Abstract: This study used a non-experimental correlational design to research the relationship between the experience of the nurse, with the application of continuous positive airway pressure therapy (CPAP) to patients presenting to a metropolitan emergency department with cardiogenic pulmonary oedema (CPO), and to establish what difference, if any, CPAP made to outcomes. A retrospective audit of records was used to extract data on all 54 patients that received CPAP over a 12-month period. The primary outcome measures were off CPAP within two hours, transfer to intensive care unit or cardiac care unit, and secondary outcome measures were length of hospital stay and death. There was a trend towards more experienced nurses attending patients who required immediate treatment or treatment within 10 minutes. These patients were more likely to be recognised at triage as requiring CPAP therapy. The early application of CPAP reduced hospital mortality, length of stay, and the need for intubation and ventilation. Attention needs to be given on how best to educate nurses so that more patients presenting with acute respiratory failure can benefit from nurses' decision-making regarding the commencement of CPAP.

Abstract: Family violence is common and there are significant long-term negative health effects from victimisation. Health professionals are now recognised as key providers of family violence intervention. The Hawke's Bay District Health Board HBDHB) launched a Family Violence Intervention Programme in the emergency department in 2002, in accordance with national directives. The Family Violence Intervention Programme includes routine questioning for partner abuse within social history assessments for all women 16 years and over who seek healthcare services. Nurses assumed responsibility for implementing this programme into emergency department practice. Establishing partner abuse screening in practice requires an organisational and attitudinal change. Achieving and sustaining this change can be difficult. Evaluation was considered an essential aspect of the systems approach adopted within the HBDHB Family Violence Intervention Programme to support change. The aim of this study was to identify the enablers and barriers to routine questioning in the emergency department one year after the programme was launched and the strategies to address these barriers. The staff who have responsibility for routinely questioning women were considered well placed to provide this information. The methodology selected was evaluation research using semi-structured interviews. The design included member checking and triangulation of the findings. Eleven emergency department staff members participated in five (two group and three single) interviews. The interviews revealed that routine questioning for partner abuse is difficult in the emergency department setting. Barriers to questioning exist and enablers can eliminate or minimise these. Enablers such as policy and training support routine questioning. Barriers identified included the lack of privacy and time. Participants suggested strategies to overcome these. These barriers, enablers and solutions were either personal or organisational in origin and all had a common theme of safety. An outcome of the study was the development of a model of barriers and enablers to ensure safety when routinely questioning women for partner abuse. This evaluation has utility within the HBDHB as it informs programme progression. However, the evaluation has wider implications. The experiences of the emergency department staff led to the emergence of key themes that may inform the development of comparable programmes. Introducing routine questioning requires a practice change; a multifaceted approach focusing on safety can assist staff to achieve that change.

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 historical research study examines some of the factors that caused problems for early New Zealand trained nurses upon their introduction into New Zealand hospitals, between 1885 and 1914. Eight incidents in the professional lives of nurses of the period are used as illustrations of the strains and discord that were apparent in this time of change. Analysis of these incidents attempts to answer the question as to whether the introduction of trained nurses into the New Zealand hospital system did add new considerations to problems encountered by nurses in their professional life. The conclusion is that there was a new dimension of difference added to the system with the introduction of the trained nurse. This developed from the evidence that these nurses, particularly if they were also matrons, had to fit into the existing power structures, which were not really ready to accept them, either through choice or lack of foresight. Enmeshed within these considerations is the influence of Florence Nightingale; her effect on nursing itself, and the consequent public and official perception, or misperception, of who nurses should be.

Abstract: This article explores the application of professional practice models in nursing. Particular reference is made to the magnet hospital model and the concept of shared governance. Key principles from these models are explored in relation to the implementation of a professional practice model in an intensive care environment. Historical, cultural and professional factors that may be seen as barriers to the implementation of this professional practice model are also explored. In conclusion, the article identifies recommendations that may contribute to a successful implementation and duration of a model in practice.

Abstract: Cultural safety is taught in all undergraduate nursing programmes in Aotearoa/New Zealand. There is a predominance of Pakeha nurse educators in teaching this content. There is little explanation of what being Pakeha entails. This perpetuates a silence and continues the dominant hegemonic position of Pakeha in Aotearoa/New Zealand. This study suggests that as Pakeha cultural safety nurse educators we examine our dominance and critique the delivery of cultural safety education. This autobiographical study undertakes to explore the Pakeha identity of a cultural safety nurse educator. The author discusses identity in the context of a globalised world, and challenges the idea of a definitive Pakeha identity. There are multiple descriptions of Pakeha, all underdeveloped and inadequate for the purposes of cultural safety education. In this study, the author uses the heuristic process of Moustakas (1990) and Maalouf's (2000) ideas of vertical and horizontal heritage to locate and present the essence of the self. In keeping with the purpose of cultural safety education, the author considers her ethnic cultural self as described by Bloch (1983) and explores Helms' (1990) theory of White racial identity development. This thesis describes the position of one Pakeha in the context of teaching cultural safety in an undergraduate nursing degree programme in Aotearoa/New Zealand. For Pakeha cultural safety nurse educators the author argues that exploration of one's heritages and location of a personal Pakeha identity is pivotal to progressing the enactment of cultural safety in Aotearoa /New Zealand.