Abstract: This thesis represents an appreciative enquiry to identify features of effective verbal communication between nurses and patients. Using a method developed by the Language in the Workplace Project (Stubbe 1998) two nurse participants recorded a small sample of their conversations with patients as they occurred naturally in clinical practice. These six conversations constitute the main body of raw data for the study. The data was analysed using a combination of discourse and ethnographic analysis. Experience in nursing, particularly insider knowledge of the context of district nursing, helped me to uncover the richness of meaning in the conversations. The subtle interconnections and nuances could easily have been missed by an outside observer. The study has shown that in their interactions with patients, expert nurses follow a pattern in terms of the structure and content of the conversations and it is possible to identify specific features of effective nurse-patient communication within these conversations. The most significant of these are the repertoire of linguistic skills available to nurses, the importance of small talk and the attention paid by nurses to building a working relationship with patients, in part, through conversation. The findings have implications for nursing education and professional development.

Abstract: This modified action research inquiry focused on the everyday, palliative care practice experiences of a group of district nurses. The intent was to develop an understanding of common issues of concern for this group of district nurses when providing palliative home care in a specific community context and to implement practical, achievable strategies in response to these local issues. Five district nurses identified four broad areas for action through four praxis group meetings and comprising one full cycle. These four areas have been named as methods of enhancing support for people and families, possibilities for creatively managing workloads, mechanisms to enrich working partnership with other palliative care providers and possible vehicles for supporting nurses' self care. Implementation of action from this action research project focused on enhancing care and outcomes for people and family served by this group of district nurses in their local community. This study illuminates everyday essences of the district nurse role and the elements articulated by this group in supporting their practice in one New Zealand community. This study also reveals some of the tensions and messiness when employing an action research methodology with nurses in the workplace. The author notes that this research focused on a little known area (palliative care delivered by district nurses in New Zealand) in a local community (a culturally vibrant and ethnically diverse yet with poor health and socioeconomic statistics). She goes on to say that it has resonance with other nurses, particularly those working in community settings who may experience similar issues and concerns. This research also offers important insights for nurses working in any practice setting.

Abstract: October 2003 marked the centenary of Wellington district nursing. Annie Holgate, a 'trained, professional' nurse, was employed to care for the sick poor in 1903. The Wellington St John Ambulance District Nursing Guild funded district nursing for over fifty years. The first president, Sarah Ann Rhodes, left a legacy of a solid financial and administrative base for the whole of the Guild's existence. From 1945 the Wellington Hospital Board assumed responsibility for district nursing and expanded the service to the greater Wellington region. In 1974 the Community Health Services were formed, with Pauline MacInnes as the nurse leader. Expansion of healthcare in the community ensued, with district nurses pivotal to client-centred, community-based, collaborative healthcare. This service was dismantled in the wake of health sector restructuring in 1989. The philosophy and operation of the Community Health Service of this period bears a striking resemblance to the current concept of Primary Health Care. Primary sources from Wellington St John, Kai Tiaki and data from official publications were used to compile this history. Emergent themes are the autonomy of district nurses' practice, the invisibility of district nursing and the impact of visionary leadership. All have implications for the future of district nursing. District nursing, initially dependent on philanthropy, has been publicly funded in New Zealand since 1944. District nursing is now an essential component of health care.