Abstract: In this research two nurse-patients have engaged in a conversation about their experience of 'being nursed'. The project sets out to address the following questions: How might our experiences as nurses who have been hospitalised be drawn upon to influence positive changes in nursing practice? What effect might our experiences of hospitalisation have on us as nurses and on our nursing practice? The study utilises narrative as inquiry and the method of story telling and auto/biography to tell the stories of Maria (a pseudonym) and the researcher herself. This interpretive research has been informed by the feminist process and sits within a postmodern framework. Maria's stories were audio taped and transcribed before being prepared for analysis using 'core story creation', and the process of 'emplotment' (Emden, 1998b). The author's reflective topical autobiographical narrative was constructed through the processes described by Johnstone (1999). Three distinct qualities emerged from both experiences. The first, 'knowing as nurse-patient' contains the three sub-themes of 'having knowledge', 'expectations of being nursed', and 'knowledge gained'. The second distinct quality 'being nursed' contains the two sub-themes of 'feeling safe and cared for' and 'presencing'; and the third, 'not being nursed', contains the four sub themes 'feeling vulnerable', 'invisibility of nurses', 'getting out' and 'feeling let down'. The sub-theme 'getting out' includes three additional sub themes of 'wanting to get out and not wanting to be there', 'leaving and the need for closure' and 'not wanting to go back'. The author notes that nursing does make a difference to patient care. However, for patients to receive therapeutic care, new graduate nurses must be preceptored/mentored by experienced nurses in supportive programmes. Suggestions for further research have been identified.

Abstract: Alleviating patient suffering, providing comfort and pain relief are all central to the philosophical caring position nurses have always espoused. Despite this, patients continue to suffer pain although we have the means to provide pain relief. The author notes that research has identified that nurses have a knowledge deficit regarding pain and its management, as well an erroneous attitudes, which combined are blamed for an inability to make significant progress in this area. This study was undertaken to uncover the contextual aspects of working within a New Zealand health care institution that affect nurses' ability to manage their patient' pain effectively. It highlights the difficulties and the complicated nature of working within an institution in the 1990's health care environment, where accountability for pain is absent and where pain is often under-assessed and under-treated. By using focus group of nurses, the author notes she was able to uncover constructions on nursing practice, which, she suggests, have been missing from the literature, but prevent nurses from implementing their knowledge. Using a constructivist research, she used nurse's stories and current literature to argue one way forward in, what she terms, the pain management debacle. This study revealed a diverse range of contextual factors that prevent nurses from using their knowledge. Many of the constraints on nursing practice are the results of complex organisational structures within health reform, which have significantly affected the nurse's ability to provide quality-nursing care. One of the most important factors limiting the management of the patient' pain is the inability of the nurse to autonomously initiate analgesia. While nurses are largely responsible for the assessment of pain, they are usually powerless to access necessary analgesia, without a medical prescription. The author argues that once an initial medical diagnosis has been made, nurses are usually left responsible for patient comfort and the management of pain. To do so effectively, nurses need to able to prescribe both pharmacological and non-pharmacological measures for the patient. Presently nurses are prescribing using a variety of illegitimate mechanisms, needing the endorsement of a doctor. To fulfil this role, nurses must be adequately prepared educationally and given the authority to either prescribe autonomously, of provided with extensive “standing orders”. While legislative changes in New Zealand in 1999 extended prescribing right to a few nurses within certain areas of care, the ward nurse is unlikely to gain prescribing rights in the near future. The author concludes that a way forward may be to encourage and further develop the use of protocols for managing pain via standing orders. Standing orders are common place within nursing practice today, have the support of the Nursing Council of New Zealand and are currently under-going legislative review. An institutional commitment to developing pain protocols for nurses would recognise the nurses active role and expertise in the management of pain and facilitate expedient relief for the patient.

Abstract: The question explored in this research project is: What are inpatient registered nurses' perceptions of the factors which influence therapeutic relationship development? The literature reviewed for this project includes the history of interpersonal relationships in nursing; therapeutic relationships; what constitutes these relationships. Also discussed is literature about phenomenology as the underlying theoretical and philosophical position that informs the research method. To answer the research question a single focus group was used to gather data from a group of registered nurses practising in inpatient mental health units. Focus groups as a data collection method produce data and insights that would not be accessible without the group interaction. The key themes to emerge from the data analysis were; time, environment, knowing / self-awareness, compassion and power imbalance / empowerment. These key themes are discussed in relation to the literature and the wider context of the mental health care environment. The contribution this research makes to nursing includes a list of recommendations to nurses, nurse leaders and managers who aim to provide therapeutic mental health unit environments.

Abstract: This thesis explores the theoretical notions of suffering and caring within the nurse patient relationship in the context of emergency nursing. It includes a small pilot study that aimed to assess the feasibliity of a major research project, by describing the impact of vicarious traumatisation in emergency nurses, specifically in relation to their self capacities. This pilot study utilised a descriptive, correlational design. Data was collected by using the Inner Experience Questionnaire (IEQ) a twenty four-item questionnaire developed by Dr Pearlman (1995), and a profile sheet which identified demographic details. Twenty-seven emergency nurses participated in this pilot study. The IEQ was assessed for internal reliability by applying the Cronbachs alpha and utilising a focus group to gain insight into the usability and relevance of the questions. The internal reliability of the IEQ suggests that it may be an appropriate tool to measure disruption of self capacities in the population of emergency nurses. Although the results are limited, and conclusions cannot be drawn, findings suggest a correlation between the variables of age, experience, nursing qualifications and a history of personal trauma and the IEQ. There is evidence that emergency nurses are affected psychologically when caring for the victims of trauma in emergency departments and the IEQ has the potential as a tool to be integrated into future emergency nursing studies. A multidimensional methodological approach is recommended to capture the many contours of the complex phenomena of vicarious traumatisation and the emergency nurse.

Abstract: This thesis presents a study of a nursing 'practicum' from the perspectives of nursing students and staff 'buddies'. A grounded theory approach was used to interview six nursing students during their transition placement, the final practicum of their Diploma in Nursing programme. Five staff nurse buddies selected by the students were also interviewed. An informal, conversational interview was used and data was analysed from an experiential learning perspective.This study differs from others because it focuses on the clinical experience component of nursing education, 'practicum', and includess practitioners viewpoints. At present there is a re-evaluing of experience within nursing education with a new emphasis on practice-based learning. Experience-based learning is becoming increasingly acceptable within academia as a 'seamless' education system evolves.I identified three learning stages which students' experience during practicum – initiation, exploration and consolidation. The key stage for learning through experience was exploration. Learning during this stage was predominantly buddy-directed which contradicted the self-directed curriculum design. Students and staff nurses however agreed that communication between them during this stage enabled the development of 'competence'.The learning /teaching approach used by the students and staff nurses made it difficult for students to translate their 'all-round' competencies during practicum. It is argued that it is the useof such competencies during practicum which enable nursing students to become autonomous in the attitudinal and epistemological sense. The predominantly 'technical training' approach adopted was understood by students and staff nurses to be reinforced by 'silence' from tutors.Restructuring gives the opportunity for nursing to develop an ';investigative', enquiry-based approach in practice. There will increasingly be an emphasis on practice-based research as a result of the implementation of degree and post-graduate programmes in nursing. This study highlights some aspects of nursing education and it's relationship with practice which can assist the development of such an approach