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Aims and objectives This paper examines the qualitative results of two studies of Black African new settler communities in New Zealand. The analysis investigates the issues of stigma and microaggressions and their effects on Black African communities. Background Previous work that investigated experiences of stigma faced by relatively early Black African new settlers to New Zealand found that new settlers experienced stigma, and their resulting isolation had negative implications for access to health and social services, regardless of HIV status. Design This paper is a meta-analysis of two published studies, using original qualitative data from each. Methods Researchers for the first study, Standing in the Fire, interviewed 13 Black Africans living with HIV who were new settlers to New Zealand. The second study, Africa NZ Care, was a national mixed method study which surveyed 703 Black African new settlers, and included 131 participants in 23 different focus groups. The present analysis includes only the qualitative data from the second study. Some, but not most, participants of the second study were living with HIV. Results Black African identity is used as a proxy for HIV status among non- HIV specialist health care workers. Participants reported experiences of stigma and microaggressions based on their race, and a lack of knowledge about HIV in non- HIV specialist nurses and other health care workers. They also experienced poor health care and education practices, professional prejudice against colleagues living with HIV and institutional challenges including failure to protect patient confidentiality. Conclusions HIV-related stigma and microaggressions remain significant problems, not only for people living with HIV but also for those perceived to be at high risk for HIV. Relevance to clinical practice Experiences of stigmatising behaviour by health care professionals have a broad and significant range of impacts on patients' health outcomes. [ABSTRACT FROM AUTHOR]

Aims and objectives. This study investigated what Family Partnership Model practice means in the day-to-day practice of child and family health nurses working with parents. Background. The Family Partnership Model has been widely implemented in child and family health services in Australia and New Zealand, with limited understanding of the implications for nursing practice. Design. A qualitative interpretive study design was used. Method. Semi-structured interviews were conducted with 22 nurse participants, who had completed the Family Partnership Model training programme. Subsequent focus groups enabled these participants to validate the themes identified in the initial analysis and to confirm that the nurses concurred with the issues raised. Thematic content analysis produced rich descriptions and explanation of nurses' experiences and perspectives. Results. Four themes emerged from the analysis: experience of changing practices, exploring with parents, challenging unhelpful constructions and a commitment to examining practice. Conclusion. Overall, the participants embraced the use of the Family Partnership Model, providing examples of change and increasing confidence in their approach to working with parents. Relevance to clinical practice. This study demonstrates that the effective utilisation of the Family Partnership Model in nursing practice is a more complex and dynamic process than simply embracing the model. There are significant challenges to be negotiated when implementing new ways of working with parents, particularly questioning existing dominant forms of practice for nurses, managers and wider health organisations, and their clients. This paper also raises issues about sustaining practice innovation, which extends beyond the best intent of individual nurses, requiring receptive organisational conditions and leadership. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To evaluate a rapid response student telehealth placement experience implementing interRAI assessments of community‐dwelling frail older people during the COVID‐19 pandemic. To identify lessons to inform future telehealth clinical placements. Background: New Zealand undertakes assessment of older people with disabilities using the interRAI contact assessment tool for less complex conditions and home care assessment tool for complex needs. New Zealand entered lockdown in March 2020 in response to COVID‐19. New Zealand's most vulnerable community members required urgent needs assessment. Design: A clinical placement whereby 3rd year undergraduate nursing students trained by interRAI‐NZ educators worked remotely from home delivering telehealth assessment for 'at risk' older people across the Waikato District, New Zealand. This represented the first telehealth experience within an undergraduate nursing program approved by the New Zealand Nursing Council. Methods: A case study evaluation utilising mixed method questionnaire and qualitative techniques within an interpretive paradigm. 19 third year students in the fifth semester of a Bachelor of Nursing program and 5 nursing staff members engaged in delivery of the initiative completed pre‐ and post‐placement short answer questionnaires. Reflective diaries were maintained by students on placement. Post‐placement interviews and focus group discussions provided in‐depth data. COREQ guidelines informed analysis and reporting. Results: Student and tutor responses showed consistent themes: tackling COVID‐19; implementation requirements; nursing competencies; provider relationships; and community insights. These provide insight and highlight lessons learnt from this initiative. Conclusions: Student confidence in therapeutic engagement and clinical assessment and interest in aged care was increased, confirming the viability and importance of this inaugural telehealth student placement initiative. Relevance to Clinical Practice: Graduate work readiness is enhanced through telehealth placement experience and interRAI assessor training. These are recommended as core components of future nursing education programs. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The study aimed to explore the perspectives of adult children about late‐life living and care arrangements for their ageing immigrant parents living in New Zealand. Background: Older immigrants' well‐being is closely associated with filial relations and is often reliant on families as a main source of social, financial and emotional support. Research among migrant Asian adults has reported mixed findings regarding intergenerational perspectives of filial practices. Design: Qualitative design using focused ethnographic lens. Methods: Semi‐structured individual interviews were undertaken with 45 adult children of older immigrants living in New Zealand to explore their views about filial piety. The CoREQ checklist was used in reporting methods and findings. Results: Two major themes were identified in this study of adult children's view of filial piety and late‐life care for their ageing parents. The first theme, 'holding on—reconfiguring values', referred to a process described by the participants as upholding the core values and cultural familial expectations, looking after their ageing parents, yet modifying the ways in which they provide care. The second major theme 'letting go—reconfigured expectations', described participants' views of aged care for themselves, which meant they no longer held traditional values that needed to be enacted by their children. Conclusions: Adult children from immigrant families were positioned as intermediaries of these shifting values of their own and within younger generations. The adult children's shift of thinking and acceptance of reconfigured expression of filial duties impact care and living arrangements of older people from immigrant and culturally diverse backgrounds, which also influences health and well‐being in later life. Relevance to clinical practice: Healthcare professionals including nurses working in the ageing and aged care sector need to accommodate the changing generational perspectives about filial piety to cater to the unique late‐life care requirements and health needs of older people and their families. [ABSTRACT FROM AUTHOR]

Aim: This study determines whether the culture within an acute care hospital empowers 'all' nurses to be leaders by exploring intersectionality and nursing leadership in the context of the social environment. Background: Nurses practice leadership in their day‐to‐day activities as clinical leaders alongside traditional roles of management and leadership. However, some nurses do not acknowledge nursing work as leadership activity, nor is it seen so by others where hierarchical leadership approaches remain prevalent. Social constructs of gender and race are barriers to accessing formal leadership positions for some, while dominant power structures such as class diminish the value of bedside nursing work. Unexplored is the impact of the intersection of these and other social identities on nurses being leaders. Design: An embedded case study design. Methods: Thirty‐one participants participated in semi‐structured interviews. Four levels of analysis including inductive and deductive approaches were applied to the data. The research complied with COREQ guidelines for reporting qualitative research. Results: This study shows nurses do not identify themselves as leaders without an associated title and the pathway to leadership varies depending on intersecting social constructions. Conclusion: The impact of the organisational structures and the experience of navigating intersecting social constructions on nurses being leaders goes unseen, privileging some while disadvantaging others. Relevance to clinical practice: Health organisations need to be aware of intersectionality in the workplace and explore equity in their structures to be genuinely empowering. Nursing leadership must examine strategies that challenge and decolonise the nursing profession. Bedside nurses should be given more power and respected as leaders of the patient experience, achievable through a renewed emphasis on the fundamentals of care and resonant leadership, which can neutralise a culture of managerialism. Intersectionality can inform the development of new nursing leadership roles that enable nurses to remain clinically active, widening opportunities. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the impact of the COVID‐19 pandemic on alcohol and other drug nurses providing treatment for individuals presenting with problematic alcohol and other drug use. Background: COVID‐19 has caused disruption to contemporary health service delivery, including alcohol and other drug treatment. Provisional research on drug and alcohol consumption patterns shows changes attributable to the pandemic, with implications for service delivery. Research also indicates the impact of the pandemic on healthcare staff is significant, leading to workforce challenges that threaten care provision. Design: Qualitative descriptive study design. Methods: Data were collected using semi‐structured, individual telephone interviews with practising alcohol and other drug nurses from Australia and New Zealand (n = 19). COREQ reporting guidelines were used. Results: After thematic analysis, three key themes emerged: 'No room at the inn: Changes to service delivery due to COVID‐19', 'We are providing care to a very vulnerable group of people: Consumer factors during COVID‐19' and 'Personally, we were very, very stressed: Workforce factors due to COVID‐19'. Conclusions: The findings from this study indicate that the impact of the pandemic was felt by alcohol and other drug nurses, services and healthcare consumers alike. The experiences of alcohol and other drug nurses through the COVID‐19 pandemic need further exploration both to ensure workforce sustainability and that disruptions to alcohol and other drug services do not occur in future outbreaks of communicable disease. Relevance to clinical practice: COVID‐19 has had a profound effect on nurses in all settings, and these effects are likely to be felt for some time after the pandemic: nursing specialties require support to ensure ongoing workforce sustainability and well‐being of nursing staff. All nurses need to be aware of changes to alcohol and other drug use during the pandemic and screen healthcare consumers accordingly. [ABSTRACT FROM AUTHOR]

Aim and objective: To explore and establish the language, clinical opinions and workplace culture around neonatal skin injury nomenclature. Specifically, what nomenclature is used to describe, define, identity and communicate neonatal skin injuries including (a) terms, (b) locations, (c) associated risks and (d) mechanical forces. Background: Skin injuries are affirmed or denied based on visual assessment with findings reported by language rather than measurements. However, if language or nomenclature is ambiguous, assessments could be misinterpreted effecting healthcare delivery. Design: Qualitative enquiry including applied discourse analysis and between‐method triangulation, within a larger exploratory mixed‐methods study. Methods: Data were collected over two years from four sources: literature, documents, interviews/focus groups and free text injury assessments. Data analysis included content analysis, selective coding and thematic analysis. The collective data were further explored using discourse analysis and triangulation to achieve collective conclusions