AIM:Although the majority of doctorally prepared nurses work in academia, a percentage choose clinical work. Knowledge about the contribution of doctorally prepared clinical nurses (DPCNs) is growing, but further exploration is required. This research explored the value that DPCNs provide to nursing practice and healthcare. DESIGN AND METHODS:Using an interpretive descriptive approach, individual interviews were conducted with 18 DPCNs. Data was collected between 2021 and 2022. Reflexive thematic analysis informed the data analysis. RESULTS:Five key mechanisms drive DPCNs' value: being a knowledge expert; an enhanced approach to practice; increased credibility/prestige of the doctorate; valuable conversations; and new opportunities and collaborations. Challenges to value contribution were also highlighted, including identity issues; negative external perceptions; fragmented mentorship; no post-doctoral pathway; and little recognition from nursing leaders. CONCLUSION:Doctorally prepared clinical nurses bring significant value to nursing and healthcare through distinct mechanisms that should be nurtured and strengthened. IMPLICATIONS FOR PRACTICE:Doctorally prepared clinical nurses add important value to healthcare. However, these nurses are under-utilised and require support to enhance their value contribution. IMPACT:Identifying the mechanisms driving value provides a unique opportunity to acknowledge, support and enhance the value provided by DPCNs. The research will be impactful for nurses considering doctoral study, nursing leaders and healthcare managers. REPORTING METHOD:This research is reported following SRQR guidelines. PATIENT OR PUBLIC INVOLVEMENT:This study did not include patient or public involvement in its design, conduct or reporting.

This study articulates the relationship between conceptualisations of time and the accounts of good care in an acute setting. Neoliberal healthcare services, with their focus on efficiencies, predominantly calculate quality care based on time-on-the-clock workforce management planning systems. However, the ways staff conceptualise and then relate to diverse meanings of time have implications for good care and for staff morale. This phenomenological study was undertaken in acute medical-surgical wards, investigating the contextual, temporal nature of care embedded in human relations. The study interviews involved 17 participants: 11 staff, 3 previous patients and 3 family members. Data were analysed iteratively to surface the phenomenality of temporality and good care. The following constituents of the data set are explored that together illustrate the relationship between the conceptualisations of time and the accounts of good care in an acute setting: patient time as a relational journey; patient time, sovereign time and time ethics and time, teamwork and flow. The findings are clinically significant because they offer a contrasting narrative about the relationship between time and care quality. The experiences of giving and receiving good care are indivisible from how temporality is experienced and the social relations within which care is embedded. Healthcare staff experience temporality differently from patients and families, a point that healthcare participants in this study appeared to comprehend and accommodate. For all parties involved in providing care or being the recipient of care, however, the capacity to be present was valued as a humanising ethic of care. Our study reinforces the importance of not creating presumptive binaries about which temporal structures are more or less humanising-there is a place for a fast-paced tempo, which can be experienced as being in the flow of human relations with one's team and on behalf of patients.

This study articulates the relational constituents of good care beyond techno-rational competence. Neoliberal healthcare means that notions of care are readily commodified and reduced to quantifiable assessments and checklists. This novel research investigated accounts of good care provided by nursing, medical, allied and auxiliary staff. The Heideggerian phenomenological study was undertaken in acute medical-surgical wards, investigating the contextual, communicative nature of care. The study involved interviews with 17 participants: 3 previous patients, 3 family members and 11 staff. Data were analysed iteratively, dwelling with stories and writing and rewriting to surface the phenomenality of good care. The data set highlighted the following essential constituents: authentic care: caring encompassing solicitude (fürsorge); impromptu care: caring beyond role category; sustained care: caring beyond specialist parameters; attuned care: caring encompassing family and culture; and insightful care: caring beyond assessment and diagnosis. The findings are clinically significant because they indicate the importance of nurse leaders and educators harnessing the potential capacity of all healthcare workers to participate in good care. Healthcare workers reported that participating in or witnessing good care was uplifting and added meaning to their work, contributing to a sense of shared humanity.

