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• Experienced registered nurses who are employed as nurse navigators provide effective co-ordinated care to people living with multiple chronic conditions. • Nurse navigators effectively use value-based care to help reconnect patients who have lost trust in the health service, to reconnect with their interdisciplinary teams. • Nurse navigators provide individualized, authentic care, which is more than the sum of hospital avoidance. Nurse navigators are an emerging workforce providing care to people with multiple chronic conditions. The role of the navigators is to identify patients requiring support in negotiating their health care. A critical discourse analysis was used to examine qualitative data collected from nurse navigators and consenting navigated patients to identify key indicators of how nurse navigators do their work and where the success of their work is most evident. Nurse navigators help patients who have lost trust in the health system to re-engage with their interdisciplinary health care team. This re-engagement is the final step in a journey of addressing unmet needs, essential to hospital avoidance. Nurse navigators provide a continuum of authentic and holistic care. To acknowledge the true value of nurse navigators, their performance indicators need to embrace the value-added care they provide. [ABSTRACT FROM AUTHOR]

Aim: To understand the impact and causes of 'Failure to Attend' (FTA) labelling, of patients with chronic conditions. Background: Nurse navigators are registered nurses employed by public hospitals in Queensland, Australia, to coordinate the care of patients with multiple chronic conditions, who frequently miss hospital appointments. The role of the nurse navigator is to improve care management of these patients. Evidence for this is measured through improvement in patient self-management of their conditions, a reduction in preventable hospital admissions and compliance with attendance at outpatient clinics. Failure to attend (FTA) is one measure of hospital utilisation, identifying outpatient appointments that are cancelled or not attended. Method: The cohort for this study was patients with multiple chronic conditions, and nurse navigators coordinating their care. Data describing the concept of FTA were thematically analysed twelve months into this three year evaluation. Results: Although the patient is blamed for failing to attend appointments, the reasons appear to be a mixture of systems error/miscommunication between the patient and the health services or social reasons impacting on patient's capacity to attend. Themes emerging from the data were: access barriers; failure to recognise personal stigma of FTA; and bridging the gap. Conclusion: The nurse navigators demonstrate their pivotal role in engaging with outpatient services to reduce FTAs whilst helping patients to become confident in dealing with multiple appointments. There are many reasons why a patient is unable to attend a scheduled appointment. The phrase 'Failure to Attend' has distinctly negative connotations and can lead to a sense of blame and shame for those with complex chronic needs. We propose the use of the neutral phrase "appointment did not proceed" to replace FTA. Implications for Nursing management: This article advocates for further consideration of collaborative models that engage the patient in their care journey and for consideration of the language used within the outpatient acute hospital setting, proposing the term 'appointment did not proceed.' [ABSTRACT FROM AUTHOR]

Aims: This paper describes findings from a survey conducted in New Zealand exploring nurses' decision‐making about when to delay care, delegate care, hand care over or leave care undone. Unanticipated findings identified processes that nurses go through when deciding to take planned/unplanned leave when wards are constrained through budget limitations. Background: Missed/rationed care is increasingly the focus of attention in international studies, identifying a complex interplay of organisational, professional and personal factors affecting nurses' decision‐making when faced with limited organisational time, human and material resources to provide care. Methods: The survey presented nurses with Likert‐scale questions with option for free text comments. This paper reports on the commentaries about work–life balance. Results: Nurses described workload pressures that lead to rationing care affected them, and the long‐term effect on them as individuals. Nurses verbalized the difficulties and associated guilt about taking leaving and sick leave when wards were short staffed. Conclusions: Nurses consider how their absence will affect the workspace and their home first, considering the impact on themselves last. Implications: The findings may provide valuable insights for nurse managers in relation to workforce allocations and resources where acknowledgement of work–life balance is considered. [ABSTRACT FROM AUTHOR]

Aims: The article examines nurses' experiences to institutionally enforced choices they must make regarding what patient care will be left undone. Cognitive dissonance theory is used to discuss how missed care is reconciled with the nurses' sense of professionalism and feelings of compassion. Background: Research into missed nursing care and care rationing is increasing, with an awareness that it impacts on nurses' coping ability. Methods: In‐depth video and telephone interviews were conducted with four experienced nurses who were asked to describe how they made choices regarding required patient care and how they managed care under workload pressures. Results: Thematic analysis of interview narratives revealed four key themes describing the experiences of nurses managing their work: compromising care; incongruity between professional standards and organisational resources; emotional exhaustion; and depersonalization. Conclusions: Nurses expressed concerns that their professional values regarding patient care are being lost in a quest to achieve financial targets. It raises questions regarding ethical and psychological dilemmas created for workers by work intensification. Implications for Nursing Management: Financial effectiveness negatively impacts on nurses' emotional and clinical well‐being cannot be easily dismissed, given that cognitive dissonance arises from attempting to provide quality care of patients whilst meeting organisational financial targets. [ABSTRACT FROM AUTHOR]