about opinions, emotions, feelings, perceptions and workplace cultures. The COREQ checklist provided structure for the reporting of study methods, analysis and findings. Results: A total of 427 data points were collected from literature, documentation and two clinical data sources. Data convergence revealed that neonatal skin injuries are described by numerous terms with preferences for "injury," "trauma" or "redness." Injuries occur in over 20 anatomical locations and risks for injuries included hospitalisation, specific treatments and prematurity. Essential medical devices, clinical condition, lack of clinician experience and overactive neonates were uniquely associated risks. There was incongruency between sources. The literature and documents empathise pressure as the primary force related to skin injury, while varied forces were identified within interviews, focus groups and free text injury assessments. Conclusions: The variety of unique terms, locations and risks for injury indicate the need for updated neonatal skin injury frameworks. If frameworks and policies continue to be created without the empirical knowledge of neonatal clinicians, misrepresentation of neonatal skin injury locations and risk will continue to dominate the literature. Relevance to Clinical Practice: The recognition and management of neonatal skin injuries are related to language used to describe assessments in the absence of diagnostic confirmation, which has implications for both the neonate and the healthcare team. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To answer the question "What is the lived experience of hospitality during a patient's hospital stay for elective surgery?" Background: Hospitality centres on a host offering comfort to others, as in a personal care context. Caring constitutes the essence of what it is to be human, having a profound effect on well‐being and recovery from surgery. Caring is one of the most elusive and diversely contested concepts in nursing; however, care provided by nurses seldom transcends as deep human connections and social utility. This study explored the nature, meaning and experience of hospitality as care from the perspective of elective surgery patients. Consolidated Criteria for Reporting Qualitative criteria were used. Design: A hermeneutic phenomenological methodology. Methods: Data were gathered through semi‐structured, face to face interviews with seven patients from both private and public hospitals, and from different cultural backgrounds. Results: Three interpretative notions were as follows: experiences of hospitality as feeling "really" cared for, being at ease and being healed. Hospitality exists in the receiver's lived experience, evoking a special moment which leads to feelings of great comfort and feelings of being truly cared about. When hospitality is received, patients feel a connection; they begin to trust and their healing begins. Conclusion: The offering of often small, yet heartfelt acts of hospitality, indicated that nurses can evoke powerful lived experiences which benefit patients undergoing elective surgery. Relevance to clinical practice: The importance of prioritising emotional and social connections to the hospitality experience needs emphasis at all levels of the clinical structure. Hospitality as caring needs to form a part of all undergraduate and postgraduate nursing curricula, and ongoing professional development. The participant quotes presented in this article could form exemplars for the provision of hospitable nursing care practices, highlighting nurses getting to know and understand their patients, and being interested in their lives. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the experiences of first‐year nursing students, their motivations for working and how they juggled study and other commitments while engaging in paid work. Background: There has been a global rise in the number of students balancing full‐time study, paid work and other commitments, with the main antecedent financial reasons. Design: Qualitative exploratory study. Methods: Drawn from a larger Australasian sequential exploratory mixed‐method study, this qualitative study was conducted with fifty first‐year undergraduate nursing and midwifery students who commenced their nursing studies in 2017. Telephone or face‐to‐face interviews were conducted with purposively selected students engaged in either nursing or non‐nursing fields of work. Interviews were conducted from April–July 2017. Interviews lasted from 15–40 min. Results were thematically analysed. EQUATOR guidelines for qualitative research (COREQ) applied. Findings: Two main themes and accompanying subthemes were identified. The first theme explored students' motivation behind combining work and study and identified the need for financial security and "me time". The second theme "Juggling many balls" provided insights into the benefits students perceived, how they kept the "balls" in the air and at times dropped "balls" while balancing work, study and other commitments. Conclusions: The motivation behind paid work was mainly financial; however, students also reported work allowed an escape and time for self which had social and health benefits. Working provided a range of positive benefits, including a sense of achievement, improved self‐esteem and financial independence. Relevance to clinical practice: Being able to juggle and multi‐task improved skills such as organisation and the ability to prioritise, all skills that have applicability for the role as registered nurse. [ABSTRACT FROM AUTHOR]

Aims and objectives: To compare the communication and practice experiences of migrant nurses in geographically distant, culturally dissimilar countries in Eastern and Western contexts. Background: Considerable research has focused on the experience of acculturation of migrant nurses into geographically diverse locations. However, there remains scant comparative research which considers the ways in which migrant nurses interpret their experience through making "sense" of events encountered in their practice. Design: An exploratory qualitative study was conducted using face‐to‐face interviews with 36 migrant nurses currently practising in New Zealand and 20 migrant nurses practising in the United Arab Emirates. Methods: The same question schedule was used to explore influences on communication and practice in both settings. Thematic analysis and sensemaking theory guided coding and analysis of data. COREQ guidelines informed the reporting of qualitative data. Results: Qualitative analysis resulted in five representative themes, three illustrating similarities across diverse cultures and two that demonstrate the differences migrant nurses require to navigate across contrasting cultural environments successfully. Conclusion: Cultural value‐based differences in both locales caused both systemic and interpersonal sensemaking challenges for migrant nurses that emphasise the importance of orientation and education programmes for internationally qualified nurses. However, cultural conflicts also exist within groups. Orientation programmes should address culturally patterned responses among different groups of internationally qualified nurses. Relevance to clinical practice: Findings demonstrate a need for migrant nurses to be willing to embrace ambiguity in order to acculturate into a collaborative team culture in each of the geographical locations in this study. As registered nurses (RNs) also carry their cultural imprint, orientation interventions targeting the cultural variations of nurses in less standardised orientation programmes may be more beneficial in enhancing acculturation and in turn, staff retention. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the living and care arrangement plans of older Filipino immigrants in New Zealand. Background: New Zealand is rapidly becoming the host to an increasing number of ageing Filipino immigrants. Despite this sizeable population growth of ageing Filipinos in New Zealand, still very little is known about this ethnic group's care needs and living arrangement preferences in later life within the New Zealand context. Design: Qualitative descriptive approach. Methods: Data were collected from 15 older Filipinos who participated in face‐to‐face interviews. Data were analysed using a thematic analytical framework. Results: Two major themes were identified from the data analysis. The first theme "preferred living and care arrangements" is about older Filipinos' preferred plans for future residence and in receiving care when no longer able to function independently in their own homes. The second theme "negotiating readiness and acceptance" is about hypothetical situations that older Filipinos described and anticipated that will greatly facilitate their readiness and acceptance to living in aged care facilities. Conclusion: The study results have implications for service delivery within the New Zealand residential aged care sector. Due to an increasing number of older Filipino immigrants requiring care, residential aged care facilities must ensure their care models meet the needs of this growing group of older people. Relevance to clinical practice: Nursing staff skill sets in the aged care sector require sensitivity to older immigrants' health needs without compromising cultural beliefs and practices while living in residential aged care facilities. [ABSTRACT FROM AUTHOR]

Aim and objectives: To examine trends since a previous 2006–2008 survey in diabetes knowledge held by primary health care nurses and their use of national diabetes guidelines, perceived ability to advise diabetes patients and preferences for further diabetes education. Background: The obesity epidemic has led to a rapid increase in the prevalence of prediabetes and type 2 diabetes and to greater expectations for an expanded role for primary health care nurses in the prevention and community management of diabetes. Design: Cross‐sectional survey using a self‐administered questionnaire and telephone interview and adheres to the STROBE guidelines. Methods: All nurses who provide community‐based care in a major urban area were identified, and stratified by group, prior to random selection to participate in the study. A total of 1,416 practice, district (home care) and specialist nurses were identified who provide community‐based care. Of the 459 who were randomly selected, 336 (73%) participated in 2016 and were compared with a representative sample of 287 nurses surveyed in 2006–2008. Results: Compared with nurses in 2006–2008, significantly more nurses in 2016 used diabetes guidelines, knew that stroke was a diabetes‐related complication, had a greater understanding of the pathology of diabetes and reported having sufficient knowledge to advise patients on laboratory results and improving outcomes through lifestyle changes. Despite these improvements, in 2016, only 24% of nurses could state that stroke was a complication of type 2 diabetes, only 37% felt sufficiently knowledgeable to advise patients on medications, and <20% could state that hypertension, smoking and the dyslipidaemia profile were important modifiable risk factors. Conclusion: There have been improvements in nurse's knowledge but gaps remain for cardiovascular outcomes and associated modifiable risk factors and medication management. Relevance to clinical practice: Education programmes should focus on improving cardiovascular risk management in patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore patients’, families’ and health professionals’ experiences of a long‐stay patient in an intensive care unit. Background: The fast‐paced technologically driven intensive care unit environment, designed for a short patient stay, supports the provision of complex physiologically focused care for those with life‐threatening illnesses. Long‐stay patients with pronounced fundamental care needs fall outside predicted patient pathways, and nurses can find caring for these patients challenging. Design and methods: A longitudinal, qualitative, multicase study of six cases from four New Zealand units. Case participants were patients, family members, nurses and other health professionals. Data collection methods included observation, conversations, interviews and document review. Data were analysed using thematic analysis, vignette development and trajectory mapping. Results: Challenges and successes of providing fundamental care for long‐stay ICU patients are attributed to two interlinked factors. First, the biomedical model influences ICU nursing practices, resulting in prioritising tasks and technology for patient survival while simultaneously devaluing relational and comfort work. Fundamental psychosocial needs such as family presence, comfort, relationships and communication may be unmet. Second, the unit environment and culture have a significant impact on long‐stay patients’ ICU experiences and form physical and psychological barriers to families being present and involved. Some nurses negotiated these challenges to provide fundamental, patient‐ and family‐centred care by adopting an approach of knowing the patient and these nurses reported satisfaction when seeing patients’ positive responses. Conclusion: The care environment and culture provide challenges to the provision of patient‐ and family‐centred care for long‐stay patients; however, when nurses prioritise knowing their patient these challenges can be overcome and patient and family distress reduced with the potential to improve patient outcomes. Relevance to clinical practice: Recognition that patients have fundamental care needs irrespective of the setting where they receive care. Intensive care environments and cultures create challenges for nurses when there is such a heavy burden of physiological needs to be met and technological tasks to be undertaken, with a focus on acuity; however, improving provision fundamental care can result in positive patient outcomes. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore an innovative primary healthcare gerontology nurse specialist role from the perspectives of older people and health professionals. Background: Primary care is struggling to meet the needs and demands of complex older people. New models which incorporate holistic assessment and care coordination are necessary. Design: A qualitative descriptive general inductive design was used. Methods: Older people at risk of health and functional decline were identified and received a comprehensive gerontology assessment and care coordination. Older adults (75 years+) enrolled within one of three primary healthcare practices in Auckland, New Zealand were eligible. Healthcare professionals directly involved with the primary healthcare gerontology nurse specialist model were invited for study participation. Face-to-face interviews were held with five older people and six health professionals were interviewed by telephone. A semistructured interview guide was used for all interviews. A general inductive approach was undertaken for analysis to systematically identify codes and themes. Results: Data analysis revealed two central themes from the older people perspective: “holistic expertise” and “communication.” Two main themes were identified from the health professional perspective: “competency” and “service delivery.” Results showed the gerontology nurse specialist role was highly regarded by both older people and the health professionals. The in-home comprehensive geriatric assessment was identified as greatly beneficial. Conclusions: The competence and care coordination of the gerontology nurse specialist reduced fragmentation and were deemed immensely valuable. Care coordination should be recognised as a key component to meeting the complex needs of at risk older people in the community. Relevance to clinical practice: The expert knowledge of the gerontology nurse specialist and in-home comprehensive geriatric assessment were crucial aspects of the new model. Equally important was the assimilation of primary and secondary care infrastructure to upskill and deliver mentorship to the gerontology nurse specialist. [ABSTRACT FROM AUTHOR]

Aims and objectives To understand how a vision of care is formed and shared by patients and the primary care professionals involved in their care. Background To achieve the best health outcomes, it is important for patients and those who care for them to have a mutual understanding about what is important to the patient in their everyday life and why, and what care is necessary to realise this vision. Shared or team care does not necessarily translate to a consistent and integrated approach to a patient's care. An individual patient's care network of clinical and lay participants can be conceptualised as the patient's own 'Community of Clinical Practice' of which they are the central member. Design Working alongside a long-term conditions nursing team, we conducted a focused ethnography of nine 'Communities of Clinical Practice' in one general practice setting. Method Participant observation, in-depth qualitative interviews with 24 participants including nine patients, and the patients' medical records. Data were analysed using a template organising style. Findings Primary care professionals' insight into a patient's vision of care evolves through a deep knowing of the patient over time; this is shared between 'Community of Clinical Practice' members, frequently through informal communication and realised through respectful dialogue. These common values - respect, authenticity, autonomy, compassion, trust, care ethics, holism - underpin the development of a shared vision of care. Conclusions A patient's vision of care, if shared, provides a focus around which 'Community of Clinical Practice' members cohere. Nurses play an important role in sharing the patient's vision of care with other participants. Relevance to clinical practice A shared vision of care is an aspirational concept which is difficult to articulate but with attentiveness, sustained authentic engagement and being driven by values, it should evolve amongst the core participants of a 'Community of Clinical Practice'. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the processes neonatal intensive care nurses used in their child protection role with preterm infants. Background Neonatal nurses' screening for family violence is important in identifying at-risk preterm infants requiring protection upon discharge from neonatal intensive care settings. We know little about neonatal nurses and their role in child protection. Design A qualitative research design using Glaserian grounded theory. Methods Ten in-depth semi-structured interviews were conducted with New Zealand neonatal intensive care nurses. Data were simultaneously analysed using constant comparative analysis and theoretical sampling to develop a substantive grounded theory. Results Dancing around families is the substantive grounded theory explaining how neonatal intensive care nurses respond to and manage an infant needing child protection. Knowing at-risk families is the process these nurses used, which draws on their personal and professional knowledge to identify an infant's child welfare requirements. A tension exists for neonatal nurses in shaping and framing the baby's safety and protection needs between their role of nurturing and protecting an at-risk infant and it belonging to the family. Conclusions Child protection is a source of conflict for neonatal intensive care nurses. A lack of education, dodgy families and lack of confidence in child welfare services all compromise effective child protection. Their reality is tension between wanting the best possible outcomes for the baby, but having little or no control over what happens following its discharge. Relevance to clinical practice Neonatal intensive care nurses are ideally positioned to identify and respond to those preterm infants at risk of child maltreatment. They need education in child maltreatment, and protection focused on preterm infants, collegial support and clinical supervision. [ABSTRACT FROM AUTHOR]