Increasingly, kaumātua (Māori elders) in Aotearoa (New Zealand) live apart from whānau (Māori extended family) in residential care, where policies are shaped by post-colonial legislation and ethical principles that privilege individual rights over Indigenous priorities and rights. The communal context of residential care has created late-life opportunity for intimacy and sexual expression with new partners. These issues are addressed in the international literature, highlighting the benefits and complexities. Literature report there may be clashes between resident and family members’ wishes, and tensions around privacy and consent. This article considers survey data and semi-structured interviews with kaimahi (Māori care workers) and a kaumātua who were part of a larger study of staff, residents, and family in the residential aged care context. Post-colonial individualistic rights-based approaches do not necessarily fit with a Māori worldview. A Māori-led articulation of consent is essential to uphold the mana (authority, influence, power) of kaumātua and whānau.

Background The existing literature on sexuality and intimacy in residential care tends to focus on either the question of rights, or the value of autonomy. Where the literature does reference values other than autonomy, such values are considered in the context of being a guide to whether or not a resident is autonomous, rather than being important values in their own right. Objective This paper draws on qualitative data gathered as part of a larger study in order to inform practice on how care workers respond to intimacy issues that arise with residents with dementia and to inform a general ethics of sex and sexuality, demonstrating that an approach which permits value pluralism can be appropriate in certain contexts. Research Design The qualitative data referred to in this paper was gathered from semi-structured interviews undertaken as part of a larger mixed-method research project. The interview text was analysed using Thorne’s methodological approach, interpretive description. Participants and research context The qualitative arm of the project consisted of semi-structured interviews conducted between October 2018 and October 2019 with participants (staff, residents and family members) recruited from 35 residential care homes in Aotearoa New Zealand. Ethical Considerations Participation was informed, voluntary and written consent was gained before interviews. The project was approved by the Massey University Human Ethics Committee (Northern), number NOR 18/25. Findings Analysis of the scenarios presented in this paper shows that decision-making around sexual intimacy involving people with dementia in a residential care setting is complex and requires recognizing and weighing the different values that may be a in play. Conclusion A focus on safety and consent to the exclusion of other values which matter morally in this context is a mistake which prevents care workers from providing appropriately person-centred care to residents, as policies which focus on the goal of care allow space for critical examination of issues which are likely to be highly context-sensitive.

Introduction Sexuality and intimacy in residential aged care (RAC) are receiving increased research attention. In this article, porneia refers to access to sex workers, as well as online pornography, and masturbation by residents in RAC. Sex work is legal and regulated in Aotearoa New Zealand. Methods The present study was a two-arm mixed-method cross-sectional study using a concurrent triangulation design. A validated survey tool was developed. Data were collected in 2018-2019: 433 staff surveys were collected from 35 RAC across the country; 61 interviews were carried out with 77 staff, residents, and family members. Results Staff opinions about sex work and pornography were inconclusive. Nevertheless, access to sex workers occurs in many RAC facilities across the country. Interviews demonstrated a diversity of responses among the three groups; staff attitudes are paramount. Conclusions Some staff are prepared for resident requests for sex workers; others continue to look to policies and management for guidance, but such policies are often lacking. Most staff have adopted the language of needs vs. rights which dominates the literature. Policy Implications Staff education on sexuality and facility policy is essential; education for residents and their families is also desirable. Facilities often over-notify third parties. Discourse about sexuality needs to move towards a person-centred, salutogenic approach.

