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: This study provides insight into the experience of being an ICU nurse and relative of a critically ill patient. Analysis of data from interviews of four ICU nurses who had experienced having a family member admitted to ICU brought up several themes. These included: a nurses' nightmare, knowing and not knowing, feeling torn, and gaining deeper insight and new meaning. Recommendations for organisational support for ICU nurse/relatives, and education for staff are made, based on the findings.

Abstract: The New Zealand nursing workforce is increasingly made up of overseas trained nurses. There is extensive literature from elsewhere in the world on the impacts of international nurse recruitment and migration on individual nurses and on health services. The literature also portrays evidence of abuse and exploitation, yet few studies are available relating to the experiences of migrant nurses in New Zealand. This research conducted a survey of overseas-trained nurses, specifically focusing on those nurses for whom English is not their first language, to understand the experiences and factors affecting migrant registered nurses in New Zealand. Given the importance to the New Zealand workforce of overseas-trained nurses, this research highlighted that more warnings and advice regarding recruitment agencies and information about nursing in New Zealand and the Nursing Council requirements for registration should be made available to nurses prior to their migration. Nursing leaders should be particularly alert to any evidence of bullying or discrimination based on race or overseas origin.

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.

Abstract: A research portfolio submitted in partial fulfilment of the requirements for the degree of Master of Nursing, the University of Auckland, 2010.
Sustained weight loss maintenance is a constant challenge, especially for morbidly obese individuals who have tried and failed repeatedly. Why is it then, that some individuals are successful whilst others are not so successful? This two-phase sequential, mixed methods study sought to identify and gain insight into the factors associated with successful weight loss maintenance for participants in an adult weight management programme in the Waikato. Success appeared to be independent of age, gender, ethnicity, domicile, employment status and the presence of co-morbities.
Four major themes emerged:
- “Actions speak louder than words – just do it” (Following a lower energy diet, having higher levels of physical activity, regular self weighing, and vigilance in adjusting their behaviours based on the results)
- Routines were also important in supporting the changed behaviours
- What's it worth to me
- Valuing the achievements associated with lesser weight was seen as another important factor of success

Abstract: A research portfolio submitted in partial fulfilment of the requirements for the degree of Master of Nursing, The University of Auckland, 2009
This paper is a report of a study seeking to understand the experience of New Zealand rural dwelling Mäori clients with end-stage renal disease who receive haemodialysis. End stage renal disease (ESRD) is related to lifestyle, genetic factors and environment, and Mäori are at higher risk of renal disease which results of need for renal replacement therapy to sustain their lives. Dialysis clients are a group of ?silent? clients under the care of the dominant health professionals. Adherence with therapeutic regimes has been a main issue for health care professionals and service delivery, as it directly contributes to the efficacy of the treatment and cost effectiveness. Mäori clients? experience of living with haemodialysis has not been explored. Although there are a number of studies describing the experience of patients living on dialysis so far, no studies have yet focused specifically on the experience of Mäori clients towards their renal replacement therapy. The continual demands of dialysis treatment are significant and given the high proportion of Mäori having dialysis. It is timely to explore the experience of Mäori clients and their family/whänau in order to understand the need for quality of care and to promote Mäori health outcomes in chronic kidney disease management

Abstract: A dissertation in partial fulfilment of Master Health Sciences (Clinical)through University of Otago
The nurse practitioner is one of the newest nursing health care professionals to be introduced to the New Zealand health system for many years. Eighty-six nurse practitioners are credentialed in New Zealand, with three working in urban Emergency Department settings. Nurse Practitioners are common internationally especially in the United States, Canada, United Kingdom and Australia. The purpose of this integrated literature review is to explore current research and literature in regards to the Emergency Department Nurse Practitioner, and their role within emergency settings. This review presents the growth and development of the nurse practitioner as an advanced practice nursing position. Four key themes emerge from the literature review; education of the Emergency Nurse Practitioner , how and who defined the Emergency Nurse Practitioner role, practice setting of the Emergency Nurse Practitioner, and what the barriers are to independent practice. The economic, legal and governance aspects of the Nurse Practitioner role are also portrayed. This integrated review documents the potential for further development and expansion of the Emergency Nurse Practitioner scope of practice to provide a broad range of patient care services within Emergency Departments, and emergency care settings. Future research is essential for the promotion of autonomous practice of the Emergency Nurse Practitioner within the international and New Zealand health care system.