Nursing roles and responsibilities in general practice: three case studies.

INTRODUCTION: Primary care nursing teams may now comprise registered nurses (usually termed practice nurses), nurse practitioners, physician assistants, enrolled nurses, and primary care practice assistants, clinical assistants, or nursing assistants. There is a need to understand how practitioners in the different roles work with patients in the changed environment. The aim of this study was to describe the different configurations of health professionals' skill-mix in three dissimilar primary care practices, their inter- and intra-professional collaboration and communication, and to explore the potential of expanded nursing scopes and roles to improve patient access. METHODS: Document review, observation and interviews with key stakeholders were used to explore how health practitioners in three practice settings work together, including their delegation, substitution, enhancement and innovation in roles and interdisciplinary interactions in providing patient care. A multiphase integrative, qualitative and skill-mix framework analysis was used to compare findings related to nursing skill-mix across case studies. FINDINGS: Three models of primary care provision, utilising different nursing skill-mix and innovations were apparent. These illustrate considerable flexibility and responsiveness to local need and circumstances. CONCLUSION: Enabling nurses to work to the full extent of their scope, along with some adjustments to the models of care, greater multidisciplinary cooperation and coordination could mitigate future workforce shortages and improve patient access to care.Published onlin

Comprehensiveness, integration, and coordination : a study of their application and role in coastal management in Aotearoa/New Zealand

Coastal management practices in Aotearoa/New Zealand have historically been counterproductive in terms of maintaining environmental quality. A plethora of complex legislative and jurisdictional arrangements is identified as a primary contributor to high social, economic and environmental costs. The nature of the coastal resource, and the demands placed upon it, dictate a more comprehensive, integrated approach to management. Recent reform of resource management law has produced a framework for coastal management that is found to be in many ways superior to any previously existing, but still far short of replicating any 'ideal type'. The new legislation and institutional arrangements are characterised by a more comprehensive approach, and contain integrative mechanisms. A greater degree of comprehensiveness and integration is desirable, but will not, for a number of conceptual, political, and practical reasons, be readily achieved. An argument is advanced that at least some of the shortcomings of the management regime as it is interpreted and practised may be overcome by better co-ordinating the activities of agencies and individuals that have an impact on the coastal environment. The verb 'co-ordinate' is used in this instance quite deliberately. Like all language, the word is value laden, and capable of being interpreted (or 'deconstructed', to use the post-modern vernacular) in an enormous variety of ways. Some care is taken to establish exactly how the term is utilised, and should be interpreted, in the context of this paper

Child health and development record book: tool for relationship building between nurse and mother.

AIM: This paper is a report of a study of the role and impact of the child health and development record book in New Zealand society since its inception. BACKGROUND: Nurses working in child health roles in New Zealand use child health and development record books to record advice and developmental characteristics of children as they grow. The book has been used since 1921, but there has been no exploration of how it has been used by nurses or mothers. METHOD: Using an oral history approach, 35 participants ranging from 30 to 84 years of age were interviewed. Data were collected from November 2004 to December 2005, with follow-up interviews in 2006. FINDINGS: The book plays an important role in the relationship between mother and nurse. It is used as a point of commonality that supports the efforts of both as they work toward establishing an effective relationship, as a tool of practice, and as a means of building strength within families. CONCLUSION: Mothers read, reflect upon and reminisce with child health and development record books for generations. Nurses must consider the ways in which they currently use these record books, remaining mindful of both the short-term and potential long-term impact their notes may have on mothers