Abstract: As the healthcare system moves toward a consumer-driven paradigm, visiting hours for family and significant others of the intensive care unit patient have become a topic of interest and discussion. Research since the 1970s has generated controversy and speculation over the ideal visiting practices in the adult intensive care unit. The aim of this dissertation was to examine the benefits for the patient, family members and nurses of appropriate visiting practices within intensive care areas in order to establish if open visiting is the best regime for patients in the adult intensive care unit (ICU). This dissertation explores visiting practices in adult critical care unit settings. Specifically, the benefits of visiting for patients, and the factors that may impede or facilitate visiting practices within the ICU were critically discussed. These factors included the benefits and disadvantages of open visiting, and the nurse as an influential factor in visiting. These areas linked together to form the basis for consideration of visiting in the ICU. Review of existing literature pertaining to visiting in the ICU indicated that patients wanted open visiting hours yet also indicated that they would like some visiting restrictions. Nurses appeared to value family input into care and were aware of patient and family needs, even though they may restrict visiting to suit their own work practices. Family members can provide the patient with psychological support, provide important historical data, assist the nurse with selected aspects of physical care, and actively encourage the patient's efforts to recover. The outcome of this exploration is the recommendation of an open visiting policy tailored to individual patients, as, the author suggests, this would foster nursing practice and ultimately benefit patients and their families.

Abstract: An essential part of nursing practice for the nurse on the surgical floor is to relieve the discomfort of post operative pain for patients in their care. Post operative pain management encompasses a series of processes from assessing pain, providing relief, assessment of measures used to relieve pain through to documentation in the patient record. Yet literature, both internationally and from Australia and New Zealand, suggests that post operative pain continues to be poorly managed despite having the means to provide more than adequate relief. Events leading up to the commencement of this study indicated that locally, post operative pain assessment, including documentation in the patient record may be substandard. The objective of this study was to develop and test an audit tool; undertake a retrospective audit of nursing records, including nursing notes and the nursing care plan, in respect of what postoperative pain assessments nurses document in the patient record; evaluate data and make recommendations for practice. Methodology: A five part, 23 question Likert scale audit tool, designed specifically for this study was used to collect data over a period of two months. In total 40 patient records that met the inclusion criteria were audited.The results indicate that local practice reflects poor documentation standards found in other studies. The most complete recordings were those entered on specifically designed charts such as the Patient Controlled Analgesia and Epidural charts (N 28) but this did not carry over into the patient record. Despite that fact that the patient's self reports of pain is said to be the single most reliable indicator of pain, there was only four occasions when the patient's verbal response to pain was recorded. None of those responses were according to any type of pain rating scale. Evidence of evaluation following measures used to relieve pain was more likely to be recorded if pain was poorly controlled or when side effects such as nausea were experienced by the patient. The author concludes that overall the audit has highlighted many gaps in what is or is not recorded in the patient record in respect of post operative pain assessment and has highlighted the need to develop standards of practice that will improve post operative pain management practices.

Abstract: Kai Tiaki, first published in New Zealand in 1908, provides a means of communication among New Zealand nurses. It is currently the journal of the New Zealand Nurses Organisation members and previously was aligned to the New Zealand Trained Nurses' Association in the 1920s. This dissertation examines what nurses write about professional development through the pages of Kai Tiaki. Two time periods are examined, 1920 to 1930 and 2000 to 2006.
Central to the discussion on professional development is post-registration education. Post-registration education in nursing commenced in New Zealand in 1928, and has progressed to the current day where nurses can engage in post-graduate nursing to master and doctoral level. Kai Tiaki provides a channel for nurses to discuss and debate their thoughts on post-registration and post-graduate education. Two key themes emerge from analysis. Firstly, the survival mode of nurses highlights oppression as a contributing factor to professional development. Secondly, examining the role of the New Zealand Trained Nurses Association (1920s) and the New Zealand Nurses Organisation (2000s) presents an understanding of the political nature of the journal itself and how this influences professional development. This dissertation provides critical reflection on professional development for nurses through the pages of Kai Tiaki and provides suggestions for future research.