Objective: To explore which nursing intervention: early mobilisation versus laxative use, is more effective in reducing constipation in post-operative orthopaedic patients who require strong analgesia. Background: The use of opioids to manage pain in orthopaedic patients causes post-operative constipation. Nursing interventions used to relieve constipation in patients post-operatively include encouraging patients to eat a high fibre diet, to increase their hydration, to mobilise and to use laxatives. However, varying results have been demonstrated on the effects of early mobilisation and laxative use, specifically in managing opioid-induced constipation. Study design and methods: An integrative literature review was used to identify articles from online databases between January 2000 and June 2020. Grey literature was also utilised. Data were quality appraised, extracted, and thematic analysis was used to synthesise the results. Results: The use of laxatives was effective in some studies, while some studies found laxatives to be either ineffective or partially effective. Most of the studies and grey literature recommended early mobilisation, however not in isolation, but in conjunction with other interventions including increased fibre, fluid intake and laxative use. Discussion: Although the benefits of early mobilisation have been identified, it is not advocated for independently and is usually advocated for in conjunction with other interventions such as a diet high in fibre, increased water intake along with laxative use. Laxatives used as the first line of constipation treatment are not always effective. Multiple doses are often required as they may not deal with the underlying cause of opioid-induced constipation. Conclusion: This study determined there is no clear evidence to support a singular course of action; early mobilisation or laxative use. Each intervention potentially contributes to preventing constipation therefore both interventions should be utilised concurrently. Implications for research, policy, and practice: Post-operative constipation is an ongoing problem in this subset of patients. However, there is always a need for reviewing current practices and re-educating and reminding patients and staff of the benefits of a multipronged approach. Practices recommended include discouraging bedpans, following protocols, documentation and having an open dialogue with patients. Further research is needed to examine the effectiveness of early mobilisation only in relieving constipation in post-operative orthopaedic patients and orthopaedic patients in general who require strong analgesia.

This integrative review aimed to explore how current nursing and healthcare practices can be designed to facilitate effective type 1 diabetes (T1D) self-management in young adults aged 16-25 years. The review explored relevant quantitative and qualitative literature published between 2017 and 2021. Five electronic databases were searched: CINAHL, Medline, Scopus, PubMed and PsycINFO. PRISMA reporting was used to show the flow of information through the different phases of the review. Articles that met the inclusion/exclusion criteria were critically appraised using the Mixed Methods Appraisal Tool. Four main themes emerged through thematic analysis: digital information systems; glucose monitoring and insulin devices; group and peer education and peer support; and diabetes care delivery style. Findings from the review identified that 1) platforms for text messaging, social media, email, and smartphone apps were innovative communication strategies that worked for this age group; 2) the use of continuous glucose monitoring and insulin devices were found to improve self-management routines and psychological well-being of young adults; 3) health service support and education needs to be flexible, dynamic and young adults want to be treated as partners in their own care; and, 4) young adults prefer to be socially engaged, interacting either in group educational settings or with peers through social media. This integrative review highlights the importance of adopting age-appropriate interventions to improve young adults’ engagement in T1D self-management, requiring nurses and healthcare practitioners need to keep up to date with the rapid changes in digital technology and diabetes-related device technology. However, relational engagement remains an essential component integral to nurses supporting young adults living with T1D.

This paper explores attitudes of staff, residents and family members towards sexually diverse persons based on data from the first national study of its kind in Aotearoa New Zealand. The study was a two-arm mixed-method cross-sectional study using a concurrent triangulation design. The quantitative arm included the results of 433 staff surveys related to knowledge, attitudes, behaviours and beliefs about sexuality, intimacy and ageing. The qualitative arm included interviews with 77 participants including staff, residents and family members. This paper focuses only on sexual diversity. A generational cultural effect was noted among all respondents; younger participants expressed the most open and accepting views of diversity. Residents were aware that they mostly held the views of their generation; nonetheless they also looked to staff to set the tone. Staff held varying views and felt that residents would be less accepting; some staff felt the issue of intimate relationships was not something they were willing to discuss at intake. Facilities will want to establish policies about sexuality and intimacy and communicate those policies and practices to staff, residents and family members. Facilities may also wish to consider specific educational events about sexual diversity for residents.

In January 1987, Jocelyn Keith (now Lady Keith CBE) was a lecturer in the Department of Community Health at the Wellington School of Medicine and presented a paper at the conference of the Australian and New Zealand Association for the Advancement of Science. An introduction to "The right to health or the right to health care," as it was published in the July 1987 issue of Nursing Praxis, sets up a complex problem: What constitutes appropriate healthcare to protect the right to health and wellbeing, in the light of New Zealand's obligations as a signatory to international declarations and covenants; and our Government's obligations to honour Te Tiriti?

