Abstract: Drawing on data from a large convenience sample of caregivers in New Zealand, this article argues for a reappraisal of the way in which care homes view death and dying and advocates the more widespread adoption of a palliative care philosophy. Increasing numbers of people are dying in care homes yet little is known about the nature and quality of their deaths. The limited research available suggests that there is a need to promote a philosophy of palliative care that is not confined to the terminal phase of life. However, adopting such an approach appears to be inhibited by a lack of understanding, education and training, as well as continuing reluctance to discuss issues of death and dying in an open and honest way.

Abstract: This article explores the importance of evaluation of nurse-managed clinics using the Mana Health Clinic in Auckland, as an example. Fourth generation evaluation is offered as an appropriate methodology for undertaking evaluation of nurse-managed clinics. Fourth generation evaluation actively seeks involvement of clients in the process and outcome of the evaluation, resulting in participation and empowerment of stakeholders in the service – a precept often forgotten in traditional evaluation strategies and of vital importance in understanding why people use nurse-managed clinics. The method proposed here also incorporates the need for quantitative data. The main argument is that a combination of qualitative and quantitative data sources is likely to give the greatest understanding of nurse-managed clinics' utilisation.

Abstract: This article outlines a model for the nursing role in the chronic health care context of renal replacement therapy. Materials from several streams of literature are used to conceptualise the potential for nursing work in the renal setting as negotiated care. In order to present the role of the renal nurse in this way it is contextualised by viewing the renal setting as a specialised social context constituted by a dominant professional discourse and a contrasting client discourse. While performing specific therapeutic activities in accord with the dominant discourse, renal nurses can develop a relationship with the person living on dialysis, based on responsiveness to their subjective experience reflecting the renal client discourse. In contrast to the language of noncompliance prevalent in the renal setting, nurses can, through their relationship with renal clients, facilitate their attempts to negotiate the requirements of the therapeutic regime into their own personal life situation. Nurses can mediate between the dominant and client discourses for the person living on dialysis. Care describes the quality that nurses actively seek to create in their relationships with clients, through negotiation, in order to support them to live as fully as possible while using renal replacement therapy. The author concludes that within chronic health care contexts, shaped by the acute curative paradigm of biomedicine, the model of nursing work as negotiated care has the potential to humanise contemporary medical technologies by responding to clients' experiences of illness and therapy.

Abstract: A thesis submitted in fulfilment of the requirements for the Degree
of DOCTOR OF PHILOSOPHY IN EDUCATION, UNIVERSITY OF CANTERBURY 2003.
This thesis highlights the ways in which the practices of contemporary midwives in
Aotearoa/New Zealand are caught within the intersection of an array of competing discourses. The context for this is the reconstruction of midwifery in Aotearoa/New Zealand as an autonomous feminist profession founded on partnership with women. Interviews and participant observation with midwives, based mainly in one New Zealand city, are the basis of an analysis of the complexity of midwives? praxis as professionals. The analysis draws on insights from critical and feminist approaches to Foucault?s theories of discourse, power and the subject. It includes discussion of the conditions which came to produce and authorise the concept of ?partnership?. Which subjects can speak about partnership, and when? What claims
are made about it? What challenges it?

Abstract: The incidence of postoperative complications is reduced with early identification of at risk patients and improved postoperative monitoring. This study describes the development and effect of a nursing preoperative assessment tool to identify patients at risk of postoperative complications and to reduce the number of acute admissions to ICU/HDU. All surgical patients admitted to a surgical ward for an elective surgical procedure (n=7832) over a 23-month period were concurrently scored on admission using the preoperative assessment tool. During the time period studied, acute admissions to ICU/HDU reduced from 40.37 to 19.11%. Only 24.04% of patients who had a PAS >4 were identified by the surgeon and/or anesthetist as being at risk of a postoperative complication, or if identified, no provision was made for improved postoperative monitoring. This study supports the involvement of nurses in identifying preoperatively patients at risk of a postoperative complication and in need of improved postoperative monitoring. The postoperative monitoring requirements for the PAS >4 patients were relatively low technology interventions.

Abstract: This paper reports the three-stage development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand. In Study 1, clinical indicator statements (n = 99) generated from focus group data, which were considered to be unobservable in the nursing documentation in consumer case notes, were included in a three-round Delphi process. Consensus of ratings occurred for the mental health nurse and academic participants (n = 7) on 83 clinical indicator statements. In Study 2, the clinical indicator statements (n = 67) that met importance and consensus criteria were incorporated into a questionnaire, which was piloted at a New Zealand mental health service. The questionnaire was then modified for use in a national field study. In Study 3, the national field study, registered mental health nurses (n = 422) from 11 New Zealand district health board mental health services completed the questionnaire. Five categories of nursing practice were identified: professional and evidence-based practice; consumer focus and reflective practice; professional development and integration; ethically and legally safe practice; and culturally safe practice. Analyses revealed little difference in the perceptions of nurses from different backgrounds regarding the regularity of the nursing practices. Further research is needed to calibrate the scores on each clinical indicator statement with behaviour in clinical practice.

Abstract: The health status of indigenous peoples is a global concern with mortality and hospitalisation data indicating that the health of indigenous groups falls below that of other ethnic groups within their countries. The preliminary findings of grounded theory research project undertaken with a group of 23 New Zealand Maori women about their health priorities and 'mainstream' health service needs provide the foundation for an exploration of issues impacting on the health status of indigenous people. The role that nursing and nurses have in improving access and use of health services by indigenous people is discussed. Strategies are suggested that nurses can utilise within their practice when working with local indigenous groups.

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.