Abstract: Psychiatric consultation liaison (PCL) nursing is an evolving specialist area of mental health nursing in the USA, UK, Australia and New Zealand. The aim of this dissertation is to explore models of PCL nursing practice in order to develop and discuss a PCL nursing model applicable to the New Zealand context. The role of the PCL nurse was of particular interest to the author as a new practitioner in this specialist area. While there have been PCL nurses in practice for over 50 years, the literature does not offer much clarity about models of PCL nursing. From a review of the literature, four themes were recurrent in the work of PCL nurses. These themes represent four functions which are vital to the role of the PCL nurse: partnership, expertise of the PCL nurse, therapeutic relationship and organisational consultation. The needs of the patient are the core of this model and the primary objective is to improve the quality of care of patients in the general hospital with co-existing physical and psychological problems. It is imperative that PCL nurses evaluate their practice and embark on research to investigate clinical outcomes, cost effectiveness and the impact of PCL nurse practice on patients and staff. This PCL nursing model provides a beginning for this process. It also clarifies and articulates the role of the PCL nurse which enables the service to be promoted to colleagues. This PCL nursing model represents a critique of the author's understanding of the role of the PCL nurse. As expertise develops, the model will continue to be tested and refined.

Abstract: The author notes that many registered nurses undertake a role in the community which may or may not be recognised for what it really is – one of these roles may be that of the unpaid health care provider. The nurse may be called on by family, friends, neighbours, or the wider community to provide a voluntary health service at any time of the day or night according to the need of the person wanting the information or assistance. This is the story of one such nurse. Four themes have been uncovered from a nursing practice that has spanned three decades of providing an on-call basic first aid service to a community of about two hundred households in a rural community. These experiences are used to shape the stories within the story of this voluntary role, and provide a framework to discuss the implications for the future of voluntary practice.The themes are: Maintaining personal and professional boundaries; Maintaining values and a high standard of care; Commitment to ongoing education; Accepting accountability for one's actions. The confidence and competence that such practice demands is explained from a personal perspective, along with an attempt to answer a question that is often asked – “Who will or indeed does anyone want to replace me when I retire or shift away from the district?” This question is addressed in the context that this story is written, the changes that the healthcare system is experiencing at present, and the impact that these changes may have for the future.

Abstract: The focus for this research was nursing culture satisfaction and intent to remain working within a secondary hospital in the New Zealand public healthcare system. A specific group of 117 registered and enrolled nurses were surveyed to identify what issues would encourage them to remain working within the organisation. Descriptive data derived from the Nursing Culture Satisfaction Questionnaire found higher levels of job satisfaction and intention to stay from the staff in operating theatre, compared to other surveyed areas. Factors reported as contributing to job satisfaction included supportive, friendly staff, teamwork, and organisation size. Important issues regarding recruitment and retention include pay parity, personal satisfaction, conditions of employment, the valuing of staff and poor nurse patient ratios. Findings suggest that hospital management should foster positive work environments and respect, to promote job satisfaction and discourage nurses leaving the organisation. While pay parity was a large issue at the time of the questionnaire, the inclusion of the district health board in the nurse Multi Employer Collective Agreement may have reduced this as a contributing factor.

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: The author tells a story to describe her advancing practice as a registered nurse practising in the rural context. Storytelling is a way to add to the growing knowledge of rural nursing practice in New Zealand. By sharing her rural nursing story through a storytelling framework, she suggests that other nurses may be in a position to utilise this framework and tell their own stories. She has adapted a formalised storytelling framework from McDrury and Alterio (2002). Concepts of the storytelling framework, including reflection, critical reflection and critiquing, can lead to new knowledge and understanding of nursing practice. Past experience is a component of this framework as are the concepts of surface and deep learning. In this way, nursing practice can be deconstructed then reconstructed for new knowledge to be obtained. The innermost thoughts and feelings of the nurse are an integral part of this whole process and need to be acknowledged. The author wanted to answer questions she asked of herself, namely, “how do I practise and how can I improve my practice for the benefit of my patients?” The rural context is expanded upon in her nursing story as this is where she practises as a registered nurse. Her various nursing roles, including advanced practice as a district nurse and rural nurse specialist, are described in depth as are the two areas where she has lived and worked as a rural nurse.