Background: Patients with complex chronic conditions experience fragmentation of care, unnecessary hospitalization and reduced quality of life, with an increased incidence of poor health outcomes. Aim(s): The aim of this paper was to explore how nurse navigators manage client care. This was achieved through an examination of narratives provided by the nurse navigator that evaluated their scope of practice. Method(s): All nurse navigators employed by Queensland Health were invited to participate in a study evaluating the effectiveness of the service. Eighty‐four self‐reported vignettes were thematically analysed to understand the work from the nurses' perspectives. Results: Two themes emerged from the vignettes. Theme 1, the layers of complexity, is comprised of three sub‐themes: the complex patient, the complex system and patient outcomes. Theme 2, professional attributes, has two sub‐themes: person‐centred care and clinical excellence. Conclusion: Navigators innovatively integrate services and address the fragmented nature of the health system. They apply expert clinical and social skills, through consistent and robust communication, to meet the needs of those with multiple chronic conditions. Implications for nursing management: Results provide insight into the new role, illuminating the work they achieve, despite system complexities. [ABSTRACT FROM AUTHOR]

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This article examines nurses' commentaries from a survey conducted in New Zealand that studied contradictions between quality assurance and work intensification in nursing care. Nurse managers were blamed for either avoiding or not recognizing work intensification affecting quality care delivery. However, the data illustrate key structural issues resulting in missed care that impact on patient safety, rather than a problem directly attributable to managers. Until these structural issues are addressed, missed care and adverse events will continue to affect the quality of care. [ABSTRACT FROM AUTHOR]

This article describes an investigation into the use of technology and the issues nurses face undertaking nursing assessment. It reports qualitative, descriptive research involving interviews with ten ward nurses from three hospitals in New Zealand. Thematic analysis of the data revealed three key issues: the impact of technology, the influence of early warning systems and nurse autonomy. Results show how clinical decision making around nursing assessment is influenced by technology and the Early Warning Score. These clinical decisions may not always be informed by critical thinking in complex healthcare environments. The article concludes that nurse autonomy, while supported and endorsed in theory, is frequently in conflict with hospital risk-management policies and the use of prescriptive algorithms. [ABSTRACT FROM AUTHOR]

This paper reports nurses' perspectives of their role delivering an extended Well Child/Tamariki Ora (WC/TO) service to teenage mothers. It focuses on what nurses consider is required to successfully deliver the service to this client population and the challenges they face. Since 2011, an extended WC/TO service has been delivered by the Royal New Zealand Plunket Society (Plunket) to teenage mothers in Hawke’s Bay, beginning with a pilot service involving 21 teenage mothers. This service was twice evaluated, when the babies receiving the service were six months old and again when they were three. The evaluation method included face-to-face interviews with WC/TO nurses delivering the extended WC/TO service. Thematic analysis of the qualitative data indicated that trusting nurse/client relationships, strong inter-agency relationships, team work and good support were considered key to successful service delivery and for providing positive parenting experiences for teenage mothers. Challenging social issues routinely required nurses to work outside their scope of practice. [ABSTRACT FROM AUTHOR]

This is an investigation into nurses' practice of when they would not take and record a patient's respiratory rate. It reports results of qualitative, descriptive research involving interviews with ten ward nurses from three hospitals in New Zealand. Results affirm that, despite it being the most sensitive vital sign for managing patients, nurses acknowledged circumstances in which respiratory rate taking was missed. Reasons were complex and, contrary to expectations, not always associated with the introduction of technology to record other vital signs. Time pressures, work interruptions and rationalised judgements made by experienced nurses all contributed to incidences of missed respiratory rate taking. It is concluded that patient respiratory rate measures do not seem to be highly valued, calling into questions nurses' level of understanding of respiratory physiology, as well as the extent to which intuitive nursing practice is supported by critical analysis. [ABSTRACT FROM AUTHOR]

