Abstract: The transition of patients from intensive care to the ward environment is a regular occurrence in intensive care. Today patients are often transferred earlier and sicker due to the demands for intensive care beds. This results in patients with higher acuity being cared for in the wards. Here ward nurses have to meet the ongoing complex demands of caring for higher acuity patients, alongside managing high patient-to-nurse ratios, staffing concerns, and varying levels of experienced nurses. This research explored the experiences of ward nurses receiving patients transferred from intensive care. The aims were to identify any areas of concern, highlight specific problems that occur on transition and to address what information is pertinent to ward nurses when receiving patients from intensive care. A qualitative descriptive methodology using focus groups was utilised to gather information about these experiences. Three focus groups were held with ward nurses from various wards within the study setting hospital. All participants had considerable contact with intensive care and were familiar with the processes of transferring patients. Five themes emerged from the focus groups – Patients as intensive care staff say they are; Time to prepare the biggest thing; Documentation as a continuation of patient care; They forget what its like; and Families, a need to know about them. The theme Patients as intensive care staff say they are relates to reliable information sharing focused on the patient, their needs and condition. Participants expressed their concern that patients were not always in the condition that the intensive care staff stated they were on the referral. Having adequate time to prepare was considered important for the majority of ward nurses receiving patients from intensive care. Documentation was highlighted in the theme Documentation as a continuation of patient care particularly in relation to fluid balances and vital sign history. The theme They forget what its like suggests there is a perception that intensive care nurses have a lack of understanding of what the ward staff can actually manage. Decreased staffing levels during certain shift patterns and a lack of appropriately experienced staff on the wards is a common concern for ward nurses. Ward nurses also recognised that caring for families was part of their role. Patients and families may respond differently to the transfer process and their inclusion in transfer planning was seen as essential. Communication was a reoccurring element throughout all themes.The author concludes that communication is the paramount factor that impacts on a 'smooth transition' for ward nurses. A 'smooth transition' refers to the transfer of patients from intensive care to the next level of care. Subsequently, nurses' perceptions need to change, whereby transfer planning from ICU should be the focus rather than discharge planning. Transfer planning and education for all nursing staff is vital if the transfer process is to be improved. Consequently, transitional care within the context of ICU aims to ensure minimal disruption and optimal continuity of care for the patient. The knowledge gained from this research may provide better understanding of the multifaceted issues linked with transitional care that may be adapted for a wider range of patients in various clinical environments.

Abstract: The intention of this heuristic study was to explore and discover the essence of the positive influence of the natural environment on the human spirit. The study quest was identified as a central concern that evolved from the author's personal experience of spiritual awakening in the natural environment and an interest in the concept of connectedness in nursing care and practice. The study also focused on the self of the nurse and the qualities of holistic nursing care. Guided by heuristic methodology developed by Moustakas (1990) the thesis traces a journey of discovery. Using conversational interviews, six nurses were asked to describe their experiences of their spirit being positively influenced in the natural environment. These nurses were also asked if these beneficial experiences had any flow-on effect to their nursing practice. From these interviews various commonalities of experience were identified as well as some experiences unique to the individual participants. The participant knowing was articulated using Reed's (1992) dimensions of relatedness in spirituality as a framework. Reed describes these dimensions as being able to be experienced intrapersonally, interpersonally and transpersonally. A substantive body of nursing and non-nursing literature was explored to support the participant knowing and provide strength to the discussion. The study discovered that the human spirit is positively influenced in the natural environment. The three actions of personal healing and wellbeing in the natural environment, knowing self – knowing others and sustaining self in nursing practice were valued by the participants as contributing to the quality of their nursing care. In bringing together spirituality, the natural environment and nursing, holism was discovered to be the significant and connecting constituent. The study has some implications for the discipline of nursing that are also discussed by the author.

