Abstract: Aims to establish evidence-based oral care guidelines for nurses, in order to improve oral care for dependent adults. Considers how interprofessional collaboration and education (IPC/IPE) might improve nursing oral care practice. Intends to use guidelines in a pilot programme with community nurses caring for older adults living at home or in aged residential care.

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.

Abstract: The delivery of palliative care within contemporary New Zealand society is discussed, in the light of the recent publication of The New Zealand Palliative Care Strategy (2001). The viewpoint taken is largely descriptive rather than prescriptive, being based on a literature survey of international research and academic theory, which is also informed by the author's professionally gained knowledge. Four different perspectives, comprising a mix of providers and recipients of care are investigated: those of central government planning; specialist palliative care units; aged-care complexes; and patients, family and whanau. As an area of healthcare which current demographic projections indicate will become increasingly significant, the provision of palliative care to residents of and patients within aged-care complexes receives special attention. A metaphor of “parallel travellers” on “parallel journeys” is used to provide a thematic basis to the paper. The lived experiences and perceptions of each group of “parallel travellers” are explored. Difficulties in defining and evaluating palliative care, the implications of main-streaming, the scope of palliative care provision, the educative role of specialist palliative care providers and the current focus on mechanistic outcome measures are discussed. It is contended that the values and goals, both explicit and implicit, of the four specified groups may not at present be sufficiently congruent to optimise the effective provision of palliative care from the point of view of all concerned. While adequate resourcing and a genuinely collaborative approach among healthcare providers are both acknowledged to be critical, the potential for palliative care nurse practitioners to be appointed to the role of “care co-ordinator” alluded to within The New Zealand Palliative Care Strategy (2001), is also seen as pivotal. Insights from a postmodern perspective are offered as one possible way of achieving greater congruence.