Abstract: This study explores the phenomenon of a personal exploratory field visit to HIV programmes in Malawi and how that informs the author's future plans to work cross-culturally with HIV. He uses hermeneutic phenomenology with the guidance of Heidegger and Gadamer, and draw on Ackermann, Hill, Maluleke, Moltmann, and Thielicke for theological direction. This study analyses how personal formation takes place and how the meaning of that experience can inform future cross-cultural interaction. The data of this study is drawn from a range of people interviewing 'me'. This includes a pre and post interview in relation to the author's three week exploratory visit to Malawi, and recorded daily reflections during the visit. Upon return he was interviewed about the experience by ten people from the following areas: nursing, counselling, development, theology, business, medicine, clergy, an Expatriate Malawian, and a women working from a Maori paradigm. These interviews focused on the author's experience with questions framed from the interviewer's specialty area. The transcripts become further data for this study. The findings of this thesis suggest that people wishing to work cross-culturally need to understand their motivation for their work, and understand who they are before entering a foreign land. This transformative journey also needs to continue as part of the process of working with people because we can only be effective with change if we are listening and hearing the other's perspective. It is in being open to this difference between persons that we continue to find ourselves. While perhaps we have a tendency to want to make everybody like us, we can only grow into our full potential in relationship with truly different others. Tensions experienced demonstrate that there is a complex need to understand how the context controls how HIV is perceived. This requires uncovering some of the deeper issues of HIV and culture, and knowing how to conceptualise these in both positive and informative ways. This thesis asks four key questions for the global-co-worker to work through before embarking on cross-cultural mission: 1. How do you know you should go?; 2. How are you going to make a difference?; 3. Who are you going to be?; and 4. What will sustain your involvement? The author's own experience has drawn me into a deeper awareness of the need for a vital connectedness of faith, hope and love underpinning the everydayness of such an experience.

Abstract: The purpose of this research is to examine the cultural context which makes violence and abuse against women and children possible. In 2003, the public debate on prostitution law reform promised to open a space in which discourses on sexuality and violence, practices usually private or hidden, would publicly emerge. Everyday discourses relating to prostitution law reform reported in the New Zealand Herald newspaper in the year 2003 were analysed using Foucauldian and feminist post-structural methodological approaches. Foucauldian discourse analysis emphasises the ways in which power is enmeshed in discourse, enabling power relations and hegemonic practices to be made visible. The research aims were to develop a complex, comprehensive analysis of the media discourses, to examine the construction of harm in the media debate, to examine the ways in which the cultural hegemony of dominant groups was secured and contested and to consider the role of mental health nurses as agents of emancipatory political change. Mental health promotion is mainly a socio-political practice and the findings suggest that mental health nurses could reconsider their professional role, to participate politically as social activists, challenging the social order thereby reducing the human suffering which interpersonal violence and abuse carries in its wake.

Abstract: This study examines the experience of managing Type 2 diabetes from the perspective of part-European people from Fiji who have this disorder. A qualitative approach was used, and the methodology was grounded theory based on the theoretical perspective of symbolic interactionism. Data was collected from the in-depth interviews of nine participants who have been living with Type 2 diabetes. Text from the interview transcripts was analysed using the version of grounded theory advocated by Strauss and Corbin (1998). This process facilitated the discovery of 'Carrying On With Life And Living' as the main concern shared by part-Europeans managing Type 2 diabetes. It also identified the substantive theory of 'Walking The Line' as the core category and the basic social and psychological process by which part-Europeans resolve their main concern of 'Carrying On With Life And Living'. This was a three-stage process involving firstly 'Carrying on Regardless', secondly 'Attempting Balance in Time and Motion and Control', and thirdly 'Balancing, Unbalancing, and Recovering Balance'. The results of this study reveal that the social and historical contexts of part-European culture, such as heavy drinking, carrying on with life and living in the face of adversity, and taking traditional medicine impact significantly throughout their managing process. Findings of this study may contribute to development of some culturally aware strategies that could assist healthcare services to provide appropriate support, intervention, and education for part-Europeans with Type 2 diabetes. This study also addresses the lack of studies concerned with the management of Type 2 diabetes in Pacific peoples and serves to inform research initiatives and priorities set by the Health Research Council of New Zealand.

Abstract: This study explored the perspectives of Pacific nurses on what it is like for them to work in a Pacific community mental health (PCMH) service within a district health board. Five Pacific Island nurses who worked in the three Pacific community mental health services based in the Auckland region participated in the project. The study employed narrative inquiry to gather data through focused storytelling method. The results of the study have indicated that PCMH nursing is a unique nursing field as well as highlighting significant practice issues for nurses. Complex service infrastructure and language have been found to be the major contributing practice constraints. The findings suggest the need for district health board authorities, Pacific mental health service management, professional nursing education and development programs to consider addressing these practice issues to prevent further increase in the problem of PCMH nurses shortage and enhance recruitment and retention of these nurses.

