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Dillon, D. R. (2006). Islands, islandness and nursing: Advanced nursing practice in rural remote and small island areas. Ph.D. thesis, , .
Abstract: This dissertation focuses on the concepts of island, island-ness, and isolation. It aims to further advance the national and international literature relating to the health beliefs of island people as linked to the provision of primary health care services within New Zealand. New Zealand is an island nation made up of two main islands and numerous outlying islands, relatively isolated from the rest of the world by water. This geography means going anywhere from New Zealand involves traveling either “over” or “on” the sea. All people of New Zealand since the first inhabitants, whether residents or visitors, have arrived to New Zealand either by sea or more recently by plane. The population of New Zealand is 25% rural, with most of these rural dwellers residing in the South Island, and several of the smaller off shore Islands. This builds a sense of culture of the people, or tangata whanua (the people of the land), for whom there are degrees of island-ness, and the characteristics of this can be seen amongst the people of New Zealand. A further challenge which is discussed comes in the form of the “island penalty” which encompasses high transport costs, long distances to travel to main centres, lack of specialists and trained health workers, effects of migration and tourism, and communication difficulties. The more isolated people are, the tougher the challenges become. Most rural island populations are served by lay care workers, volunteers, and rural and remote nurses. Nurses are often the main health care providers to small island populations, and they demonstrate advanced nursing practice which is acknowledged internationally as meeting Nurse Practitioner competencies. As a group these nurses possess knowledge of the extrinsic and intrinsic factors involved in the health needs and health determinants of these island communities. Researching these advanced nursing roles adds to the body of knowledge around isolated and island communities. The author suggests that studying the concepts of islands, islandness, and isolation in relation to health beliefs will bring more understanding of services for the advanced rural nurse to consider in developing appropriate, accessible, affordable and adaptable Primary Health Care which is fair and equitable.
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Maw, H. (2005). The challenge of developing primary health care nurse practitioner roles in rural New Zealand. Ph.D. thesis, , .
Abstract: When the New Zealand Nursing Council introduced the nurse practitioner as a new level of nurse in 2001, the opportunity arose for the introduction of primary health care nurse practitioners into the rural practice arena in this country. This dissertation explores the influences on the development of rural nursing in the last decade in New Zealand including the role of the Centre for Rural Health in advancing rural nursing education, as well as the impact the shortage of health professionals in rural New Zealand has had on the development of the rural primary health care nurse practitioner concept. For pioneering primary health care nurse practitioner roles to be successfully implemented in rural communities in New Zealand, several challenges need to be faced; the creation of roles and employment opportunities, community acceptance of the role, medical and nursing acceptance of the role and the establishment of independent nurse prescribing within the constraints imposed by current legislation. The dissertation explores the current literature in an attempt to offer solutions to the identified challenges. With the creation of primary health care nurse practitioner roles and the establishment and acceptance of these roles in rural communities, a new mode of health service delivery in rural New Zealand will begin.
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Magrath, K. L. (2005). From chrysalis to butterfly: Transition experiences of new graduates in primary health care nursing practice in New Zealand. Ph.D. thesis, , .
Abstract: Primary health care is a dynamic and ever-changing area of practice which has undergone many changes in the last ten years. Traditionally, primary health care was not a routine choice for new graduate nurses as they were encouraged to work in a hospital setting before seeking a position in the community. Bachelor of Nursing programmes emphasise primary health care practice and increasingly nurses and their employers are moving away from the traditional belief of 'doing your time in the hospital' before contemplating the move to primary health care. Currently in New Zealand increasing numbers of graduates from Bachelor of Nursing programmes want to begin their working life as registered nurses in this area. A constructivist approach was taken to explore the experience of five nurses who entered primary health care practice as new graduates. Participants were interviewed using a semi-structured format. They constructed their experience as role transition and identified a number of significant factors which had impacted on their practice. These factors included both the personal and practice challenges they experienced and the strategies they used to address them. Further research findings were a transition time of one year, the importance of both formal and informal support, planned orientation and opportunities for reflection. A number of mediating factors including new graduate programmes, peer support and mentorship were also discussed. Key implications for practice, education, employers and future research regarding transition to primary health care for new graduates are discussed. This research emphasised the importance of appropriate resources and support for new graduates from Bachelor of Nursing programmes. These factors are suggested as integral to the development of new graduates' practice in primary health care and reduction of the challenges inherent in this transition.
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Hansen, S. (2005). The reality: Doctors and nurses in general practice in New Zealand. Ph.D. thesis, , .
Abstract: Provision of a primary health care system that delivers timely, appropriate, affordable and effective care is a challenge throughout the world. The purpose of this work is to discuss the realities of collaborative practice in primary health care, where care is delivered by doctors and nurses in general practice settings in New Zealand. The close relationship between the two professions has been historically marked by the dominance of medicine over nursing. Unclear articulation of nursing practice by the nursing profession along with historical gender issues has further hindered a more collegial relationship between medicine and nursing. The author suggests that historical gender inequalities have also contributed to a system which has disadvantaged nurses in the execution of their work. Collaboration occurs when mutual respect is present between two parties intent on furthering mutual goals. Collaboration is not supervision or co-operation. It is therefore, the author suggests, questionable that collaboration exists in the New Zealand system other than through the good will of individual practitioners. An examination of these issues using the work of Jurgen Habermas and Michel Foucault offers insight into how the current working situation between medicine and nursing came about. The author concludes that the emergence of the nurse practitioner role in New Zealand along with a change in the way that primary health care is being managed nationally provides opportunities for the nursing profession to move into emancipatory collaborative practice roles.
