Abstract: Mothers, whose children had undergone a liver transplant more than one year ago at time of interview and whose children were outpatients of Starship Children's Hospital, were invited to participate in this research. A Heideggerian hermeneutic phenomenological approach, informed by the work of van Manen (1990) was used. Three mothers of children who had received a liver transplant were interviewed to reveal the meanings of the phenomenon – what is the meaning of lived experience of mothers in caring for their child who has undergone and recovered following liver transplantation? Little previous study regarding mothers' lived experience of caring for their child, who had recovered from a liver transplant, was found in the literature. The emerging themes were punctuated with stress being a consistent feature. Utilising Ruddick's (1983) concepts of maternal thinking, the emerging themes were merged within the three interests governing maternal practice; preservation, growth and acceptability. The absolute capacity for attentive love draws the experience together. An essential theme identified out of the analysis was the concept of survival relating to the unique features of liver transplantation and the consequences of liver rejection and failure. The findings contribute to the understanding of the phenomenon, emphasising the need for good support systems for families of children who have undergone transplantation; assistance in the establishment of maternal coping strategies and regular feedback on the children's progress acknowledging the role and care provided by mothers.

Abstract: This study explored what some New Zealand families believe constitutes the successful management of unsupervised childcare. It was designed to increase social understanding and practitioner knowledge of the issue by exploring families' beliefs, practices and perspectives. The researcher was concerned with the professional role nurses may play with this group of children. A qualitative descriptive approach was used to obtain a straight description of successful unsupervised childcare, using the everyday language of the participating families. Data was collected in semi structured interviews with five family groups, and subjected to content and thematic analysis. Findings suggest unsupervised childcare is both choice and solution, though parents are fearful of the legal and social consequences of using it. Context of the care is important, with the child's preference, community context and availability of adults through distal supervision critical components of its success. Trust between parent and child, the use of rules and boundaries to regulate child behaviour, the teaching of skills and strategies to build child competency, and parental support of children while unsupervised are identified by parents as factors linked to success. Parents identify increasing child independence and self responsibility as positive outcomes from the successful use of unsupervised childcare. This study has helped to identify positive factors resulting in good outcomes from which successful interventions could be developed, provides information that will be of particular interest to practitioners and policy makers, and provides a platform to launch larger studies into the issue of unsupervised children.

Abstract: The author notes that it is widely accepted that there is a global shortage of nurses, and there are many studies in the health workforce literature about the negative aspects of nurse work environments, nursing workloads, decreased job satisfaction of nurses and the impact these have on patient health outcomes. In the past five years there has also been international and New Zealand-specific research into the effects of health restructuring on nursing leadership, retention of nurses, and on patient care. Much of this research has shown that countries with very different health care systems have similar problems, not only with retention of qualified nursing staff due to high levels of job dissatisfaction, but also with work design and the provision of good quality patient care in hospitals. This dissertation explores the many detrimental effects on nurses and nursing leadership, of extensive, and continuing, public health restructuring in New Zealand. The context of this dissertation is New Zealand public hospitals, with references pertaining to medical and surgical areas of nursing practice. Health reforms have negatively impacted on patient care delivery systems, patient health outcomes, and retention of educated nurses in the workforce. In order to resolve these issues, coordinated efforts are required in New Zealand district health boards to develop and sustain effective nursing leaders, who will promote and assist in the development of strong, healthy organisational cultures to retain and support professional nurses and the ways in which they wish to practise.

