Abstract: The experience of loneliness within a people-centered profession has supported nursings silencing and invisibility. A literature expedition through communication texts and journals led to an awareness of the paucity of literature which explores and acknowledges how we dialogue together, rather than the more fashionable focus on how we should communicate with others.

Abstract: An emergent theoretical perspective in the nursing literature relates to nursing as a human science and the application of critical social science and feminist frameworks to nursing research. This research adds to the discipline's knowledge base in that it is at the leading edge of exploring how critical case study illuminates critical issues in the practice of nursing.My interest in the research question came from hearing colleagues espouse the view that other than a legal one, there were no differences in practice between enrolled and registered nurses. How accurate was this perception? Without answers to this question, members of the nursing profession in New Zealand were likely to make some major decisions about the future of enrolled nursing which history will show were ill founded. Since I “walk the talk” of both the world of practice and the corridors of nursing power relationships, I sought answers by incorporating the viewpoints of both groups into the research design.Five registered nurses who had previously been enrolled nurses were asked to consider what was different about their present practice compared to their experiences as an enrolled nurse.Through critically reflexive discourse and journalling, Liz, Emma, Kathy, Helen and myself came to reflect on our nursing worlds in order to transform them.Writing about these transformations in a way that kept our voices alive was more difficult. The cases were written as stories, using storytelling as a legitimate academic activity to link the methodology with the theoretical perspectives. This ensured our individual voices were heard rather than silenced by the research process. It also left a clear decision trail for the reader to follow related to issues of rigor. Paradoxically, the identification of patterns across the case studies was facilitated.Two main patterns emerged in answer to the question “what's different in your practice now from when you were an enrolled nurse?” The differences were explicated in the pattern “Becoming a registered nurse” while “She was one of us” exposed the underlying power and control issues. This study found that the enrolled nurse controls practice at the bedside.The nursing profession's stance on the future of enrolled nurses was also explored through case study. Key nursing stakeholders were interviewed using a proposed legislative change to the Nurses' Act, 1977, that would lead to the demise of the enrolled nurses as a category of nurse, as a focus point. These different perspectives expose for critique the socio-political forces that silence the voice of enrolled nurses in determining their own future. At a legislative level, the stakeholders' voices are dominant. The future of enrolled nurses looks increasingly bleak in New Zealand as the nursing profession positions itself legislatively for the 21st century

Abstract: This phenomenological study describes the lived experience of mothering a child hospitalised with acute illness or injury. Seven mothers who had experienced this crisis within twelve months of our first interview agreed to share their stories with me. The resulting data were analysed and interpreted using van Manen's interpretation of Heideggerian phenomenology.Four phenomenological themes emerged from this study. Mothers have a special kind of knowing. They have a need to do with and for their child. Handing over to or leaving their child in the care of strangers and waiting for their child to be returned to their care are very difficult things for mothers to do. Their constant vigilance is enabled by their special kind of knowing and their need to do. The difficulty of handing over, leaving and waiting is emphasised by mothers' constant vigilance.Personal experiences during the course of my study presented significant challenges to my ability to offer an effective phenomenological description of the phenomenon under study. Continuous reflection aided by dialogue with fellow phenomenological researchers has resulted in a meaningful narrative.This description of mothering in a context of crisis is useful in the potential contribution it makes to nurses' understanding of mothers' experience of the hospitalisation of their children. It supports the philosophy of family-centered care and highlights the ability of individual nurses to make a positive difference to a very stressful experience

Abstract: Since 1995 we have provided a bereavement follow-up service but the benefits of this to clinical care have not previously been reported . We reviewed the 1995 results, documentation methods, system design, discussed with reviewers their data collection, interview process and its effect on them and their practice. Next-of-kin of only 99/151 patients ( M87 age 14-88) were contacted 16-149 median 34 days after the death. Sleep disturbance (55/99) were the most common problems. We now give next-of- kin literature including a pamphlet which introduces our service and discusses these problems. Most next-of-kin (77/99) commented favorably on DCCM care, but 16/99 identified inadequate facilities and communication problems as service deficiencies. We have improved facilities (paint, furniture, telephone, drinks machine). We now notify patients general practitioners of every death and bring families back for meetings with staff when necessary. We changed systems of case identification and recording of next-of-kin information. Nurse interviewers (8) identified their needs for improved telephone skills, education about grief and research, debriefing after calls and their need for acknowledgement of participation in this service. Study days now address these issues. Interviewers difficulties with interview content have lead to changes. They suggested peer review of data forms to improve completeness which now occurs. Some found the interview process personally disturbing, but all reported positive changes in their practice with bereaved families.Within two years a bereavement service has led to improvements in facilities, communication, and staff expertise, it is now part of our holistic care

Abstract: In 1995 we conducted a retrospective audit on a prospectively collated database to find out which intensive care patients missed out on psychiatric care after self poisoning. Our results showed that 57 patients in 1995 may not have received psychiatric follow-up assessment. Department of Critical Care Medicine (DCCM) follow-up was also less successful for this particular group. It was recommended that on admission to intensive care, all self poisoning patients would be referred to the Liaison Psychiatry Service (LPS).In 1996 we reviewed the databases of DCCM and LPS to determine if the quality of psychiatric follow-up had improved after the initial 1995 audit. In 1996 124 patients had 149 admissions (85F, age range 14.6-85.3, median 35, median GCS 9, 99 ventilated, 3 deaths). Thirteen patients had 25 admissions within 6 months of their index admission , 7/13 had a major psychiatric disorder. Mixed poisoning remained common. Forty-five admissions took cyclic antidepressants, 21 sedatives, 52 other medications, 25 ethanol (median 43 mmol/l ), 30 carbon monoxide and 5 took various non-prescription poisons.Thirteen went home, 32 to other hospitals, 4 to psychiatric hospitals and 97 were transferred to wards within Auckland Hospital. Psychiatric follow-up assessment was successful in 96/97 patients prior to discharge from Auckland Hospital. Those discharged to other hospitals or home were referred and followed up by LPS teams or other Mental Health Services.DCCM follow-up 4-6 weeks post discharge was more successful for 1996 with 120/146 contacted of which 33/120 were receiving ongoing psychiatric care.