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Higgins, A. (2006). Collaboration within primary health care in rural New Zealand. Ph.D. thesis, , .
Abstract: In November 2005, the Oxford Community Health Centre (OCHC) introduced an innovative way of delivering primary health care to the residents of Oxford. This was in response to the difficulty with recruitment and retention of medical staff for the solo General Practitioner (GP) at OCHC. Primary health care services are now the shared responsibility of the Rural Nurse Specialists (RNS) and the GPs. This initiative is underpinned by a collaborative approach in sharing patient care between the GPs and RNSs to improve access to primary health care and foster staff retention. The team at OCHC is keen to consolidate and enhance the success of collaboration. Therefore, this dissertation has reviewed a range of literature in order to identify lessons that can be learned for the future. Two key factors that have implications for OCHC are the structural effects of the organisation and the interpersonal relationships between the GPs and RNSs. The structural effects include: the structure and philosophy at OCHC, and the social, cultural, and educational influences within the organisation. It is the nature of the interpersonal relationships that can affect the development and success of collaboration through a willingness to collaborate and the existence of mutual respect, trust, and effective communication between the RNSs and GPs. Strategies to foster collaboration at OCHC in the future include: staff participation in making collaboration visible within the philosophy at OCHC, a workshop for staff to further define roles and differentiate activities according to skill-mix; and the involvement of a nurse in decision-making at the organisational level. The author suggests that these strategies could also be beneficial to other rural practices that are striving to maintain a sustainable primary health care service.
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Farmer, D. (2008). Wairarapa Primary Health Care Nursing Workforce Survey – 2007: A replication. Ph.D. thesis, , .
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.
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Dennis, J. (2005). How will transformative primary health care nursing leadership facilitate better health outcomes for Southlanders? Ph.D. thesis, , .
Abstract: Changes within the New Zealand health system have led to an emphasis on primary health care. The New Zealand government and the Southland District Health Board have identified that nurses can make significant contribution to improving the primary health outcomes for New Zealanders. However, within Southland there exist barriers to nurses influencing health outcomes. A Southland draft Primary Health Care Nursing Strategic Plan 2005 recommended that the employment of a primary health care nursing leader would reduce these barriers and lead to a comprehensive primary health care nursing service. This dissertation argues, using literature, that the employment of a transformative nursing leader, using a facilitative style, would implement changes that would develop a community responsive nursing service, establish a primary health care educational structure and ensure quality nursing care. Successful implementation would occur as the leader facilitates experiential learning within groups and with individuals to review current experiences and implement transformative primary health care nursing changes that improves health for all. The dissertation introduces the background to the changing primary health care environment in New Zealand and to the Southland current situation in chapter one. Chapter two describes the unique features of transformative leadership style and how it is applies to nursing and specifically to Southland's changing primary health care environment. The chapter specifically emphasises the role of and the art of facilitation which is a critical transformative leadership process. Chapter three describes the process of the experiential learning cycle, which the author argues will improve health outcomes, when used by the transformative leader to enable nurses to learn from their experiences and make nursing changes that improve health care. Chapter four addresses the dissertation question by describing how transformative leadership will facilitate the experiential learning process to Southlanders and improve health outcomes, reduce inequalities and increase accessibility through a comprehensive primary health care nursing service.
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Litchfield, M., & Ross, J. (2000). The role of rural nurses: National survey. Christchurch: Centre for Rural Health.
Abstract: A survey was used to reach as many nurses as possible involved with nursing in “rural” areas throughout New Zealand and to build a profile of nurses involved in the provision of healthcare beyond the urban centres. The contact also sought to inform nurses of the rural healthcare project and encourage them to contribute their experience to the development of health services in the new health service structure. Data is presented on the characteristics and employment conditions of nurses and access to resources including information technology. The inadequacy of information on the rural nurse workforce is identified: nurse roles are historically defined yet employment patterns are changing according to the workforce demands of new structures, and the existing definitions of rural health service design and delivery are only in terms of general medical practices and on-call coverage. Recommendations are made for definitions of “rurality” and “rural nurse” that will allow a more useful depiction of the nurse workforce.
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Litchfield, M. (2002). The successful design and delivery of rural health services: The meaning of success. Christchurch: Centre for Rural Health.
Abstract: This is the report of the analysis of data from an in-depth survey designed by Sue Dawson, previously Rural Health Researcher in the Centre for Rural Health, and follow-up interviews. The study purpose was to construct a definition of “successful design and delivery of rural health services” as a step towards a measurement tool. Participants were grouped as general practitioners, nurses and community representatives. A format for a participatory approach to evaluation of rural health services is derived from the criteria of success identified, with its relevance for the implementation of the new Government primary health care strategy explicit. This format provided the basis for a subsequent evaluation case study undertaken in a small rural forestry township by the Centre for Rural Health.
