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.

Abstract: A new approach to mental health legislation has seen the involvement of a range of health professionals in legislated mental health roles, including the power of registered nurses to detain patients in hospital under Section 111 of the New Zealand Mental Health (Compulsory Assessment and Treatment) Act (1992). Under this Section, a nurse who believes that a voluntary patient meets the legal criteria of the Act can independently detain the patient for a period of up to six hours, pending further assessment by a medical practitioner. However, anecdotal evidence and a clinical audit undertaken by the authors suggest some doctors 'prescribe' Section 111 at the time of admission. This practice instructs nurses to initiate Section 111 if particular voluntary patients choose to leave hospital. This study outlines practice issues resulting from 'prescribing' Section 111; provides a legal critique of medical practitioners' involvement in this practice; and makes recommendations for guidelines toward a more constructive use of Section 111.

Abstract: This article presents a literature review of current research on perioperative nursing. Research studies are summarised. Overall findings include that there is a lack of exposure to perioperative nursing in undergraduate level, that expert nurses in the operating theatre make a positive economic and social contribution to patient outcomes, and there are barriers to registered nurses expanding their role in operating theatres.

Abstract: In New Zealand the clinically focused postgraduate papers and programmes, available through universities and polytechnics, are evaluated from an educational perspective but little evaluation of the implications for practice has been undertaken. This paper is Part One of a report on a study that sought to illuminate the impact of clinically focused postgraduate education on advancing nursing practice. Hermeneutic methodology provided a framework for analysing both the perspectives of nurses who had undergone such education and those who had directly employed and worked alongside these nurses. Emerging themes are described here. In a second article the findings will be discussed in relation to literature. Constraining factors will be identified and strategies designed to maximise the benefits of education for advancing nursing practice will be recommended.

Abstract: Traditionally the use of advanced physical assessment skills when assessing a patient or client has been the domain of the medical profession. The last few decades has seen many changes in health provision that have influenced nursing practice, as a result of the social and economic trends impacting on New Zealand society. A notable change in nursing practice has been an increased emphasis on the use of advanced physical assessment skills by registered nurses, as an expected part of the registered nurse's health assessment. Nurses in the United States, and more recently Canada and Australia, readily include these skills as an expansion of their health assessment into their nursing practice. The purpose of this research is to investigate whether New Zealand registered nurses have done the same. The factors that influence the registered nurses' use of these skills are also explored. This descriptive design was chosen in order to focus on exploring and describing this phenomenon in a holistic fashion. Data collection involved one hour semi- structured interviews with seven participants who all completed the same postgraduate advanced health assessment educational course. Three themes were identified as influencing the use of advanced physical assessment skills; the registered nurse's work environment, the registered nurse's attributes and the registered nurse's original nursing education. The findings from this research have implications for nurses in practice and nurse educators, in both undergraduate and postgraduate education.

Abstract: This paper continues presentation of the findings of a North Island based research project that explored the impact of clinically focused postgraduate education on advancing nursing practice. Like their international counterparts, increasing numbers of New Zealand nurses are enrolling in advanced practice programmes. Yet, despite international evidence supporting the usefulness of Masters level preparation for advancing clinical practice, questions about the need for such development persist. This paper argues that postgraduate education contributes to the development of courage and that this, in turn, is essential to overcoming the barriers that currently constrain the advancement of nursing practice.