Abstract: This study used a curriculum inquiry framework to investigate the perceptions of 184 nursing students and nurse educators in relation to bioscience in the nursing curriculum. Nursing students were found to have significantly more positive attitudes to bioscience in nursing education than nurse educators, and nurse educators were not found to have significantly better self-efficacy in bioscience than the students, although this might have been expected. The results of focus group discussions, used to investigate this in more depth, suggested that some nurse educators and clinical preceptors may not have sufficient science background or bioscience knowledge, to help nursing students apply bioscience knowledge to practice. As a result of this, it is suggested that the aims of the intended and prescribed nursing curricula are not being fulfilled in the implemented curriculum.

Abstract: This study traces the author's transition from being a mental health nurse to becoming a facilitator of an education programme, the Health and Wellbeing course, for those in recovery from mental illnesses. Within this transition, she describes a journey from disease-focused paradigms toward emancipatory paradigms, evidenced by her application of the recovery approach to her teaching. The 'recovery approach' proposed by the Mental Health Commission in November 1998, and other models of health, are explored using the methodology of descriptive/interpretive philosophical inquiry, autobiographical narrative and a dialectical research design. The author draws from the philosophies of phenomenology and existentialism to present excerpts from her journals, exemplars, poetry and artwork which illuminate epiphanies occurring as she integrates health paradigms in the design of the Health and Wellbeing course. Within this process the recovery approach is revealed as being consistent with the teaching principles of the Health and Wellbeing course. The author goes on to say that the dialectical research design reveals paradoxes and transformations in nursing, medical, psychological, and humanistic paradigms within the New Zealand socio-political context from the 1970s to 2003. The way these are integrated into her practice as an educator, becomes evident in the dialectical research cycles of being, thinking, developing a project, the encounter of teaching, making sense and communication. These cycles reveal her being in the roles of nurse and educator and the thinking through of paradigms that lead to the design and philosophy of a Health and Wellbeing course, the encounter of teaching, and the communication of insights gained. The author's main objective is to show the importance of nurses and educators developing a reflective consciousness when working with sufferers of mental illness. This reflective consciousness involves three levels: The primary level, or raw experience; the social level, or our socio-political contexts and social values, and, the realised level, insights gained about knowledge and experience.

Abstract: This study sought to examine the effects that hospital re-engineering may have on adverse patient outcomes and the nursing workforce. In 1993, New Zealand implemented policies aimed at controlling costs in the country's public health care system through market competition, generic management, and managerialism. The study was a retrospective, longitudinal analysis of administrative data. Relationships between adverse outcome rates and nursing workforce characteristics were examined using autoregression analysis. All medical and surgical discharges from New Zealand's public hospitals (n=3.3 million inpatient discharges) from 1989 through 2000 and survey data from the corresponding nursing workforce (n=65,221 nurse responses) from 1993 through 2000 were examined. Measures included the frequency of 11 nurse sensitive patient outcomes, average length of stay, and mortality along with the number of nursing full time equivalents (FTEs), hours worked, and skill mix. After 1993, nursing FTEs and hours decreased 36% and skill mix increased 18%. Average length of stay decreased approximately 20%. Adverse clinical outcome rates increased substantially. Mortality decreased among medical patients and remained stable among surgical patients. The relationship between changes in nursing and adverse outcomes rates over time were consistently statistically significant. The authors conclude that in the chaotic environment created by re-engineering policy, patient care quality declined as nursing FTEs and hours decreased. The study provides insight into the role organisational change plays in patient outcomes, the unintended consequences of health care re-engineering and market approaches in health care, and nursing's unique contribution to quality of care.

