cardiac intensive care area. Data were collected from 114 patients over a three-month period to identify a patient group that could be managed appropriately under the new system and to determine the effect that flexible monitoring had on patient care management. Findings include identification of a specific patient group that can be managed successfully outside the cardiac intensive care area using this system. Other findings suggest a way to improve the management of patient monitoring in the general ward areas.

Abstract: The author suggests that a nursing service would benefit by using the concept of budgets and budgeting control, in terms of management accounting and its applicability to a hospital based nursing service. The main objective of this study was to suggest a possible line of approach towards the construction of an information system designed to yield reliable and useful data, without which there can be little hope of any truly effective guide to the development of nursing services.

Abstract: A description of the establishment and the first year's operation of an occupational health service set up as a limited liability company and offering contracted fee- for- service health care for employees of clients' businesses. The report tells how the two nurses established the company and how the company secured contracts, it describes the delivery of health care in the workplace. The nurses' perception of their work and the client managers' evaluation of the service are included.

Abstract: This reports the results of a national survey to ascertain what direction education of theatre nursing personnel is taking. It includes method and content preselection, orientation and in service education/ staff development phases of education. Options for the future are also addressed.

Abstract: This feminist study is an exploration of the subjectivity of women working as nurses within the gynaecological ward. Gynaecology has a long history as a unique area of concern to the health practitioners of any given period. However, the author suggests, recently with the development of modern gynaecology, this specialty has become based on male knowledge and male texts, women either as patients or nurses appear voiceless within this canon. Major tests within nursing mirror a medical construction of gynaecology, with the women involved in the discourse again absent from the literature. To explore the nurses' reality within the gynaecological ward, the author has undertaken a feminist interpretive study. To contribute to this debate the author drew on certain specific notions from feminist and postmodern epistemologies. These notions of the Other, difference, the body and discourse provided a unique way of viewing the practice of the nurses in this gynaecological setting. These epistemological concepts were then interwoven with feminist strategies to undertake the research. Through the process of feminist praxis, which included the author working alongside the nurses and conducting in-depth interviews, three areas of general concern to the nurses emerged. Firstly the relationships, that is their relationships with each other as nurses and with their women patients. Secondly, the difficulties inherent in nurses' practice in this setting due to the nature of the experiences of the women they were nursing. These difficulties arose in relation to two particular situations, nursing women experiencing a mid-trimester termination and nursing women with cancer. Thirdly, the relationship with/in the medical discourse and individual doctors which, according to nurses, had a major impact on their work. This study contributes to nursing knowledge by providing a forum for the voices of women as nurses, who nurse women in the gynaecological ward, to be heard. The author concludes that nursing and feminism have much to offer each other and share an emancipatory goal of positive action to support and assist people in their lives.

Abstract: Practice development, situated at the nurse-patient interface, is a crucial aspect of professional development as a whole. The Nursing Development Unit (NDU) is one model of structured clinical practice development. NDU have their origin in a desire to provide the best possible care for patient through the support and development of autonomous therapeutic nurses. All possible sources of NDU-related literature from 1983-1999 were reviewed to determine the effectiveness of the NDU model. The purpose of the research was to establish the role of the parent organisation in supporting the ongoing viability of NDU; to describe the key processes and activities of NDU that are instrumental in the development of nursing practice; to clarify the role of the NDU in contributing to improved patient outcome; and finally to identify the critical indicator of successful NDUs for their application in the New Zealand context. The study found that British nursing journals have played a large part in promoting the NDU model. The pioneering units were given positive coverage and this has by and large continued. Accreditation systems have been important in maintaining standards and providing a generic framework for implementation. The trend is now towards internal funding from the parent organisation. The review identified a number of key features for the successful establishment of NDUs. NDUs appear to have under emphasised the development of socio-political acumen in the nursing staff. However, the NDU does offer a model for the development of confident, assertive, autonomous professionals. The NDU model values nursing as professional practice. The author concludes that the NDU model has stood the test of time, and demonstrated the ability to be at the vanguard of contemporary practice development. The model is flexible and its potential is maximised when it is tailored to meet the need of the parent organisation. The model has been successfully established in Australia, and has the potential to be adapted and refined for the New Zealand context.