Abstract: As has been the case internationally, deinstitutionalisation of dual diagnosis (intellectual disability and mental illness) services has also occurred in New Zealand. Inpatient services have been redefined to respond to the more acute focus that has arisen out of this deinstitutionalisation process and nurses are having to redefine their roles in response. This study was undertaken to explore and describe the culture of nursing practice in a dual diagnosis inpatient unit in one psychiatric hospital. A focused ethnographic approach was used to triangulate data gathered from fieldwork observations, review of documents and semi-structured interviews. Schein's (1985) levels of culture model, was used to identify and explore the artifacts, values and assumptions evident in this nursing practice. Analysis presents three key themes categorised as 'communication', 'assessment' and 'safety'. While these key themes are shown to be evident in the everyday practice of the nurses, how these relate to the notion of 'dual diagnosis nursing' is not clear. Therefore, the author describes the major finding of this study as revealing a nursing culture holding tight to traditional psychiatric and psychopaedic nursing practices and struggling to develop a distinctive culture in the absence of a defined dual diagnosis knowledge base. The author concludes that these findings suggest an urgent need to provide nurses with support in gaining contemporary knowledge regarding dual diagnosis nursing. Support for nurses in advancing these areas then impacts on support for the patients. It is suggested that additional research is undertaken to assess the learning needs of the nurses in order to develop clinical practice guidelines for this area. Further recommendations are made to address system issues which are contributing to the gap in knowledge.

Abstract: The researchers evaluate two case-management models of respite relief care at Waitemata District Health Board. The evaluation consisted of semi-structured interviews and postal surveys for clients utilising respite care and staff members involved in both the North/West and Rodney models of respite care in Auckland. Across the two regions, a total of 2 older people and their informal caregivers, 2 respite coordinators, and the Needs Assessment Service Coordination (NASC) Manager were interviewed. In addition, postal surveys were received from 21 older people, 36 informal caregivers, 11 NASC workers, and 3 allied health professionals. Findings revealed there was generally high satisfaction with both the respite models. Caregivers believed the respite service did give them a break, although it was insufficient. Caregivers reported concerns regarding how respite facilities could improve and the older person's deterioration post respite. Staff identified improvements for each of the models.

Abstract: This article explores historical, philosophical and theoretical perspectives of health assessment, and discusses one institution's experiences developing and implementing undergraduate health assessment courses.

Abstract: This report is an evaluation of the academic journey undertaken by a group of newly graduated nurses who were sponsored by a New Zealand district health board to work in a variety of primary health care nursing settings. The impetus for this pilot employment option was the Ministry of Health's focus on primary health care nursing and workforce development for this sector and the Expert Advisory Committee for primary health care nursing's recommendations to district health boards regarding employment of graduate nurses and support for them to engage in post graduate study. Evaluation participants were primarily the graduate nurses who were interviewed at the end of their first year of practice which was following programme completion then again nine to ten months later. Findings include the nurses reflections on what supported them and what acted to impede as barriers to their learning success and practice development. The report concludes with five recommendations that can be used to ensure that the travels of future newly graduated nurses taking this pathway are supported, safe and successful.

Abstract: A Grounded Theory approach was taken to explore the concept of the gap between theory and practice, whereby they are seen to be discrete entitites. For this study, the first phase of data collection was a series of computer mediated group discussions, and the second a number of individual interviews. In both sets of interviews participants were asked to describe how they experienced and managed differences they perceived between theory and practice in nursing. The participants referred to different types of theory relevant and central to effective nursing practice. The first was private theory; the second was formal theory and third was situational theory. For the students it was a conflict that produced uncomfortable emotions, distrust of others and personal self doubt. In an effort to reduce this discomfort the students sought an explanation for the differences between theory and practice, some of which challenged their key personal values. However, the most emotionally neutral explanation that also preserved the integrity of their key values was that there was a gap between the theory and the practice of nursing. The theory Negotiating Different Experiences has implications for the education of nurses in that personal knowledge and experiences must be incorporated in a programme of study and the feelings evoked by learning must be acknowledged as a catalyst to enhance learning. Further, the different forms of theory to which students will be exposed must be made explicit and nursing educators who must involve the individual student as an active partner in the mapping of a personalised programme, which includes the creation of individual assessment methods.

Abstract: This study explores the experiences of men who are nurses in Aotearoa New Zealand. Utilising discourse analysis a social constructionist reading of men, masculinity and nursing is provided to offer an alternative reading to much of the extant literature with respect to men in nursing. The study draws upon a number of different sources of “text”, including over 600 written works, two films and interviews with eighteen men who currently are, have been or are intending to be, nurses. Drawing primarily upon the “literary” textual sources a number of themes were identified for further exploration in interview with the co-researchers. These themes were the construction of masculinity, the construction of images of the nurse, the reaction to men who are nurses, sexuality issues, career development, and men and caring. The findings of this thesis reveal that the literature pertaining to men in nursing is replete with paradox and contradiction and fails to adequately account for the male experience. It is argued that the images and arguments provided in the literature with respect to men in nursing are based on out-of-date models and understandings of gender relations, masculinity and nursing. It is suggested that rather than enjoying patriarchal privilege, men who enter nursing must contend with being constructed as both an inferior man and inferior nurse. Their careers are not, as is alleged in the literature, based on developing “islands of masculinity” and male privilege, nor upon the avoidance of the emotional labour of nursing but reflect a belief that career is one way of doing care. It is argued in this work that men in nursing have fewer “taken-as-givens” upon which to base work and that they work to develop trusting relationships with their patients that are based on communication and empathy within a context defined by the patients' circumstances.