Abstract: The introduction of the 2001 New Zealand Primary Health Care Strategy has seen increased emphasis on the development of the national primary health care nursing workforce. National and local nursing workforce development initiatives, in response to the strategy, have seen evolving models of primary health care nursing practice in New Zealand. Research was undertaken in 2007 to review the current position of the Wairarapa primary health care nursing workforce. Quantitative, descriptive data was generated through the application, at a local level, of the 2001 Ministry of Health Primary Health Care and Community Nursing Workforce survey tool. Many of the regional challenges highlighted by survey respondents in 2007 are similar to those identified in the national 2001 survey. These include predominantly low numbers of Maori, Pacific and male primary health care nurses and a fragmented, part-time and aging workforce with many respondents indicating they undertake more than one nursing role in their organisation. Respondents were similarly unsure or did not have clear clinical career pathways available to them, a mechanism by which nurses can advance their clinical practice. Some unique service provision and workforce development issues related to Wairarapa's rural context include: geographical barriers, population spread and the high health needs of its rural population. Some unique regional differences compared to the 2001 data are: lower numbers of nurses studying toward further qualifications and specific barriers to accessing education opportunities that can be linked to living in a rural region. More respondents indicated they could work collaboratively with other nurses and health professionals within their own and other organisations. While many respondents were able to provide insightful examples of specific nursing strategies in their practice targeted towards reducing inequalities for groups at risk, others could not. Enrolled nurses remain part of the Wairarapa primary health care nursing workforce. Ten percent of the respondents were actively practising enrolled nurses with an average of 24 years experience in primary health care nursing. Direction and delegation requirements by registered nurses for this group and national attrition trends with corresponding loss of workforce experience of enrolled nurses highlight an area in the Wairarapa primary health care nursing workforce that requires further consideration. Overall this study contributes to current knowledge by establishing a regional nursing workforce baseline from which to measure and enable focused future workforce development initiatives and research. Regional findings can be used to inform recommendations within the Wairarapa Primary Health Care Nursing Action Plan 2006-11 to enhance the delivery of well-developed primary health care nursing services with benefits for the Wairarapa community.

Abstract: As carers of patients who are clinical research participants, nurses' contribution to the success of clinical trials is acknowledged in the literature. Ethical dilemmas and challenges that clinical trials may present for nurses are also recognised. Although there is some discussion regarding these issues, few studies explore and identify the perceptions of intensive care nurses regarding clinical trials and how they may impact on nursing practice. This thesis explores and describes the viewpoints and experiences of sixty intensive care nurses from a tertiary level referral centre in New Zealand engaged in clinical research activities. The descriptive study utilised a self-administered questionnaire to gather information regarding nurses' roles in clinical trials, associated issues encountered and contributory factors, and the impact of issues on nursing practice, stress and satisfaction levels. Suggestions for potential strategies to minimise the impact of issues on nurses' practice were also sought. Descriptive statistical and content data analyses identified three key areas in which nurses' encounter issues associated with clinical trials and their practice: nurses' workload; ethical concerns; educational preparation and support. The findings indicate that, when issues exist in these areas, routine patient care can be delayed, the enactment of nurses' patient advocacy role can be affected, and nurses' stress and satisfaction levels can be negatively impacted upon. The perceptions of a group of intensive care nurses who are enveloped in the daily balance of patient care, the need for clinical research, and their professional obligations are discussed in this thesis. While the study's findings are reflective of one group of nurses in a distinct practice setting, their experiences can prompt other nurses, research teams and clinical leaders to reflect upon their own clinical research environment.

Abstract: This study explores the phenomenon of dilemma in paediatric practice. Using a hermeneutic phenomenological method informed by the writings of Heidegger [1889-1976] and Gadamer [1900-2002] this study provides an understanding of the meaning of 'being in dilemma' from the perspective of predominantly paediatric health care professionals but also families in New Zealand. Study participants include four families who had a child requiring health care and fifteen health care practitioners from the disciplines of medicine, nursing, physiotherapy, play specialist and occupational therapy who work with families and children requiring health care. Participants' narratives of their experiences of 'being in dilemma' were captured via audio taped interviewing. These stories uncover the everyday realities facing health professionals and families and provide an ontological understanding for the notion of dilemma. The findings of this study suggest that experience of dilemma for health professionals reveals a world that is uncertain and questionable where they are thrown into having to make uncomfortable choices and must live with the painful consequences of their actions. The consequences of being in such dilemma are having to find ways of living with the angst, or risk becoming too sensitive or desensitizing. For families the experience of dilemma reveals a similar phenomenon most evident in circumstances where they feel totalized by the impact of heath care encounters. This study has uncovered that the perspectives that health professionals and families bring to the experience of dilemma reveal different concerns and commitments and may be hidden from each other. This thesis proposes that health professionals and families need support in living with their own personal encounters of enduring experiences of dilemma.

