Abstract: Eighty alcohol and/or drug dependent women who were consecutive admissions to an outpatient alcohol and drug service were interviewed with the aim of gathering information regarding childhood adversity, psychiatric comorbidity and alcohol and drug history, including extent of treatment and alcohol and drug related criminality. A secondary aim of the study was to investigate associations between both the multiplicity of alcohol and drug dependence diagnosis and the presence of psychiatric comorbidity in relation to exposure to childhood adversity, including sexual, physical and emotional abuse.The data demonstrate that the study sample was a relatively severe group of alcohol and drug dependent women. A sizeable percentage came from backgrounds characterised by parental separation, conflict and alcohol and drug problems. Many were regularly exposed to physical abuse perpetrated by both parents or main parental figures and over two-thirds were exposed to some form of sexual abuse within their first 15 years. Sixty percent had been dependent on more than one psychoactive substance, with half having undergone previous alcohol and drug treatment. The women also presented with substantial histories of criminal convictions, with a quarter having served a prison sentence. The results indicate the presence of extensive psychiatric comorbidity in the sample. Two-thirds of the women met current DSM-IV criteria forat least one of the following Axis I disorders: major depressive syndrome, social phobia or bulimia nervosa, while nearly half had antisocial personality disorder. More importantly, significant associations were found regarding the presence of psychiatric comorbidity in relation to four measures of severe childhood adversity, i.e. childhood sexual, physical and emotional abuse and parental problems. Multiplicity of alcohol and drug dependence diagnosis was associated with severe emotional abuse, severe parental problems andpsychiatric comorbidity. Emotional abuse during childhood was the most pervasive indicator of comorbidity and multiplicity of alcohol and/or drug dependence. The main implication for clinical practice arising from the results of this study is the need for the development of a broader approach to alcohol and drug service provision. In order to achieve positive treatment outcomes, alcohol and drug service may need to routinely screen and plan treatment for unresolved childhood trauma, psychiatric disorder and other problems related to alcohol and drug use in all clients presenting for alcohol and drug treatment

Abstract: This study investigates the way that medical, nursing and institutional discourses construct knowledge in the specific context of Not-for-resuscitation (NFR)in a New Zealand general hospital where NFR guidelines are available in the wards and from the regional ethics committee. The thesis argues that there are ranges of techniques that staff use to construct NFR knowledge, enacted through various forms of speech and silence, which result in orderly and disorderly experiences for patients nearing death. The study was conducted through a critical analysis of the talk of health professionals and the Chairperson of the Regional Ethics Committee.

Abstract: This qualitative study explores the perceptions of mental health nurses regarding assessment in an acute adult inpatient setting in Central Auckland. Fourteen mental health nurses took part in semi-structured interviews answering five open-ended questions. The analysis of data involved a general inductive approach, with key themes drawn out and grouped into four categories (roles, attitudes, skills and knowledge) in order to explore the meaning of information gathered. The outcome of the study acknowledged the importance of contextual factors such as the physical environment and bureaucratic systems, as well as values and beliefs present within the unit. The participants expressed concern that their input to assessment processes was limited, despite belief that 24-hour care and the nature of mental health nursing generally suggested that a crucial role should exist for nurses. In order for nurses to be established as central in the assessment process on the unit the study concludes that a nursing theoretical framework appropriate for this acute inpatient setting needs to be developed.

Abstract: Chronic lung disease in neonates requires long term hospitalisation and more particularly “unitisation” of the baby. The particular issue of concern related to the effect of chronic lung disease on the neonate's family; psychologically, socially, and economically. This small study examines these concerns from the parent's perspective

Abstract: With the intention of decreasing emergency department demand, there has been a focus on determining those patients who do not require the services of the emergency department so they can be redirected away to an alternative health care provider or facility. Co-locating an after-hours primary health care facility near to the emergency department is a model under consideration in some district health boards. This model suggests that a substantial proportion of the patients currently managed in the emergency department can be assessed and managed in a general practice setting. It is envisaged that by redirecting the lower acuity patients away from the emergency department, overcrowding will be relieved. This is despite evidence demonstrating that low acuity patients are not the cause of emergency department overcrowding. Moreover, being treated at the emergency department is the only safety net for many people in the community who cannot afford alternative care. This research report discusses the literature regarding the practice of referring or redirecting patients away from the emergency department and the issues associated with this model. In doing this, it looks at the Australasian Triage Scale, the system used to ensure patients are seen in order of clinical urgency, because it has been suggested that this system could be used as a tool to refer patients away from the emergency department. The author concludes that even though some people could be seen by another health care provider, the triage system is not an appropriate tool for achieving this. While it is tempting to believe that patients in the lower triage categories are prime candidates for being referred away, there is evidence from hospital statistics that patients in these categories have a high number of hospital admissions and in-hospital death rates. Additionally, to complicate matters, there is no universal definition of what constitutes an 'appropriate' emergemcy department presentation and no consensus of opinion amongst health professionals in deciding patients' 'appropriateness'. For these reasons it is unethical to expect nurses who administer the triage system to use it for the purpose of referring people away from the emergency department.