Background: There is an international trend for frail older adults to move to residential care homes, rather than ageing at home. Residential facilities typically espouse a person-centred philosophy, yet evidence points to restrictive policies and surveillance resulting in increased loneliness and diminished opportunities for intimacy and sexual expression. Residents may experience what has been termed social death, rather than perceive they are related to by others as socially alive. Aim: To consider how the loss of intimacy and sexuality in residents’ lives contributes to iatrogenic loneliness experienced in residential care, and the importance of considering these issues together. Research design: The study utilised a constructionist methodology, investigating the meanings associated with intimacy, loneliness, and ageing. Participants and research context: Qualitative data used in this study are drawn from a larger dataset of a mixed-methods study. Interviews were completed as follows: staff, 21 individual interviews, and two groups with a total of 13 additional people; residents, 26 interviews with 28 people; and family members, 12 interviews with 13 people. Findings: Five key themes were identified in the data analysis: loneliness and relational identity, loneliness and functional relationships, loneliness and disrupted intimacy, loneliness and liminality, and loneliness and the built environment. Ethical considerations: The study was approved by a University Human Ethics Committee. Participation was voluntary. Consent was gained and confidentiality upheld. Discussion: Residents’ expression of intimacy and sexuality can be compromised through paternalism, ageism, restrictive policies, care-rationing and functional care, alienating residents from sustaining and developing significant relationships. Attitudes and cultural beliefs of staff and family members about ageing and intimacy, compounded by architectural design, may intensify loneliness. Conclusions: Nurses have a pivotal role in ensuring policies and practice enhance social citizenship.

Registered nurse (RN) prescribing has the potential to improve equitable patient care delivery and timely access to medicines. Changes to legislation in Aotearoa New Zealand in 2016 enabled the regulation of RN prescribers. The successful utilisation of this role is largely dependent on how organisations approach and employ this new workforce. This article presents a project which critically reflected on the journey of a registered nurse to gain the educational requirements necessary to become a RN prescriber, register with the Nursing Council of New Zealand, and then implement the role delivering RN prescribing services in a sexual health clinic. Using a mapping technique, developed as an analytic tool in institutional ethnography, the RN mapped her journey, identifying her engagement with various organisations and their guidelines and documents, and recording her work and actions. Gaps in policy and a lack of organisational readiness delayed the implementation of the RN prescriber's role in practice. The work and effort undertaken by the RN was considerable as she negotiated her way within her employing organisation, the tertiary education institute, and