Abstract: This thesis investigates the relationship between language, 'discourse' and professional knowledge and power in a specific context; that of surgical nurses' “talk” about their work managing pain in hospitalised patients. This thesis argues that the work of 'caring for' hospitalised surgical patients who report pain is influenced by discourses which are predicated on different readings/understandings of the body/patient, and from which different knowledge is constructed. Of interest to this thesis are the discourses of biomedicine and nursing, and their role in constructing a particular reality/ies which determine the ways in which surgical nurses talk about their work managing pain. Using the method of critical discourse analysis, the “texts” of transcribed audio-taped conversations with four registered nurses working in surgical specialties were analysed to uncover 'discourses of pain management'. The results of the analysis indicate that the biomedical construction of pain, and approaches to pain management, remain the dominant influence over surgical nurses' practice. There was evidence of nursing discourses with an emphasis on nurse-patient relationships also playing a role. These discourses were critically examined for what they reveal about relations of professional knowledge and power in this specific context of the nurses' practice. The implications for nursing and nursing research are considered significant because the study critically (re)presents a different perspective on, and reality for surgical nurses' pain management practices. In so doing, it elucidates an explanation for, and understanding of, why surgical nurses take care of patients reporting pain in particular ways.

Abstract: Nursing in New Zealand has been a recognised profession for one hundred years. Throughout this time the profession has made a significant contribution to the health of communities, nationally and internationally. Despite the obvious effort and achievement, the author suggests that the evidence of this contribution is not well known. She goes on to say that nurses, now as never before, are challenged to show how they 'add value' and to explain why nursing expertise is essential to safe service delivery. Finding a way to communicate this contribution has been identified as one of the most important issues facing the profession. This thesis explores the concept of contribution and presents a model, the 'Contribution Model', to show how nursing can articulate the action and achievements that show how nursing professionals have and will continue to contribute to health gain in New Zealand. Through the application of the 'Contribution Model' and framework presented in this thesis, nursing is shown to have made a contribution to health gain by using the broad range of knowledge, skills and experiences in a wide range of settings, to provide care wherever and whenever required. Case studies and scenarios from history, observation and prediction are used to show how the actions and achievements of nursing meet the expectations of individuals, the community and society: past, present and future.

Abstract: The Rating Scale for Aggressive Behaviours in the Elderly (RAGE) is a twenty-one item rating scale, designed specifically to measure aggressive behaviours in the elderly in the psychogeriatric inpatient setting. The purpose of the scale is to qualify the aggressive behaviour, note any changes in the behaviour, and record intervention and/or treatments. This study combines both qualitative and quantitative methods with exploratory and descriptive designs to explore nurses' experiences of using a consistent tool for monitoring, measuring and managing aggressive behaviours. Data gathered over a three month period of implementing RAGE aimed to provide a 'snapshot' of the prevalence, extent and type of aggressive behaviours within the inpatient setting, providing evidence to nurses in developing strategies for the management of aggression. Focus group interviews were used to enable nurses to discuss their experiences of utilising a clinically validated tool in their practice and how this made a difference to their practice. Findings from this research indicate that nurses within the setting found that RAGE is a consistent tool with which nurses can record, measure and monitor aggressive behaviours. Responses from nurses' experiences of utilising RAGE in their practice were varied, with some being unable to articulate how RAGE had made a difference to their practice. Despite this there was an overwhelming positive response for the continued use of RAGE within the setting as a clinically validated tool by which to measure, record and manage aggressive behaviours.

Abstract: The purpose of this thesis is to give voice to school nursing as a primary health care specialty, and to promote the development of school nursing in New Zealand. School nursing is an invisible practice specialty that is largely funded from within the education sector, to address the health needs of student clients. School nursing is a significant primary health care initiative that can positively influence student health outcomes. The author presents her own school nursing practice experience and philosophy, prior to reflecting upon the history of school nursing, and the health concerns present within the student population. The work then moves to review and critique school nursing literature from New Zealand, Australia, the United Kingdom, and the United States. This thesis highlights the need for collaborative policy and practice development initiatives including a legislative requirement for school nurses, school nursing competencies and standards, school nurse to student ratios, postgraduate training, professional liaison, practice funding, and research. A discourse on the reflective topical autobiographical method introduces autobiographical poetry from school nursing practice and reflective inquiry, as the central research endeavour of this thesis. Autobiographical poetry is offered as a window to this specialty practice, and accompanying reflections allow access to a further layer of practice knowledge.