Abstract: The extent of early remediable morbidity after critical illness is unclear. We began a follow-up service to determine outcomes, facilitate rehabilitation and remedy service deficiencies. A critical care nurse identified hospital survivors (DCCM and hospital databases), completed a structured telephone interview with the patient and intervened according to predetermined guidelines. Of 261 admission 1/1/95 29/3/95 50 died in hospital (39in DCCM). Of 211 hospital survivors (M115, age 15-84 median40) 31 could not be contacted, one died at home and 179 contacts were made 21- 120 (median 51) days after DCCM. One refused interview, 178 interviews took 8-60, (median 15) minutes. Only 68/178 had resumed normal activities and 26/78 workers had returned to work. Seventy patients had contacted general practitioners because of critical illness sequelae. One hundred patients gad 191 problems (including unhealed wounds29, pain 28, impaired mobility26, neurological deficit 178, infection 10 weight loss 9, tiredness 6 depression 5, sleep disturbance 3, others 57). Sixty-five described DCCM staff as helpful, 37 had complaints (hallucinations 6, staff behaviour5, restraints5 sedation/analgesia inadequate5 or excessive 2, poor communication3, fear3, noise 2 other 4) and 5 raised serious non-DCCM issues. Forty-four patients were called again 6-84, median 42 days later when 69/112 health problems had resolved but 29/44 patients had not resumed normal activity. Four attended a clinic and were referred to other services. A follow-up service is well received. Morbidity is common but improves within three months after critical care. We are addressing service issues

Abstract: This research project, a descriptive study using narratives, explored the application of cultural safety theory and philosophy to clinical nursing practice. This application was illustrated through the stories of four experienced Pakeha,Tauiwi registered nurses in Aotearoa/New Zealand, who described their realities of applying cultural safety to daily clinical practice. The incentive for this study had been identified in light of the current political climate, pragmatic realities and in keeping with the current state of knowledge.Cultural safety was first identified by Maori nursing students and subsequently described and articulated by Maori nurses, as being a potential solution to improving Maori health statistics in Aotearoa/New Zealand. Many Maori and Pakeha/Tauiwi in this country accept that the Treaty of Waitangi, a covenant signed between Maori and the Crown in 1840, is the incentive for giving cultural safety status and credibility. While the Nursing Council of New Zealand has supported this concept and made it a requirement for all nursing education, there is little literature written concerning its application to practice from a Pakeha/Tauiwi perspective.The perceptions and insights of these nurses were heard when they were invited to describe how they saw cultural safety as part of their daily clinical practice and recount their struggles, realities, practice and experience. The literature review supported the use of narratives as an appropriate method for this study. The philosophy and assumptions of narrative appear to match the oral tradition of nursing and thus it was considered possible to contemplate the fit of narrative to nursing research.The stories of these nurses, gave examples of best nursing practice in which cultural safety was integral to practice, and provided exemplars of possible beginnings and possible endings. The depiction of cultural safety in practice surfaced as the weaving of four themes which were consistent in all the stories – themes of reflection, reverencing, the environment, and hidden blessings and healing. The research evidence suggested that cultural safety was visible in practice in many diverse ways; it emphasised the complexity of the concept; accented its evolving status; and identified a relative consistency in defining cultural safety despite the varied contexts of practice.Although this study was limited by the small sample, the findings indicated that there were potential implications for nursing education, research, nurses and nursing practice as well as for other health care providers working in the current health care system. They suggested that actions from nurse educators, nurse managers, health care managers and clinical nurses themselves, would be needed to ensure that cultural safety continued to be part of nursing practice and contribute to the improvement of all health statistics in this country as well as to encourage an increased development in the focus on Maori health issues.Further nursing research suggested by the findings include studies to appraise cultural safety from a patient's perspective, and consideration given to the evaluation and assessment of nurses and their culturally safe practice. In addition, exploration and research could ascertain the benefits and rewards of culturally safe practice and identify ongoing educational needs as well as examining the views of other members of the multi-discipline team

Abstract: As the clinical consequences of power failure in intensive care are seldom documented we reviewed the effects of a power failure on patient care, outcomes and the adequacy of our disaster plan. We reviewed clinical records of all ten patients in our department during a 20-minute total hospital power failure, determined the impact of the failure on the therapies being given, and the costs of failed equipment. We assessed the departments disaster plan and identified the causes of the power failure.Nine patients were intubated; six ventilated (one receiving nitric oxide) and three receiving continuous positive airway pressure. Two patients were ventilated by Servo 300,? which continued on batteries, the other four patients were ventilated manually. Six patients were receiving nine inotrope infusions through IMED Gemini,? (battery life 30 minutes). One patient was receiving high volume ultrafiltration using a Gambro? haemodialysis system, which failed. Blood flow to prevent clotting was maintained by turning the roller pump manually. All networked monitoring (SpaceLabs?) failed and three haemodynamically unstable patients were monitored by transport monitors (SpaceLabs Scout?). No patient suffered any ill effect. Failed electronic circuits cost $NZ11,724. The disaster plan was implemented and functioned well. The aged cables supplying Auckland Central failed during an El Nino summer. The hospital generators, supplying power to the city grid, failed to switch over to the hospital. During power failure infusion pumps should be only for inotropes. We now have external 12-volt battery backup. With good pre-planning, safe intensive care continued during a short power failure