Abstract: ABSTRACT
BACKGROUND: Emergency nursing is a specialty concerned with the care of people of all ages, with either perceived or actual unwellness presenting to the emergency department(ED) for assessment, resuscitation, investigation, treatment and review of their illness or injury. Emergency nurses apply specialty knowledge and expertise in the provision, delivery and evaluation of emergency nursing care. Over recent decades social, political and professional changes have affected nursing care delivery and nursing education. In particular the 21st century has witnessed the development of state funded postgraduate nursing education programmes, developing nurses specialty or advanced nursing knowledge, quality patient/client care and nursing practice within the tertiary education system.
AIM: The aim of this study is to investigate emergency nurses? perceptions of the impact of postgraduate education on their practice in New Zealand (NZ).
METHODS: This study utilises critical social theory as the overarching framework, informed by the writing of Jürgen Habermas (b.1929- ). It is the three phases of
Habermas?s practical intent of critical social theory; namely enlightenment, empowerment and emancipation, that this study is concerned with. This descriptive research study employs both quantitative and qualitative methods and is therefore known as mixed-methods research. Data collection took place over 12 weeks, from August to November 2006, using a survey questionnaire obtained with permission from Ms Dianne Pelletier, Sydney, Australia. The sample included 105 emergency nurses from District Health Board (DHB) emergency departments in NZ, 10 respondents from this sample self-selected to be interviewed by telephone. Ethical approval for this study was obtained from the University of Otago Ethics Committee for research involving human participants. Data was analysed using the Statistical Package for Social Sciences (SPSS).
RESULTS: Two main themes arose from the thematic analysis; these being positive and negative, these themes were further divided into 10 sub-themes. The results indicate that postgraduate study (PGS) has increased nurses? perception of their knowledge; leadership and understanding on the quality of patient care delivered, increased their academic and research skills and increased their confidence/self-esteem and recognition by their colleagues and team. Therefore the majority of respondents perceive postgraduate education has been an instrument of liberation and a process of empowerment and emancipation. A smaller percentage of respondents perceived that PGS had no effect on various aspects of patient care and another significantly smaller percentage of respondents reported negative results from PGS. This research identified similarities between this study and that of Pelletier and colleagues? (2003; , 2005; , 1998a; , 1998b) Australian study.
CONCLUSION: This study adds to the existing literature on postgraduate studies undertaken by nurses. No known study has previously investigated solely emergency nurses?perceptions of the effects of PGS, either nationally or internationally. The results of this study offer enlightening information regarding emergency nurses? perceptions of their PGS within NZ and offers a platform from which other studies may be undertaken. It also has the potential to inform nurses contemplating PGS and educators facilitating these programmes,as well as provide implications for policy development by the Nursing Council of NZ, NZ Universities, DHBs and the Ministry of Health.

Abstract: The author takes a multidisciplinary approach to examine how the location and concept rural is defined and provides a critique of the disparate definitions available. Definitions encompass different disciplines such as sociology and anthropology, and there are national distinctions based on historical factors. The chapter also investigates the way researchers speak about rural people, particularly as the human aspect of health is a primary concern to nursing. The focus is on the socio-cultural, occupational, ecological, and health aspects of rurality. The Rural Framework Wheel is introduced, which is a method to categorise rural contextual definitions. Rurality is presented as a variable and evolving concept that provides particular challenges to nursing practice.