Abstract: An analytical tool of Force Field Analysis was used to identify and describe forces influencing the development of innovative roles, including the nurse practitioner role, in primary health care nursing. At the commencement of the study an initial analysis of research, literature and policy identified forces driving or restraining the development of innovative roles. A mixed research method of surveys and focus group interviews with key stakeholders, namely nurses in innovative roles, general practitioners and nurse leaders, was then used to identify factors influencing development within the Northland District Health Board. Descriptive statistics and interpretative methods were used to analyse the data. A final analysis enabled a picture of forces influencing innovative role development to be presented. Driving forces reflected international trends and were strongly influenced by economics and a political imperative to reconfigure health care services towards a primary health focus. The Treaty of Waitangi was also a key influence. Driving forces had greatest impact on the development of new roles. Forces were identified as drives towards cost-effective evidence-based health care (effective services), equity for Maori, response to local needs and workforce reorganisation. The major forces restraining the development of innovative roles were reinforced by attitudes, customs and support systems. These forces were identified as poor professional identity and support, an outdated nursing image, inadequate education and training and slow transition from traditional practices and structures (tradition). These forces had a negative influence on support for innovative roles. Promotion of kaupapa Maori, involvement of the local community, local Maori and nursing in decision-making and promotion of a team culture have the potential to support further development of innovative roles. Political ideology and the Treaty of Waitangi will continue to be major influences directed through policy and the contracting and funding process.

Abstract: Table of Contents: 1. Background and overview; 2. Research design and method; 3. Literature review; 4. Preparation of the individual for an appointment at the general practice; 5. Care provided by the practice nurse at the general practice; 6. The giving of information; 7. A discussion of the dualities of the contribution of practice nurses to the care of individuals with chronic conditions; 8. Study summary and conclusions.

Abstract: The intention of this research is, through collaborative discussion and selective conversations, to explore female caregivers' expectations and perceptions of primary health services for some Te Atiawa Maori children. The research process was developed in a partnership between the Maori women participants and the researcher. In addition, two local kuia actively participated in and supported the process. Emancipatory critical social theory underpinned and informed the project. Power relationships between the researcher and the participants can be overtly explored within this theoretical framework. In terms of this particular exploratory study, participatory research appeared to be applicable. The participants are female caregivers of Te Atiawa children. Data collection was done using group interactions and semi-structured interviews in the winter of the year 2000. A thematic analysis of the data was used, in which common themes were identified, compared and discussed. From the analysis of the data of the participants' conversations, key ideas were identified. The major findings have been identified within two main themes. These are: a concept of health is not the same for Pakeha as for Maori, and access issues are still problematic for the participants in this study. Many quotes from the interview participants are included in order to keep the focus of the project on the voices of the women interviewed. In terms of the significant contribution of this research, this study aims to allow voices of female caregivers of Te Atiawa Maori children to be heard. Individual and collaborative interactions offer insights into what is important to them in terms of Maori child health. Clearly, the primary health initiatives promoted by the New Zealand government are not reaching at least some of the people for whom they are intended. The research participants offered their ideas as to how these deficits could be remedied in their community.

Abstract: This paper has been developed from part of the writer's doctoral thesis on forces influencing the development of innovative roles in primary health care nursing. The focus of this paper is leadership strategies designed to reduce the issue of poor professional identity and support.

Abstract: There is a considerable body of literature discussing the stressors experienced by nurses and other health professionals when caring for those who are terminally ill and dying. Also, a number of articles offer suggestions, including the views of staff, as to what type of professional and organisational support is required when working in this often demanding specialty. There are, however, very few reports of assessment of the effectiveness of such supportive interventions and in particular, the impact of such support on the quality of patient care. This literature review examines any reported relationships between the quality of nursing provided by palliative care nurses and the staff support received by those nurses.

Abstract: A report on 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 (GPs), 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.

Abstract: This paper focuses on the work of primary health care nurses on chronic conditions, through both formal chronic care management (CCM) programmes and informal work. The author overviews the key components of CCM and describes Care Plus, a funding stream accessed via PHOs. The author gives examples of nurse led clinics and programmes in the general practice environment, and outlines the structures and processes necessary. A table summarises nurse involvement in several PHOs throughout the country. The author finds that the role of PHC nurses within a framework of inter-disciplinary chronic condition care is diverse and increasing.

Abstract: The author investigates why nurses in New Zealand stay working in rural areas when their Australian counterparts and medical colleagues are leaving rural areas at alarming rates. She looks at international recruitment and retention issues, and particularly compares rural nursing in Australia with New Zealand. Local research shows that over 50% of rural nursing is in the practice environment. Practice nurses report high job satisfaction, specifically around working with diverse populations, autonomy, and working with GPs, the local community, and local iwi. The only perceived barrier identified in the New Zealand literature to job satisfaction and collaborative team behaviour has been the funding of nursing services in rural areas. This contrasts with many barriers to rural nursing in Australia, and the author suggests New Zealand policy makers may learn from Australia's retention issues.