Aims and objectives To develop insight into the experiences of lesbian and bisexual women accessing sexual health services and an understanding of their needs within the New Zealand context. Background Lesbian and bisexual women are typically invisible in healthcare settings due to heteronormative assumptions. As lesbian and bisexual women are reluctant to come out to clinicians, opportunities for targeted opportunistic health education are often missed. Lesbian and bisexual women have different needs from both heterosexual women and gay men when seeking healthcare. There has been little exploration of the experiences of lesbian and bisexual women accessing healthcare in the New Zealand context. Design Qualitative descriptive design. Methods Participants ( n = 6) were recruited via advertisements and snowball sampling. Those recruited lived in a provincial city in New Zealand; self-identified as lesbian or bisexual; and met the inclusion criteria. Semi-structured, face-to-face interviews were used to obtain narrative data about participants being recipients of healthcare. Results Five themes were identified within the data set: Heteronormativity; The conundrum of safer sex; Implied and overt homophobia; Engagement with health promotion; and Resilience. Conclusion This study highlighted the difficulties that lesbian and bisexual women face when seeking sexual healthcare, primarily due to clinicians' heteronormative assumptions. Lesbian and bisexual women have found ways of navigating the health system that make them feel safe(r) despite experiencing many adversities such as homophobia. Relevance to clinical practice This study's findings can be used to guide further research to identify ways to optimise clinicians' engagement with lesbian and bisexual women. Recognition of diversity and skilful communication are essential to rectify inequities and effectively target health information. [ABSTRACT FROM AUTHOR]

Aims and objectives This study seeks to identify the factors that shape the communication networks of men who face a potential diagnosis of prostate cancer, and how these factors relate to their disclosure about their changing health status. Background Men facing a potential diagnosis of prostate cancer are in a challenging situation; the support benefits of disclosing their changing health status to others in their communication networks is set against a backdrop of the potential stigma and uncertainty of the diagnosis. Design All men on a prostate biopsy waiting list were eligible for inclusion in an exploratory and interpretive study. Methods Semi-structured interviews with 40 men explored their network structures and disclosure of health information. Thematic analysis highlighted the factors which contributed to their network structures and their disclosure about their health status. Results Four network factors shaped men's perspectives about disclosing their health status: (1) tie strength, comprising both strong and weak ties; (2) knowledgeable others, with a focus on medical professionals in the family; (3) homophily, which included other individuals with a similar medical condition; and (4) geographical proximity, with a preference for face-to-face communication. Conclusion Communication networks influence men's disclosure of their health status and in particular weak ties with medical knowledge have an important role. Men who use the potential for support in their networks may experience improved psychosocial outcomes. Relevance to clinical practice Using these four network factors-tie strength, knowledgeable others, homophily or geographical proximity-to forecast men's willingness to disclose helps identify men who lack potential support and so are at risk of poor psychosocial health. Those with few strong ties or knowledgeable others in their networks may be in the at-risk cohort. The support provided in communication networks complements formal medical care from nurses and other health professionals, and encouraging patients to use their communication networks improves the psychosocial health of the men themselves, their partners and their families. [ABSTRACT FROM AUTHOR]

Aims and objectives. This study explored nurses' attitudes, views and beliefs about their role in long-term condition self-management. Background. Nurses are well-placed to assist individuals in long-term condition self-management. Yet, there is limited research exploring underlying beliefs of nurses regarding their role in long-term condition self-management and how those beliefs may impact on the practice of self-management. Design. A descriptive, cross-sectional qualitative design. Participants. A purposive sample of nurses (n = 14) working in primary care and secondary care settings in New Zealand. Methods. One focus group and two interviews were conducted. Data were analysed through thematic analysis by the three authors. Results. All nurses interviewed described promoting patient self-management of long-term conditions and the approaches they took to do so in practice. The nurses described a strong sense of accountability in relation to their practice. They worked to ensure patient follow-up and referrals as necessary and described themselves as lynch pins in the management of long-term conditions. Nurses also recognised that patients would engage at different levels in the self-management process. However, the sense of accountability did raise a question around the balance between professional accountability and responsibility for the management of the condition and the reality of nurses' ability to work with patients as partners in the self-management of long-term conditions. Conclusions. Nurses described both understanding of the importance of promoting patient self-management but also a strong sense of professional accountability to provide quality care. Nurses recognised that they needed to work to find a balance between these two positions. Relevance to clinical practice. In order for nurses to work as an advocate to support optimal care it is vital that nurses recognise where patient's boundaries and capabilities lie. Nurses are at risk of blurring the boundaries and may not always support people to make choices that promote and/or maintain "self" control (or autonomy) in long-term condition management. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore how nurses' recognise depression in older patients with multiple long-term conditions and the strategies they use to support the patient. Background Depression decreases an older person's quality of life and sense of wellness, and increases functional impairment. The positive role of nurses working with patients with long-term conditions is now being recognised internationally; however, there is a gap in the research about how nurses recognise depression in older patients and how this impacts on their practice. Design This is a qualitative study informed by a constructivist grounded theory approach. Methods In-depth telephone interviews were conducted with 40 nurses working in geographically diverse areas in New Zealand. Results Having the conversation with older patients about their low moods, or specifically about depression was not something that all the nurses had, or felt they could have. While some nurses knew they could provide specific advice to patients, others believed this was not their responsibility, or within the scope of their role. Conclusion Faced with an increasing number of older people with long-term conditions, one of which maybe depression itself or as a result of living with other long-term conditions, ongoing monitoring and support pathways are necessary to prevent further decline in the older person's quality of life and well-being. Relevance to clinical practice Nurses in primary health care can build on current knowledge and skills to increase their capability to promote 'ageing well' with older people who have long-term conditions and depression. [ABSTRACT FROM AUTHOR]

