Abstract: This thesis examines the forces influencing the development of contemporary advanced nursing practice in New Zealand. It begins with an historical approach to explore the various meanings of advanced nursing practice from the late 1800s through the first years of the 21st century. Seven historical understandings of the meaning of 'advanced' nursing practice emerge. The author's analysis of the broad scope of New Zealand nursing history, including a case study of the development and implementation of the nurse practitioner, draws on theoretical perspectives from sociology, political science, and nursing. She develops a “framework of critical factors for nursing to take into account when considering how to ensure the profession is able to deliver on its great potential to improve the health of New Zealand communities”. Examining the work of a range of nursing leaders, past and present, and drawing on the work of political scientist, John Kingdon, the author describes the work of several nurses as “policy entrepreneurship.”

Abstract: This thesis presents a study of the every-day moral decision making of experienced nurses. Eight experienced registered nurses participated in the completed research that is based on data gathered through interviews, document audit and literature review. A grounded theory approach was used to analyse the extensive data gathered for the study. This methodology generated a theoretical description involving the antecedents, processes and consequences of nursing moral decision making.Nursing practice has moral content, if not an entirely moral purpose, and moral decision making is the central component of this practice, yet the ethical aspects of nursing practice remain a comparatively recent field of study. It is therefore essential to nurses and their patients that this process is adequately studied and theorised. To date, very few studies have been undertaken in this area in New Zealand. This study aims to at least partially redress this situation by offering insights through conceptualisation and theoretical description of nursing moral decision making.The findings of the study reveal that antecedents such as personal moral development, upbringing and social experiences, contribute to a 'nursing ethic' in the moral decision making of experienced nurses. Furthermore, the study shows that the context and individual and shared perceptions of moral events influence the degree of nursing involvement in ethical situations. Finally, the study maintains that an intrinsic and persistent nursing ethic guides ethical decision making in nursing. This ethic is an undeniable phenomenon of considerable significance to nursing practice and education

Abstract: This thesis provides an interpretive critique of the way in which knowledge is viewed, transmitted and crystallized in the practice worlds experienced by four registered nurses working in acute care hospital settings. The theoretical assumptions of critical social theory underpin both the methodological approach (case study) and the analysis of data. In-depth unstructured interview, a critically reflexive dialogue between the investigator and participant focussed on the practice world experiences of the nurse, was the principle research method. A brief analysis of documentation was also undertaken.It is argued that previous studies related to nursing practice, and to the social worlds of nursing, have been limited by their failure to take account of the socio-political context in which nursing takes place. There has been a tendency to treat the transmission of knowledge in nursing and nursing practice process of information exchange. No account of socially generated constraints on personal and professional agency, or of systematic distortions in communication within the practice setting are therefore given.The analysis of data in this study demonstrates the way in which constraints on personal and professional agency were experienced by each of the four participants. In particular, practice expressing the participant's professional nursing knowledge and values ws often denied in the face of shared understandings reflective of the institutional ideology. These shared understandings included a belief in the legitimacy of medical domination over other social factors and the support of doctor, rather than nurse or patient, centered practices.This study demonstrates that the way that nurses and other social actors come to “know” and interpret their social worlds is dependent on the socio-political contest in which that knowledge in produced. It also shows how this knowledge may be treated ad though it were 'an object'. This tendency to treat existing social relationships and practices as 'natural' hence unchallengeable masks possibilities for transformative action within the practice of nursing.It is argued that a particular form of knowledge is required if nurses are to overcome the types of constraint experienced by these four nurses. This knowledge, emancipatory knowledge, is that developed in the process of shared, socially critical self-reflection rather than solitary, self-critical reflection