Abstract: The aim of the study was to determine the practice of nurses employed in integrated care projects in New Zealand from late 1999 to early 2001. Integrated care was a major health reform strategy that emphasised primary health care as a means to improve service provision between the health sectors. An investigation of nurses' practice sought to determine the extent to which primary health care principles had been adopted in practice, as a comprehensive primary health care approach has been advocated globally in the management of chronic conditions; the leading cause of disability throughout the world and the most expensive problems faced by health care systems. The philosophical basis of the research was postpositivism. The study employed a quantitative non-experimental survey design because it allowed numeric descriptions of the characteristics of integrated care projects to be gained for the purpose of identifying nurses' practice. The unit of inquiry was the integrated care project, and 80 comprised the study population. Data were obtained on projects from expert informants (n=27) by telephone survey using a structured interview questionnaire developed by the researcher. Data obtained from interviews were statistically analysed in two stages. First, data were produced to comprehensively describe the characteristics of integrated care projects and nurses practice. The 'Public health interventions model' was used as a framework to analyses the interventions (activities) and levels of population-based practice of nurses. Following this, the social values embedded in nurses' practice were determined using 'Beattie's model of health promotion' as a framework for analysis. A strong association was found between nurses' practice in projects and strategies used in integrated care, such as information sharing, guideline development and promotion, and case management, and projects with an ethnic focus, low income focus, chronic condition focus, and well-health focus. Whilst nurses undertook interventions most frequently at the individual practice level they were also strongly associated with the small proportion of interventions that were undertaken at the community level. The majority of interventions by nurses reflected the health promotion value of health persuasion, indicating a paternalist and individual-oriented philosophy. Nurses were engaged in two interventions that indicated a collective-oriented philosophy – coalition building and community development, the latter reflecting health promotion values of negotiation, partnership and empowerment. The study demonstrated that nurses' practice in projects was predominantly centred on individual-focused population-based practice suggesting the need for a framework to assist nurses to transition their practice to include more activity at the community and systems levels. Without a reorientation of practice, nurses will remain limited in their ability to achieve health gains for populations. In response to this conclusion, and drawing on research results and reviewed literature, a new model, The 'Primary Health Care interventions model' was constructed. Recommendations include advocacy for the acceptance of the model by the health funder, professional nursing bodies, health organisations, educational institutions, nurses, communities, and individuals.

Abstract: The introduction of nurse practitioner registration into New Zealand in 2001 was heralded as a move that would open up a wealth of opportunities for registered nurses to extend their practice into more independent roles and to provide a client-centred health service. It was also seen as a way to retain experienced registered nurses in the clinical practice area by providing a credible clinical career pathway. If nurse practitioner's are to meet these expectations, then, the author suggests, it is important to understand the processes that encourage or discourage nurses from advancing their practice. One of the early scopes of practice to be introduced was nurse practitioner with an endorsement in aged care scope of practice. Grounded theory was the method used to generate an explanation of how registered nurses working in aged care were preparing for the introduction of nurse practitioner roles. An analysis of early data highlighted codes around registered nurses in aged care extending and advancing their practice rather than preparing specifically for the nurse practitioner role. The research question for this study was: 'How are registered nurses in aged care advancing their nursing practice?' Semi-structured interviews were used to collect data from ten experienced registered nurses working in aged care clinical practice settings ranging from secondary hospital facilities, to community settings and residential care villages. Dimensional analysis of the data eventually generated three major conceptual categories: 'ownership of nursing', 'extending practice', and 'moving out of a comfort zone'. Of these, 'ownership of nursing' was identified as the core construct that linked the other categories together. The substantive theory that explains how registered nurses in aged care advance their clinical practice is 'developing autonomous ownership'. Nurses who develop autonomous ownership of nursing are more likely than other nurses to move out of a current comfort zone and advance their practice into more independent roles that suit their autonomous ownership of nursing. This study identified important contextual factors and conditions that support the development of an autonomous ownership of nursing and that subsequently facilitate advancing nursing practice. These include creating supportive environments, organisational commitment to advanced nursing practice roles, visible nursing leadership, congruence between organisational and nursing philosophies, interdisciplinary collaboration and participating in postgraduate education. The author suggests that the significance of this study is that it generated a theory about the processes that encourage or discourage nurses from preparing for, and progressing into, advanced nursing practice roles such as nurse practitioner.