Aims and objectives To understand how people who present on multiple occasions to the emergency department experience their health professionals' moral comportment (ethic of care and duty of care); and to understand the consequences of this for 'people who present on multiple occasions' ongoing choices in care. Background People ( n = 34) with chronic illness who had multiple presentations were interviewed about the role that emergency departments played within their lives and health-illness journey. Unprompted, all participants shared views about the appropriateness or inappropriateness of the care they received from the health professionals in the emergency departments they had attended. These responses raised the imperative for specific analysis of the data regarding the need for and experience of an ethic of care. Design Qualitative description of interview data (stage 3 of a multimethod study). Methods The methods included further analysis of existing interviews, exploration of relevant literature, use of Tronto's ethic of care as a theoretical framework for analysis, thematic analysis of people who present on multiple occasions' texts and explication of health professionals' moral positions in relation to present on multiple occasions' experiences. Results Four moral comportment positions attributed by the people who present on multiple occasions to the health professionals in emergency department were identified: 'sustained and enmeshed ethic and duty of care', 'consistent duty of care', 'interrupted or mixed duty and ethic of care', and 'care in breach of both the ethic and duty of care'. Conclusions People who present on multiple occasions are an important group of consumers who attend the emergency department. Tronto's phases/moral elements in an ethic of care are useful as a framework for coding qualitative texts. Investigation into the bases, outcomes and contextual circumstances that stimulate the different modes of moral comportment is needed. Relevance to clinical practice Findings carry implications for emergency department care of people who present on multiple occasions and for emergency department health professionals to increase awareness of their moral comportment in care. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate the diabetes nurse specialist prescribing project with the aim of determining whether diabetes nurse specialist prescribing is safe and effective and to inform the implementation and extension of registered nurse prescribing. Background Registered nurses in many countries are able to prescribe medicines, but in New Zealand, prior to the diabetes nurse specialist project, nurse practitioners were the only nurses who could prescribe medicines. New regulations allowed the nurses to prescribe a limited number of prescription medicines. Design The study was a process and outcome clinical programme evaluation. Methods The project took place between April-September 2011 and involved 12 diabetes nurse specialist in four localities. Quantitative data were collected from clinical records maintained by the diabetes nurse specialist for the project (1274 patients and 3402 prescribing events), from surveys with stakeholders (general practitioners, n = 30; team members, n = 19; and patients, n = 89) and audits from patient notes ( n = 117) and prescriptions ( n = 227), and qualitative data from interviews with project participants ( n = 18) and patients ( n = 19). All data were analysed descriptively. Results Diabetes nurse specialist prescribing was determined to be safe, of high quality and appropriate. It brought important benefits to the effectiveness of specialist diabetes services, was acceptable to patients and was supported by the wider healthcare team. Conclusions These findings are consistent with the findings reported in the international literature about nurse prescribing in a range of different practice areas. Clarification of the education and competence requirements and resourcing for the ongoing supervision of nurses is recommended if the prescribing model is to be extended. Relevance to clinical practice Diabetes nurse specialist prescribing improved access to medicines by providing a more timely service. Nurses felt more satisfied with their work because they could independently provide a complete episode of care. As novice prescribers, nurses need to be well prepared educationally and have access to supportive clinical supervision. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore issues and challenges associated with nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory from the perspectives of senior nurses. Background Nurses play an important part in managing sedation because the prescription is usually given verbally directly from the cardiologist who is performing the procedure and typically, an anaesthetist is not present. Design A qualitative exploratory design was employed. Methods Semi-structured interviews with 23 nurses from 16 cardiac catheterisation laboratories across four states in Australia and also New Zealand were conducted. Data analysis followed the guide developed by Braun and Clark to identify the main themes. Results Major themes emerged from analysis regarding the lack of access to anaesthetists, the limitations of sedative medications, the barriers to effective patient monitoring and the impact that the increasing complexity of procedures has on patients' sedation requirements. Conclusions The most critical issue identified in this study is that current guidelines, which are meant to apply regardless of the clinical setting, are not practical for the cardiac catheterisation laboratory due to a lack of access to anaesthetists. Furthermore, this study has demonstrated that nurses hold concerns about the legitimacy of their practice in situations when they are required to perform tasks outside of clinical practice guidelines. To address nurses' concerns, it is proposed that new guidelines could be developed, which address the unique circumstances in which sedation is used in the cardiac catheterisation laboratory. Relevance to clinical practice Nurses need to possess advanced knowledge and skills in monitoring for the adverse effects of sedation. Several challenges impact on nurses' ability to monitor patients during procedural sedation and analgesia. Preprocedural patient education about what to expect from sedation is essential. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the ageing experiences of gay men in New Zealand over the age of 65 years. Background An increased acceptance by many people in Western societies towards men who are same-sex attracted is likely to result in a corresponding increase in the number of visible older gay men being the recipients of nursing care. Previous research has shown that nursing has some way to go towards providing a service that is culturally safe and appropriate. Design A critical gerontological approach was employed to explore the ageing experiences of gay men in New Zealand over the age of 65 years. This methodology ensured the voices of older gay men were foregrounded in the research. Methods Semi-structured digitally recorded individual interviews with 12 gay men aged between 65-81 years who lived in the community were undertaken. Data were analysed using thematic analysis to identify the repeated patterns across the men's talk. Results Three main themes relating to the ageing experiences of these men were identified: 'homophobia', 'being with someone' and 'future care'. Conclusions Resilience was a significant factor in how well older gay men aged even in an environment where homophobia and heterosexism were common. Having a strong social support network was an important factor that contributed to supporting the ageing process. These gay men were wary about having to go into residential care, preferring to age in their own homes. Relevance to clinical practice Nurses and other healthcare professionals need to ensure healthcare services meet the needs of older gay men. Any interaction with older gay men should occur in a way that is open and respectful. The usage of best practice guidelines will assist organisations to deliver culturally safe and appropriate care to this group. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore women's understandings of sexual problems. Background Prevailing knowledge about women's sexual problems has prioritised the material body. Particular attention is given to the importance of penetrative sexual intercourse, orgasm and the reproductive imperative, which fail to take account of contextual factors that contribute to women's experiences of sexual problems. Design Qualitative in-depth interview study. Methods Individual in-depth interviews conducted with 23 women aged 23-72 years, recruited from members of the general public and a psychosexual clinic. Results The findings suggest that sexual problems are bodily experienced and socially and psychologically mediated. Women's views were influenced by the relational context of their experiences. At the same time, their views were deeply embedded within a patriarchal framework to make sense of their own sexual functioning and satisfaction. Conclusion This study presents a challenge in the drive to medicalise women's sexual problems via the female sexual dysfunction label. It problematises the current diagnostic criteria for sexual problems outlined in the Diagnostic and Statistical Manual, which presupposes a highly individualised framework and favours a more nuanced approach. Relevance to clinical practice Rather than adopting or eschewing an entirely medical or psychosocial model, women presenting with sexual problems should be seen by a clinician whose assessment is holistic and takes into account relational, cultural, psychosocial and health-related concerns. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore Māori (Indigenous people of New Zealand) experiences of hospitalisation in surgical or medical settings and how these might influence length of stay. Background. Globally Indigenous peoples with histories of colonisation suffer health disparities compared with other groups. They experience higher levels of morbidity, premature mortality, lower life expectancies and differential access, use and quality of health services. In Indigenous communities' negative anecdotal accounts of hospital experiences indicate more research is needed about their hospital experiences. Design. A Māori (Indigenous) centered approach using case study methodology and three data sources: medical-surgical discharge data, interviews with Māori and a literature review. Method. Using statistical data from the New Zealand Health Information Service from 1989-2006, a retrospective interrupted time series design was used to examine length of stay for Māori patients in medical and surgical hospital settings. Semi-structured interviews with 11 participants identifying as Māori who had experienced hospitalisation in a medical or surgical setting were transcribed and thematically analysed. A structured review of the research literature on Indigenous hospital experiences was also analysed. These data were analysed individually, triangulated and interpreted. Results. Māori consistently have a shorter average length of stay than non-Māori using public hospitals in New Zealand. Marginalisation of Indigenous peoples in public hospitals was evident in both the interviews undertaken and the literature reviewed. Participants believed hospitals were not conducive to healing and negative experiences contributed to decisions to seek an early discharge. Conclusions. Given the disparities in Indigenous health status, health professionals can address negative hospitalisation experiences by attending to the quality of care delivered and nature of the hospital environment. Relevance to cinical practice. Nurses can play an important role improving health outcome disparities for Indigenous peoples linked to health service delivery, especially the delivery of culturally responsive and quality nursing care. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study on the development of a moderated guiding practice in end-of-life nursing care in New Zealand. According to the author, the process of moderated guiding, which include checking out, involving, and supporting, was used by nurses to manage different expectations in end-of-life care. She adds that moderation was required to address the tensions in nursing practice due to patient control issues, resource constraints, and the nurse-patient relationship.