Abstract: This study relates to the emphasis placed by Coronary care Nursing Staff on the technical aspects of care as compared with the personal aspects of care for the patient in this area

Abstract: This study presents information, obtained from health service managers, on the present use and possible future use of second level nurses within the region encompassing the Wanganui, Rangitikei, Manawatu, Tararua, Palmerston North City and Horowhenua districts. “ Second level nurses” are currently known as enrolled nurses and, in accordance with Section 53A of the 1983 Amendment to the Nurses Act, are required to work under the direction and supervision of registered nurses or medical practitioners. Enrolled nurses are usually allocated less responsibility for nursing assessment and judgement than registered nurses.Management perspectives, from seventy seven health workforce managers, were sought in relation to the future workforce need, the scope and boundaries of practice, and the alternatives for the future educational preparation of second level nurses. Seventy two percent of managers said that they thought enrolled nurses were essential to New Zealand's future nursing workforce. They predicted increased opportunities for enrolled nurses in care of the elderly and community care settings. Patterns in the current workforce utilization of enrolled nurses, however, did not support these views.In relation to the education of enrolled nurses, managers indicated that hospital-based training was the most preferred option. However, managers asserted that, in view of the current lack of employment opportunities no more enrolled nurses should be prepared at the present time.Although questions about education were focussed on the educational preparation of enrolled nurses, many of the respondent managers also expressed opinions about the educational preparation of comprehensive nurses. As a result, an evaluation of comprehensive nursing programmes is suggested.While the numbers of second level nurses being prepared and used is decreasing, there is a concomitant increase in the preparation and use of caregivers. This rapidly increasing group isfast becoming a “cheaper” second level workforce. The increase in the use of caregivers is seen to result from the pressure on healthcare employers to reduce spending within the current highly competitive, de-regulated economy. Managers asserted that enrolled nurses are not cost effective in comparison with either caregivers or registered nurses.The study concludes with thirteen recommendations which are made under the following four groups;1. Manawatu Polytechnic – provider of nursing education.2. Healthcare employers – users of nursing education.3. Enrolled nurses – participants in nursing education.4. Professional nursing bodies – guardians of nursing education

Abstract: This study originates from the author's practice experience working for the New Zealand Fire Service back in the late 1980's and early 1990's as an Occupational Health Nurse where she piloted a Critical Incident Stress Peer Support programme in the No.4 Region. The author identified work-related stress and related it to Critical Incident Stress (CIS) from firefighters exposure to critical incidents. This study explores four firefighters experience of Critical Incident Stress Debriefing (CISD) within a Region of the New Zealand Fire Service. It explores the application of CISD as one component of Critical Incident Stress Management (CISM), and the Nurse Researcher's philosophy of Clinical Nurse practice in relation to the application of CISD. The knowledge gained from the analysis of the data has the potential to influence professionals understanding of their experience and affect future practice and that of others working in the field of CISM. Much of the literature that supported CISD appeared to offer a rather superficial understanding of the firefighters experience in relation to CISD. A narrative approache was chosed as the methodology, utilising four individual case studies as a method of social inquiry in order to explore the experience of CISD. The narratives were able to creatively capture the complexity and the dynamic practice of CISD. An overall pattern of the formalised process was uncovered through the participants' narratives. Eight dominant themes were highlighted from the narratives which included safe environment; ventilating the stress reaction; similar feelings; getting the whole picture; peer support; bonding and resolution. While these themes were common to all the participants, each participant had a particular theme/s which was unique to their experience.

Abstract: This study is an extension of a previous study by Riker, Picard and Fraser (1999) to determine whether doctors and nurses rate patients similarly using the Sedation-Agitation Scale (SAS) in a natural Intensive Care Units (ICU) setting. The author notes that it is essential to establish whether these different professionals provide consistent scores and have a mutual understanding of the SAS and its constituent levels. This will help ensure that clinical decisions relating to sedation-needs can be made appropriately and consistently. This quasi-experimental reliability study was set in a 12-bed tertiary general ICU in New Zealand. The SAS had recently been introduced into this unit and a convenience sample of 42 nursing and medical staff performed paired ratings on 69 randomly selected adult ICU patients over an eight week time frame. The mean patient age was 58 years, and 79% of patients were on continuous infusions of Propofol. Intubated patients made up 91% of the sample. 74% of patients were given the same SAS score by the doctor-nurse pair. The weighted kappa score for inter-rater agreement was 0.82 indicating very good agreement. Of the 26% of scores where there was a difference, the two readings were only one score apart. Most of the difference occurred around SAS scores of 1-2 and 3-4. Further analysis found no staff or patient variables to be statistically significant in impacting on the ratings. The SAS was found to be a reliable sedation-scoring tool in a general ICU when used by nurses and doctors of varying experience.