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O'Malley, J. (2001). Critical social analysis of acute institutionally based mental health nursing following an action research project. Ph.D. thesis, , .
Abstract: This study using action research involving twelve registered nurses worked toward improving nursing care in an acute mental health in-patient service. Following focus groups with consumers, families, nurses, doctors, and allied health professionals, the action research group developed projects over eighteen months to improve continuity and consistency of nursing care. There was a subsequent restructuring of nursing service to better define leadership, accountability and to strengthen care delivery. The second half of the thesis involves a critical social analysis of the research data and produces a theory of mental health nursing which, the author suggests, has wide application in practice.
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Miles, M. A. P. (2005). A critical analysis of the relationships between nursing, medicine and the government in New Zealand 1984-2001. Ph.D. thesis, , .
Abstract: This thesis concerns an investigation of the tripartite arrangements between the government, the nursing and the medical sectors in New Zealand over the period 1984 to 2001 with a particular focus on primary health care. The start point is the commencement of the health reforms instituted by the Fourth New Zealand Labour Government of 1984. The thesis falls within a framework of critical inquiry, specifically, the methodology of depth hermeneutics (Thompson, 1990), a development of critical theory. The effects of political and economic policies and the methodologies of neo-liberal market reform are examined together with the concept of collaboration as an ideological symbolic form, typical of enterprise culture. The limitations of economic models such as public choice theory, agency theory and managerialism are examined from the point of view of government strategies and their effects on the relationships between the nursing and medical professions. The influence of American health care policies and their partial introduction into primary health care in New Zealand is traversed in some detail, together with the experiences of health reform in several other countries. Post election 1999, the thesis considers the effect of change of political direction consequent upon the election of a Labour Coalition government and concludes that the removal of the neo-liberal ethic by Labour may terminate entrepreneurial opportunities in the nursing profession. The thesis considers the effects of a change to Third Way political direction on national health care policy and on the medical and nursing professions. The data is derived from various texts and transcripts of interviews with 12 health professionals and health commentators. The histories and current relationships between the nursing and medical professions are examined in relation to their claims to be scientific discourses and it is argued that the issue of lack of recognition as a scientific discourse is at the root of nursing's perceived inferiority to medicine. This is further expanded in a discussion at the end of the thesis where the structure of the two professions is compared and critiqued. A conclusion is drawn that a potential for action exists to remedy the deficient structure of nursing. The thesis argues that this is the major issue which maintains nursing in the primary sector in a perceived position of inferiority to medicine. The thesis also concludes that the role of government in this triangular relationship is one of manipulation to bring about necessary fundamental change in the delivery of health services at the lowest possible cost without materially strengthening the autonomy of the nursing or the medical professions.
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Morgan, F. A. (2006). Primary health care nurses supporting families parenting pre-term infants. Ph.D. thesis, , .
Abstract: This thesis reviews the role of primary health care nurses, who have an opportunity to play a unique role in teaching, touching and empowering families with newly discharged pre-term babies. Birth of a baby earlier than 37 weeks gestation ushers in a period of uncertainty and stress for parents. Uncertainties may centre on whether their infant will survive and what ongoing growth and developmental issues their infant will face.
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Mason, B. (2002). An analysis of the role of the practice nurse in primary health care, 2000/2001. Ph.D. thesis, , .
Abstract: In 1999 primary health care in New Zealand was in the process of change from the current personal health care model, which focuses on general practitioner based care, to a population and community based health care programme. Carryer, Dignam, Horsburgh, Hughes and Martin (1999) submitted a report to the National Health Commission entitled “Locating Nursing in Primary Health Care”. This report envisaged that nurses in primary health care would be part of interdisciplinary teams, act autonomously and undertake community consultation and education. The submission suggested that nurses, currently working in primary health care, were alraedy prepared and able to move across into the new form of primary health care, without further education or training.
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Williams, H. (2006). One for the boys: An evaluative study of primary health care access by men in Tairawhiti. Ph.D. thesis, , .
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Gibbons, V., Rice, S., & Lawrenson, R. (2010). Routine and rigidity: Barriers to insulin initiation in patients with Type 2 Diabetes. NZNO Library, 1(1), 19–22.
Abstract: It has been shown that intensive management of diabetes with type 2 diabetes is effective and has led to wider use of insulin. The conversion of patients from oral medication to insulin is usually managed in primary care. The study discussed here aimed to explore how patients with type 2 diabetes mellitus (T2DM) perceived insulin. The study was conducted in 2009 in an urban general practice in a large town in New Zealand with more than 300 patients with type 2 diabetes. A qualitative study was conducted with face-to-face interviews with 13 participants. The question focused on insulin initiation, lifestyle and routine. The transcribed responses were subject to thematic anaylsis. Interviews showed participants felt restricted by the prospect and eventuality of the routine and restrictions of being on insulin. Results show there needs to be a greater emphasis on the disease being progressive. This study provides the ground work for developing resources that will benefit patients with T2DM.
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