Abstract: This thesis explores the process of an annual appraisal strategy, 'clinical conversation', from the perspective of seven nurses who were assessed using this technique. The findings demonstrate that clinical conversation is a strategy which facilitates reflection, both as a solitary exercise and with others, to ensure that learning from experience is optimised. The research used a qualitative interpretive approach informed by the model of Grounded Theory espoused by Strauss and Corbin. All eight nurses who were assessed using the clinical conversation strategy were advanced practitioners working within the scope of sexual and reproductive health. Two of the actual appraisals were observed and seven of the nurses were interviewed within eight weeks of being assessed. The outcome of the clinical conversation was primarily one of learning; the acquisition of new insights into self as practitioner. The learning was facilitated through the process of narration; telling the story of clinical practice. Three distinct narrative cycles were identified, each an experiential learning episode. The experience of undertaking a variety of assessment activities created a narrative with self and triggered an internal reflective thinking process; the experience of working with a peer created an additional narrative, a mutual dialogue reflecting back on practice; the experience of sharing practice with an assessor created a further and final narrative, a learning conversation. Each narrative can be seen as a catalyst for change. Primarily, the nurses felt differently about themselves in practice, the way they saw themselves had shifted. Such a change can be described as an alteration in perspective. These alterations in perspective led all nurses to identify ways in which they would change their actual clinical practice. In this way the nurses attempted to align their espoused beliefs about practice with their actual practice. The author notes that the study shows that each nurse responded differently to each narrative learning cycle: for some the conversation with the assessor was more of a catalyst for change than for others. In this way clinical conversation may be flexible enough to respond to a variety of differing learning styles. Learning was person specific which is an imperative for the continued professional development of already highly skilled clinicians. The implication of the research is that whilst clinical conversation was designed as a tool for appraising clinical competence, its intrinsic value lies in supporting the professional development of nurses.

Abstract: In 2003, as part of implementing the Primary Health Care Strategy, the Ministry of Health announced contestable funding, available over three years, for the development of primary health care nursing innovation projects throughout Aotearoa/New Zealand. The Ministry looked for proposals that would: support the development of innovative models of primary health care nursing practice to deliver on the objectives of the Primary Health Care Strategy; allow new models of nursing practice to develop; reduce the current fragmentation and duplication of services; and assist in the transition of primary health care delivery to primary health organisations. This report describes the findings from the evaluation of the 11 primary health care nursing innovations selected for funding by the Ministry of Health. It provides an overview of the innovations' success and of the lessons learnt from this policy initiative.

Abstract: This dissertation explores the nurse's role in addressing the sexual health needs of a rural adolescent community in New Zealand. The increasing incidence of adolescent sexual activity is widely recognised and it is acknowledged that youth face unique barriers to health care. These barriers are particularly apparent in access to contraception with a resulting increase in the rates of sexually transmitted infections, unintended pregnancies and termination of pregnancies. These deteriorating adolescent sexual health statistics are of particular concern within New Zealand's health sector. A review of national and international literature examined the potential nursing role in adolescent sexual health. Results provide strong evidence that experienced nurses can competently and confidently assist in meeting the needs of this population group, especially in rural areas. Literature consistently concluded that nurses could provide care that is as effective as that provided by a doctor. School-based health clinics are identified as a viable way to improve access to adolescent sexual health services. In conclusion, the author suggests that nurses are in a key position to provide an alternative model of health care delivery that can improve adolescent sexual health.

Abstract: In the process of introducing a new disability unit into an undergraduate nursing curriculum in a New Zealand educational setting, the opportunity arose to conduct a small study comparing the attitudes of students nurses to people with disabilities. This paper discusses the literature review, which formed the basis for the study. A range of perspectives and research was identified that explored societal and nurses' attitudes, disability studies in undergraduate nursing curricula, the impact of nurses' attitudes on patient care, and interventions for changing those attitudes. Effective nursing care can be severely compromised through negative attitudes, and concerns are expressed at the lack of attention given to this issue in nursing curricula generally. The literature showed that combining educational approaches with opportunities for student nurses to interact with disabled people provides the most effective means for student nurses to develop positive attitudes towards disabled people. The goal for nurse educators is to ensure the inclusion of disability studies as a core component in undergraduate nursing education.