Abstract: The author argues that the framework of competencies required for advanced nursing practice should include a moral dimension in order to take account of relational as well as functional competencies. There is no recognition of the relational competencies required to practice caring as a moral imperative. The Nursing Council of New Zealand expects that nurses will practise 'in accord with values and moral principles'. The paper explores the history of two nursing discourses, that which sees nursing as a functional occupation and that which emphasises the relationship between nurse and patient. A practice exemplar is used to demonstrate positive outcomes from advanced relational competencies.

Abstract: The author draws on her experience as the 'Paediatric Link Nurse' in an Intensive Care Unit (ICU) within a metropolitan area in New Zealand to examine the proposed changes to ventilation practice. Currently, due to ventilator availability and medical and nursing practice, the usual mode of mechanical ventilation is volume-limited with pressure breath triggering. The author suggests this mode can compromise effective ventilation of paediatric patients, due to air leaks around the uncuffed endotracheal tubes of infants and small children. This air leak makes a guaranteed tidal volume almost impossible and can cause ventilator breath stacking and volutrauma. This can impact on the patient's comfort, sedation requirements and airway security, and affects how these patients are nursed. Thus the ventilation of these paediatric patients by the current volume-limiting mode may be not always be optimal for the infant/child. A new ventilator will be available to the unit, with a pressure-controlled, flow breath-triggering mode available. The author critiques the possibility of using this mode of ventilation, suggesting how this will impact on nursing practice in ICU, and of the education and knowledge that will be required. She suggests this change to ventilation practice may improve comfort and safety for the intubated child/infant, through the delivery of an optimal mode of ventilation.

Abstract: This article explores the complex nature of liability in the case of standing orders and vicarious liability by employers, and also when nurses and doctors are in management roles. The authors address misconceptions about medico-legal responsibility for nursing practice with the advent of nurse prescribers and nurse practitioners. They refer to the submission made by the College of Nurses Aotearoa (NZ) on the Health Practitioners Competence Assurance Act (2003), and discuss practice liability and nurse-physician collaboration.

Abstract: This study explores perceptions of general practitioners in the Northland District Health Board (NDHB) regarding the nurse practitioner role, identifying their knowledge of and perceived problems with that role, and their experience of nurses in advanced practice. A purposive sample of all 108 general practitioners in NDHB was undertaken, with a response rate of 46.3%. General practitioners favourably viewed nurse practitioner functions traditionally associated with nursing, such as health teaching, home visiting, obtaining health histories, and taking part in evaluation of care, but less favourably viewed those functions associated with medicine, such as prescribing, ordering laboratory tests, and physical assessment. While expecting few problems with patient acceptance, the general practitioners felt that funding and doctors' acceptance would be problematic. Most general practitioners indicated they had knowledge of the nurse practitioner role and had experienced working with a nurse in advanced practice, but some uncertainty and lack of knowledge about the nurse practitioner role was evident. The author recommends more education and discussion with Northland general practitioners to ensure they are fully informed about the nurse practitioner role and its potential positioning in primary healthcare, to reduce uncertainty, minimise role confusion and promote collaboration between general practitioners and nurse practitioners.

Abstract: The environment of the Newborn Intensive Care Unit (NICU) is a stressful one for families and is often designed to provide technical care for the infant rather than facilities that would enable and support parental and family participation in infant care. Furthermore, the author notes that the environment of the NICU emerged in literature as an obstacle to meaningful family involvement in care. However, she goes on to say that a philosophy of Family Centred Care in the NICU can offer a framework of care that supports family involvement in the infant's care and family presence in the NICU. It also promotes parental participation in decision-making for the infant and gives recognition to the importance of perspectives provided by the family. This dissertation explores the difficulties associated with the practice of Family Centred Care in the environment of the NICU. It offers recommendations for features of unit design that can promote Family Centred Care by supporting and sustaining the presence of families in the NICU and therefore facilitating their involvement in the care of their infant.

Abstract: This report reviews relevant literature pertaining to clinical career pathways and associated core competencies for nursing in New Zealand. The review identifies and analyses existing clinical career pathways for nurses and mental health workers in New Zealand, paying particular attention to the content, structure, strengths, criticisms and applicability to the development of a clinical career pathway for Maori registered nurses to work in Maori mental health (NGO organisations). This report is part of Te Rau Matatini's current work on the development of a career pathway for Maori registered nurses with mental health work experience to work in NGO, community settings. It is a preliminary report, based on existing literature. A subsequent report was planned detailing the career pathway developed by Te Rau Matatini, with strong guidance and input from Maori mental health nurses and the wider Maori mental health sector.

Abstract: This retrospective quasi-experimental study reviewed assaults in two adult mental health inpatient rehabilitation units. The majority of clients in this area experience enduring mental health illnesses and have complex physical health issues. The service comprises of an intensive rehabilitation unit and a secure extended rehabilitation unit. Between May and August 2001 the service moved to purpose built facilities. The opportunity was taken to review clients' assaultive behaviour in the new environment and to compare the incidents with those in the old environment to see if there had been any significant changes. Data on assault incidents including time of assault, place of assault, who was involved and what preventative actions were suggested were collected from the Incident and Accident Hazard Reports (IAHR) dating from 1 April 2000 until 31 May 2002. Staff were expected to complete IAHR reports on all assault incidents. The research examined whether the change in environmental conditions impacted on clients' wellbeing in relation to assaultive behaviour. Trends within the IAHR reports were also examined in order to compare these to similar studies completed in other parts of the world. There were 141 IAHR reports of assault incidents. Fifty of these occurred in the pre move period, 38 in the transition phase and 53 in the post move. There was no significant difference in the rate of assaults in the pre-move to post move period. Completion of the IAHR forms was seen to be very problematic, especially in relation to legal status of perpetrators and documentation of prevention strategies. An urgent audit of existing practice is now required to establish if problems found with the quality and completion of the IAHR forms continues to be evident in the rehabilitation service and if present staff education is needed to improve the standard of documentation. Research is also needed to establish the extent to which staff implement strategies to prevent assaults, and to reduce recidivism.