Abstract: A Heideggerian Hermeneutical Analysis (HHA) approach was used for a study of returning registered nurse students (RRNS) from a nursing/health management context. In essence a descriptive interpretive study the intent has been to unveil the common meanings embedded in the lived experience of RRNS return to formal (advanced) studies. The phenomenon or issue of interest was pursued in the form of a question: What is meaningful and significant for participant RRNS in their everyday world on re-engaging in formal (advanced) nursing studies?Research from the RRNS viewpoint is scarce, so the focus of the study was to understand what RRNS themselves found to be the highlights of the experience. Participants included RRNS coming from a management background and, therefore, very much at the cutting edge of rapid and continuing change in health care provision. In addition to personal and professional reasons for returning to study, what the narratives disclosed was the compelling need experienced by the RRNS to increase understanding of changing requirements in the workplace. They looked for new possibilities to transform management of nursing/health services and for learning experiences favorable to that purpose. A key aspect of their concern related to the interactive nature of their lived experience as a RRNS with the entire context of their everyday world, that is, with the connections and relations between the study-work-homespace.Fourteen RRNS from an established university nursing programme participated in an expended non-structured interviews lasting 60 – 90 minutes. The interviews were held during 1993 in places selected by participants, some in the home but mostly in the work setting. With the consent of the participants interviews were audiotaped and then transcribed. The texts (transcriptions) were analysed hermeneutically using Heideggerian phenomenology, a particular tradition of philosophy whose concern is the meaning of Being. The concern is to make visible participants' experience of their 'world'. In this instance, it was the everyday 'world' of the participant RRNS and the lived meanings of what they experienced on return to formal (advanced) studies. Hence everyday lived experience is the focus of attention in Heiedeggerian phenomenology. In this research approach what is sought is understanding not explanation. It is a premise of phenemenology that, in general, an understanding of the meaning and significance of the lived experience can be required from the 'things' (the phenomena under study) themselves. Approaching a participant as an expert by virtue of directly experiencing the phenomenon, is basic to phenomenology. Hermeneutic analysis of the texts of the participant RRNS affirmed the authenticity of those assumptions.The study revealed several common or major themes, two relational themes and one constitutive pattern were identified through the process of textual interpretation. The constitutive pattern expressing the full complexity of the relations and connections between the themes, was found to be present in all fourteen texts; the nature of a constitutive pattern being 'that it's always there'. The constitutive pattern 'Nursing is Dwelling in Thoughtful Concern as Context Calls Forth', emerged as the major finding of the study. This pattern witnesses to the pragmatism that is inherent in nursing and commonly found in nurses' responses to the challenges presented by continuing and rapid change. For the participant RRNS nursing had become a way of engaging their energies in the workplace as appropriate to a given place, time and culture. The two relational themes accent particular aspects of the constitutive pattern. 'Nursing' is a whole pile of things'; and 'Curriculum: Reflective Openness' reveal the inherent meanings of the constitutive pattern. Firstly, that nursing is diverse in practice and has many dimensions; and,, secondly, that a curriculum befitting the diversity of nursing requires us to constantly challenge ad test the learning experiences we provide for RRNS.The fourteen participants traversed diverse pathways to acquire the understanding and skills required for altered health care structures. Adopting new relationships and 'leaping-ahead' (Heidegger, 1962), to be able to see the whole picture of what was being experienced in nursing/health care, reveals the RRNS becoming-as interpreters for both colleagues and clients. Leaping-ahead is reflective of thoughtful concern as the pattern of responding to presenting need. This way of living a life transforms work. The participant RRNS disclose that, dwelling in such a way in nursing/health work opens up a future of possibilities which brings all the presenting needs into focus. Sharing the story of their lifeworld as RRNS, the participants have exemplified the ' reflective openness' Senge(1990) advocates, as being a pre-requisite for 'learning organisations'. Contemporary oganisations require us to challenge our own thinking as well as being free to speak our minds ('participant openness'). Since, however much we value our daily life practices and understandings, they need to be 'always subject to test and improvement'. In effect, what the participants have bestowed on us is that, within the framework of a curriculum for RRNS and the content learning of a given course, we must generate a process of learning amenable to both individual and group requirements

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: The paper reviews, as a case history, the progress (to 1980) of the development of a Nursing Manpower Plan for Wellington Hospital Board.The main features of protocol are delineated.The prime requirement for the development of a manpower plan are perceived of as having available, reliable, quantifiable and comparable data.Discussion indicates the methods of collection, analysis and use (actual and potential) of quantifiable data.The use of quantifiable data indicated the potential, for the use of “nursing hours per patient per day”

Abstract: The aim of this study was to identify some nursing students' perceptions of how the process of journalling helps them to learn about nursing. The study sample were three students enrolled full time in a Bachelor of Nursing programme and at the end of their first year. Each student volunteer participated in a semi-structured audio-taped interview, guided by the opening question “What is journalling like for you?” The tapes were transcribed, coded and analysed for general themes. Each participant received a copy of her transcript and was invited to alter, add or delete any information. The findings highlighted the difficulties of beginning to journal, learning how to journal, personal growth through journalling, the journal as a critical document of oneself, a love-hate relationship with journalling, and what journalling is like now