The Before (B4) School Check is a free health and development check delivered by specifically trained nurses to four year old children throughout New Zealand, aimed to identify and address any health, behavioural, social or developmental concerns that could affect a child's ability to get the most benefit from school. Reported here are the results of an evaluation of the B4 School Checks in Hawke's Bay, focusing specifically on children assessed at the B4 School Check with behaviour issues as determined by the Strengths and Difficulties Questionnaire (SDQ). Health Hawke's Bay (HHB) records were reviewed to understand the number and demographics of the children assessed with behaviour issues at the B4 School Checks up to 31 August 2011, and the interventions to which they were referred. Telephone Interviews were conducted with 36 parents/caregivers of these children to address the questions, what difference did the B4 School Check make to children assessed with behaviour issues and what aspects of the B4 School Check delivery contributed to successful outcomes for these children? Results showed that child behaviour issues in Hawke's Bay were identified in more boys than girls and concentrated in more deprived families. Maori children were represented in numbers disproportional to the regional population. The majority of referrals for child behaviour directed parents/caregivers to non-governmental organisations for family support and parenting programmes. Thematic analysis was applied to the qualitative data derived from the interviews with parents/caregivers and results indicated high levels of satisfaction with the B4 School Check for behaviour and the referred outcomes. Implications for nursing practice arise from these findings in that they identify factors which contribute to what does and does not work well for achieving successful outcomes from the B4 School Check for behaviour. [ABSTRACT FROM AUTHOR]

The establishment of women's soccer in Auckland, New Zealand in 1973 reflected a growing world-wide trend: women's increasing involvement in sport, especially sports traditionally associated with men. This chapter explores the changing face of women's soccer in New Zealand during the past 30 years, using interviews with elite soccer players and analyses of newspapers. This exploration suggests that there has been a marked shift in the way the media perceives and reviews women's soccer, and in the players' understanding of what it means to be women soccer players. It further suggests that women's football has been emancipatory, demonstrating that femininity is an evolving process. [ABSTRACT FROM AUTHOR]

This paper examines the ways in which two women (Sweetie and Desiree) experience a dissatisfying retail encounter. Citing data derived from memory-work methodology, we illustrate how stories can be used to gain a detailed insight into the complexity of consumption experiences and give voice to women consumers. By allowing women to write about, and critically reflect on their experiences, we show how consumers attach meaning to retail encounters and how we, as researchers can offer alternative interpretations of consumer behavior to those commonly reported in the literature. In this paper we use memories of "nasty" retail encounters to illustrate how social constructs related to identity, such as ethnicity and gender, have meaning in shopping experiences. Because of the new understandings possible via this method, we argue for using reflexivity in our research and analyses informed by feminism. [ABSTRACT FROM AUTHOR]

This paper reports results from a nationally representative survey of 40–54-year-old New Zealanders investigating correlates of perceived available leisure time. The focus on women and men in midlife, the countries largest birth cohort, was based on concerns for the impact on leisure of a 'demographic squeeze' of those in this age group from pressures experienced through changed family structures and political economic policies. Multivariate odds ratio analyses were run on three models to study the relationships between explanatory variables and self-reported amounts of leisure time. Results showed that respondents predominantly reported having moderate amounts of time identified as leisure and were satisfied with that amount. Recognized correlates of leisure availability, such as education levels and ethnicity, were confirmed but others, such as gender, health status and family structures, were not. Overall there was little to statistically predict who in midlife might experience pressures impacting on leisure. [ABSTRACT FROM AUTHOR]

This study explores how female soccer players experience their bodies within the discourses of sport, gender and heterosexuality. Using in-depth interviews and participant observation, the research focused on a team that competed in a premier women's league in New Zealand. The findings indicated that the players underwent four distinct, yet interconnected, bodily experiences. This suggests that the use of a multiple body perspective enables a more subtle understanding of women's experiences in sport. The findings also indicate that the possibility of seeing one's body as being constituted differently by these multiple discourses may be a liberating experience, in that it allows women to access a diversity of feminine practices. [ABSTRACT FROM AUTHOR]

While there is a great deal of popular social commentary on sport in New Zealand, there is relatively little serious sport sociology. As a subject it is taught to students in Physical Education at the University of Otago, although individuals from other universities also contribute to sociology of sport and leisure research. Sport has a strong influence on social life in New Zealand, especially events of international significance such as rugby exchanges with South Africa. This has been a predominant topic of sociological analysis. Another area of development recently has been that concerning women in recreation and sport. [ABSTRACT FROM AUTHOR]

In 1981, women were very prominent in the organized opposition to a South African rugby team touring New Zealand. While overtly opposing racial discrimination, it is argued their protest action was motivated by anger at the exclusively male sport of rugby. They challenged the values, gender relations and power which are symbolized and reproduced by the sport. Such power, with a base in patriarchy, agriculturally based capitalism and white supremacy has excluded and oppressed women. Events since 1981 suggest that such protests made a substantial contribution to an emerging hegemony in New Zealand whereby previous power concentrations shifted considerably. [ABSTRACT FROM AUTHOR]

Reports on the increasing demand for leisure experiences in the outdoors. Balancing the desires of the individual with safety; Physical settings; Participant's level of engagement in an activity; Dilemmas surrounding risk and responsibility.