between other national organisations engaged with RN prescribing. Mapping the RN's journey highlighted areas of confusion and the unpreparedness of organisational vision and national strategy around developing and implementing this role in practice. The onus on successfully implementing RN prescribing in the specialty clinic largely fell to the individual nurse, despite the need to deliver health and prescribing services to the local population. Strong nursing leadership is required to champion the contribution that RN prescribers can make to quality outcomes for patients and to create a cohesive vision of advanced practice nursing in the workplace. This includes advocating for nursing workforce development strategy and policies, the creation of peer networks, and negotiating appropriate remuneration. # *Te reo Māori translation* # Mai i ngā ture ki te ao mahi: He whakamahere i te noho takatū mō ngā kaituhi puka rongoā tapuhi rēhita i tetahi horopaki whāiti whare tūroro o waho **Ngā ariā matua**\ Mā te tuhi puka rongoā tapuhi rēhita (RN) ka āhei pea te whakapiki i te ōrite o te horanga atawhainga tūroro me te hohoro o te whiwhinga rongoā. Nā ngā huringa ki ngā ture i Aotearoa i 2016 i āhei ai te whakarite ture mō ngā kaituhi puka rongoā RN. Ko te whakamahinga whai hua o tēnei mana kei te āhua o te pai o ngā kawenga me ngā whakawhiwhinga mahi a tēnā whakahaere a tēnā whakahaere ki tēnei rāngai kaimahi hou. Tā tēnei tuhinga he tāpāe kōrero mō tētahi kaupapa i arohaehae i ngā mahi a tētahi tapuhi rēhita kia whiwhi ia i ngā tohu mātauranga tika kia whakamanaia hei kaituhi puka rongoā RN, kia rēhita ki te Kaunihera Tapuhi o Aotearoa, kia kawea tūturutia hoki ngā mahi o te tūnga ki te tuhi puka rongoā RN i tētahi whare manaakitanga hauora hōkaka. I whakamahia e ia tētahi ritenga whakamahere, he mea whakawhanake hei taputapu tātari i ngā mahi tuhi kōrero pono mō ngā iwi i roto i ngā whare nunui, ā, ka tuhia e ia ana hīkoinga, ka tautohutia āna pānga ki ngā whakahaere huhua, me ō rātou aratohu, tuhinga hoki, ka tuhia e ia āna mahi me ana kōkiri. Nā ngā āputa i ngā kaupapa here, me te korenga e rite o ngā mahi o ngā whakahaere i uaua ai te haere a te RN ki te whakatinana i tana tūnga i te ao mahi. He nui ngā mahi i kawea e te RN i a ia e kōpikopiko ana i tōna whare i mahi rā ia hei kaimahi, te whare akoranga tuatoru, me ērā atu whakahaere ā-motu e kawe ana ki te kaupapa tuhi puka rongoā RN. Nā te whakamahere i te haere a te tapuhi rēhita nei ka āta mārama ngā wāhanga taupatupatu me te pōtatutatu o te kitenga o ngā whakahaere, me te rautaki ā-motu, mō te whakawhanake me te whakatinana i tēnei tūnga i te ao mahi. I tau ngā taumahatanga o te whakatinana tika i te tuhi puka rongoā RN ki runga i te tapuhi takitahi, ahakoa ngā hiahia kia horaina ngā ratonga hauora, tuhi puka rongoā hoki ki te iwi o te rohe. E tino hiahiatia ana ngā mahi hautū pakari hei kōkiri whakamua i te āwhina nui ka taea o ngā kaituhi puka rongoā RN ki ngā putanga whai kounga mā te tūroro, hei tārei kitenga tōtika mō ngā mahi tapuhi hōhonu i te wāhi mahi. Ka uru ki tēnei āhua te kauwhau tikanga mō ngā rautaki whanaketanga kāhui kaimahi tapuhi me ōna kaupapa here, te hanga whatunga hoa mahi, me te whakarite taumata utu tōtika mō te tapuhi.

