Abstract: This article describes the Nursing and Midwifery Practice Structure, which has been in place at Healthcare Hawkes Bay since 1996. It was developed to provide nurses and midwives in clinical positions with a professional development structure, and uses a framework to recognise and reward competence. It encourages clinical progression and was developed to link nursing competence with remuneration. The Practice Structure, based on the work of Patricia Benner (Benner, 1984), is made up of 4 levels: Beginner/Advance Beginner Practitioner, Competent Practitioner, Proficient Practitioner, Expert Practitioner. The Structure was reviewed in 1998, and a Steering Group was formed to collect feedback from nurses and midwives, identify areas of concern, and make recommendations for improvements. At the time of writing, these recommendations are being implemented and systems are being developed to ensure the Nursing and Midwifery Practice Structure continues to develop.

Abstract: This text begins with a discourse analysis of the Diagnostic and Statistical Manual of Mental Disorders (fourth edition, 1994 – DSM -IV- to illustrate the discursive construction of mental disorder. The analysis identifies how productivity, moderation, entariness and rationality are constructed by this psychiatric discourse as the fundamental attributes of normality. It is argued that this discursive construction of normality has particular implications for the subject positions available to women.The text explores how those subject positions are constituted by analysing the narratives of women who have been diagnosed as having a mental disorder. Its object is to explore how the categories 'mental disorder' and 'women' are constituted; the effect this has on some women's experiences; and to offer a feminist interpretation of those experiences. The text explores the meaning of these women's experiences and proposes that their responses can be regarded as tactical responses to the non-recognition, or disconfirming recognition, accorded to the subject positions available to them.The women's tactical responses although taking different forms, reveal some commonalities in their responses to a lack of recognition for their performances: shame regarding the body which marks them as women; a sense of meaningless and emptiness in the available performances; a sense of themselves as objects for the use of others; passive performances as self-protective tactics; a need to suppress anger; and a tension between cultural expectations of normality and their own subjective experiences. The tactical responses that these women had employed take the form of over-conformity, withdrawal and resistance. They reflect that Sass (1992:58) describes as attempts to escape the 'form of the real'. It is the women's body which establishes her engendered subjectivity and it is through the body that the tensions related to her expected performances emerge. Each women's tactical response is imbued with multiple and sometimes contradictory meanings that may represent their ambivalence in relational to the cultural expectations for productive, moderate, unitary and rational performances. To enable the meaning of the women's distress to emerge it is necessary that it be recognised by interpretations that reflect their multiple and contradictory form.Alternative readings of these women's tactical responses position the desire for recognition as central. It proposes that it is necessary to pay attention to both the literal and figurative functions of language. The possibility of 'advancing our understanding of social life' (Gergen, women constructed as mentally disordered. These readings of the narratives require an understanding of the context and construction of the narrator's life and opens up the possibility for multiple understandings that do not necessarily privilege productivity, moderation, unitariness and rationality.By attending to the significance of the women's narratives this text proposes that the DSM-IV's (1994) construction of mental disorder of effectively marginalises women's experiences of their culturally determined subject positions. It acknowledges the need to understand how women symbolize their distress in a way that creates and communicates meaning

Abstract: The aim of this study is to investigate whether clinicians consider women have different needs to men. To identify what specific treatment clinicians provided for women with alcohol and drug problems and ascertain whether various clinician variable, are elated to differences in beliefs and treatment provision.The questionnaire items for this study were included in the National Centre for Treatment Development (Alcohol, Drug & Addiction) New Zealand wide telephone survey of alcohol and drug clinicians. Independent interviewers surveyed 217 clinicians. Clinicians were first asked whether they believed women with alcohol and drug problems have differing treatment needs to men. Clinicians responses were compared with various clinician Socio-demographic characteristics (gender, age, ethnicity, professional group, years working in the alcohol and drug treatment field, work setting, qualifications/courses attended, location, and personal alcohol use).Key findings are that almost a quarter (24%) of the clinicians surveyed did not believe that women have different treatment needs to men. However the majority (76%) of clinicians do believe that women have different treatment needs to men. Furthermore findings from this study suggest that significant differences exist in relation to clinicians' practice in new Zealand in relation to clinician, gender, work setting (Crown Health Enterprise, outpatient and residential), and gender mix of caseload

Abstract: The author reconsiders the meaning of expert, specialist and advanced practice. She proposes that they are distinctive and complementary aspects of every nursing role and suggests a set of attributes for each. Expertise is discussed in terms of the quality of performance, speciality in relation to particularity of performance, and advanced practice with regard to the level of performance.

Abstract: Work-related back pain among nurses is a problem of significant proportion. Nurses have a high rate of back pain compared to the general population and other occupational groups. There has been little reduction in the rates of nurses back pain and solutions to this complex problem continue to be elusive. Many quantitative studies have been undertaken examining and identifying the risk factors contributing to a high risk of back pain among nurses. Few of these studies focus on the complexities and context of the nurses physical and social environment. An exploration of these factors may assist to explain why interventions have not been successful and why the risk of back pain among nurses remains high.This study, using a qualitative methodology, explores nurses views and perceptions of the factors that they believe contribute to nurses having a high risk for work-related back pain. In-depth interviews were conducted with nurses working in previously identified high risk areas asking them about their perceptions of the risk factors and the activities that lead to risk situations for back pain. The strongest theme to emerge from the participant interviews was that it is the work demands from nursing that create and expose nurses to high levels of risk. Other risk factors identified were environmental hazards, equipment management and the physical work environment. The interview responses were analysed using two theoretical models of risk. The Health Belief Model examines risk behaviour using a cognitive psychological approach and the Social Model of Risk views all behaviour as influenced by the social environment. Both models offer explanations as to why nurses take actions that place them at risk for back pain. This study highlights the main ideas and concerns raised by the participants. It makes recommendations for managing the problem of work-related back pain in the nursing profession, and suggests areas where more research is needed

Abstract: This research utilized a focus group methodology to discover what nurses in clinical practice considered 'caring' care meant for them. Six registered nurses volunteered to participate in the project. They practiced over a wide variety of real settings within the public hospital, which provided both acute and elective surgical and medical services, including an extensive elderly population. Taking these important 'caring' statements, I then explored with the group what factors in their work environment hindered of enhanced their identified 'caring' care in clinical practice as did their overseas counterparts. This study also highlighted the impact the health reforms had on the individual clinical practice at this hospital. The effects of the institutional changes in response to the health reforms were far reaching at both the personal and professional level. Caring is an important concept found in nursing practice. It has been widely documented By nurse scholars, researchers and nurse authors that care is at the core of nursing practice.Some have even referred to care as being the heart of nursing. The finding from the present research indicates the importance nurses place on caring in their day to day encounters with patients. It also demonstrates how nurses express their care and their perceptions of the importance of care has in the clinical practice

Abstract: The author defines and describes PTSD, and looks at how it may apply to nurses. Primarily affected by delayed PTSD, nurses may experience it as burn-out, after exposure to trauma over time. The Critical Incident Stress Management programme instigated at Healthcare Hawkes Bay is outlined.