In her editorial, Helen Rook (2018) drew our collective attention to the importance of nurses having the moral courage to speak up about contentious issues, heeding the International Council of Nurses latest campaign for us to have a voice. In this editorial, the authors, all with years immersed in women's health service delivery and/or research, respond to this call, as we draw attention to the significance of a nursing and midwifery voice in the area of women's unplanned pregnancy and abortion care. This sensitive and controversial area of care to date has been primarily medically driven. We offer a vision of nursing and midwifery-led care, and a women-centred approach focused on women's lived experience -- what has been called a provoice approach (Manninen, 2013) - where the aim is for women's experiences not to get lost in the political and philosophical 'noise' of pro and antiabortion debates.

IntroductionHealthcare assistants (HCAs) play a crucial role in the delivery of care and the well-being of older people living in aged residential care (ARC) facilities. In New Zealand (NZ) there are approximately 31,452 nursing support workers and personal care assistants working in nursing homes and in the community, with HCAs making up the majority of this workforce (Statistics New Zealand, 2013). Direct care in ARC is mainly provided by HCAs who are unregulated; a marginalized workforce, due to undervaluing of aged care services and low wages (McGregor, 2012). This aging, gendered and ethnically diverse workforce is expected to grow in response to the demands of the aging population (Kiata, Kerse, & Dixon, 2005; Ravenswood, Douglas, & Teo, 2014). There are concerns about recruitment and retention (Badkar, Callister, & Didham, 2009; Badkar & Manning, 2009; Grant Thornton New Zealand Limited, 2010; Ravenswood et al., 2014) but of equal concern is the landscape of care into which the HCA is recruited.Registered nurses (RNS) in aged care settings are responsible for the care delivered by HCAs and need to have an in-depth insight into the contemporary and evolving roles of HCAs, and the diverse challenges experienced by this workforce. Healthcare assistant responsibilities and workloads are expanding as they work with residents who have complex health conditions. Influential factors that shape the working environment of the NZ HCA were identified in a thorough review of the existing grey literature, current national policy, district health board (DHB) contract agreements and New Zealand Nursing Organization (NZNO) collective agreements. This article presents an overview of the role of HCAs in the current residential aged care environment. The authors argue that RNs need to be cognisant of the socio-political, economic and educational factors that influence HCA's ability to navigate the complexity of the aged care environment and the delivery of personcentred care in the New Zealand aged care context.Demand for aged caregivingThe demand for ARC is increasing, as are the associated costs for care and demands placed on the workforce. There were approximately 33,006 residents in aged care facilities for 2015-2016. This number is projected to increase to 40,619 for the period 2026-2027, and to 60,080 in 2031-2032 (Technical Advisory Services [TAS], n.d.-a). Currently there are 669 certified aged care facilities in NZ offering 38,742 beds (Ministry of Health [MOH], 2016a) with 90% overall occupancy rates for dedicated rest home beds, 88.8% occupancy for swing or dual beds which serve either rest home or hospital level care and 87.6% for specialist dementia beds (Kana, 2015). The DHB expenditure for the support of older people was $983 million with $590 million directed to ARC in 2016 (MOH, 2016b). The government weekly contribution for long term-residential care for individuals differs for each territorial district with the highest funding of $971.53 for Auckland City and the lowest $884.03 for Otorohanga, South Waikato, Buller, Grey, Waimate, Southland and Gore districts including Goods and Services Taxes (Chuach, 2016).The demand for ARC persists even with ageing-in-place initiatives aimed at reducing the need for rest home level care. The workforce that supports care in the home overlaps with the ARC workforce and shares similar issues. The 2002 Health of Older People Strategy (MOH, 2002) was created in response to ageing population projections and the need for a positive ageing strategy. Initiatives within the 2002 Health of Older People Strategy and the replacement Healthy Ageing Strategy (Associate Minister of Health, 2016) include improving community support so that older persons can stay in their homes longer and avoid costly ARC services. Care aimed to restore functional status is provided in the home or in the community by paid caregivers, delaying or preventing ARC admissions (Parsons et al. …

BACKGROUND:Undertaking qualitative research with vulnerable populations is a complex and challenging process for researchers. Traditional and common modes of collecting qualitative data with these groups have been via face-to-face recorded interviews.METHODS:This article reports on three internet-based data collection methods; email and synchronous online interviews, as well as online qualitative survey.RESULTS:The key characteristics of using email, sychronous online interviews and an online qualitative survey including the strengths and limitations of each are presented. Reflections and insights on the use of these internet-based data collection methods are provided to encourage researchers to embrace technology and move away from using traditional face-to-face interviews when researching with vulnerable populations.CONCLUSION:Using the internet to collect qualitative data offers additional ways to gather qualitative data over traditional data collection methods. The use of alternative interview methods may encourage participation of vulnerable participants.

Background: Routine regionalised transfer of preterm infants occurs throughout Westernised countries. Transfer to lower acuity units occurs once infants are ready for convalescence and signals an infant’s improving health. However, many parents find transfer traumatic. Aims: To investigate parents’ perceptions of preterm infants’ transfer; to provide neonatal clinicians with insights to facilitate optimal service provision. Methods: Participants had experienced their baby born at less than 29 weeks gestation, and subsequent transfer. Six parents were interviewed. Design: Data were analysed using a general inductive approach. Findings: Three themes were interpreted through data analysis: NICU - incomparable haven; abandonment; and parental expertise side-lined. These themes represent a journey of interrupted identity that parents undergo when their baby is transferred to another unit. Conclusion: Despite studies recommending more family-centred transfer planning, gaps persist. Nursing care might be enhanced by incorporating insight into parental experiences and promotion of collaborative changes within and between units.