Abstract: A study to examine the effects of pre- information ( what a Nurse learns about a patient before they meet) on clinical inference and Nursing actions, in a simulated Nurse- Patient situation. It was hypothesized that the nature of the pre-information will influence the way the patient is perceived and the resulting Nursing actions. The research was conducted in an obstetrical setting. There were 55 subjects within three groups. Two groups comprised student midwives and the third group was of second year comprehensive Nursing students near completion of clinical experience in maternal and child health nursing. A 5 minute videotape sequence of a role played post natal patient was made for use in the research. All subjects were given the same initial pre-information, viewed the videotape and gave written description of what they saw on the videotape and their response ( as the Nurse in the situation). This data provided a base line for each subject. Subject were then given additional pre-information concerning the patient's physical condition, her baby's condition or formed part of the control group ( receiving no additional information) The procedure was repeated. These responses were then compared with the base line for each subject. Responses were coded by means of content analysis. Group data was analysed using multivariate one way analysis of variance graphical display. The results indicated support of the hypothesis that the nature of the pre-information does influence the way in which a Nurse perceives a patient and resulting Nursing actions. Implications of these findings for Nurses are discussed

Abstract: Alleviating patient suffering, providing comfort and pain relief are all central to the philosophical caring position nurses have always espoused. Despite this, patients continue to suffer pain although we have the means to provide pain relief. The author notes that research has identified that nurses have a knowledge deficit regarding pain and its management, as well an erroneous attitudes, which combined are blamed for an inability to make significant progress in this area. This study was undertaken to uncover the contextual aspects of working within a New Zealand health care institution that affect nurses' ability to manage their patient' pain effectively. It highlights the difficulties and the complicated nature of working within an institution in the 1990's health care environment, where accountability for pain is absent and where pain is often under-assessed and under-treated. By using focus group of nurses, the author notes she was able to uncover constructions on nursing practice, which, she suggests, have been missing from the literature, but prevent nurses from implementing their knowledge. Using a constructivist research, she used nurse's stories and current literature to argue one way forward in, what she terms, the pain management debacle. This study revealed a diverse range of contextual factors that prevent nurses from using their knowledge. Many of the constraints on nursing practice are the results of complex organisational structures within health reform, which have significantly affected the nurse's ability to provide quality-nursing care. One of the most important factors limiting the management of the patient' pain is the inability of the nurse to autonomously initiate analgesia. While nurses are largely responsible for the assessment of pain, they are usually powerless to access necessary analgesia, without a medical prescription. The author argues that once an initial medical diagnosis has been made, nurses are usually left responsible for patient comfort and the management of pain. To do so effectively, nurses need to able to prescribe both pharmacological and non-pharmacological measures for the patient. Presently nurses are prescribing using a variety of illegitimate mechanisms, needing the endorsement of a doctor. To fulfil this role, nurses must be adequately prepared educationally and given the authority to either prescribe autonomously, of provided with extensive “standing orders”. While legislative changes in New Zealand in 1999 extended prescribing right to a few nurses within certain areas of care, the ward nurse is unlikely to gain prescribing rights in the near future. The author concludes that a way forward may be to encourage and further develop the use of protocols for managing pain via standing orders. Standing orders are common place within nursing practice today, have the support of the Nursing Council of New Zealand and are currently under-going legislative review. An institutional commitment to developing pain protocols for nurses would recognise the nurses active role and expertise in the management of pain and facilitate expedient relief for the patient.

Abstract: An exploratory study of the functioning of four multi disciplinary health care teams ( HCT) in the New Zealand services and possible implications foe Health personnel education. This research seeks to 1. establish form structure and functioning of the HCT in the relation to the delivery of comprehensive primary health care. 2. Determine what collaborative skills are being used, the extent of interdependence and these factors which inhibit the use of these skills in providing primary health care. 3. Identify the key requirements for, and these factors which limit the successful functioning of the HCT in the provision of comprehensive primary health care. Data has been collected through structured interviews and observations. The analysis will compare and contrast the functioning of the social groups in the different settings in terms of their responses to both HCT index and appropriate contextual variables such that differences and similarities are delineated

Abstract: Cultural safety is taught in all undergraduate nursing programmes in Aotearoa/New Zealand. There is a predominance of Pakeha nurse educators in teaching this content. There is little explanation of what being Pakeha entails. This perpetuates a silence and continues the dominant hegemonic position of Pakeha in Aotearoa/New Zealand. This study suggests that as Pakeha cultural safety nurse educators we examine our dominance and critique the delivery of cultural safety education. This autobiographical study undertakes to explore the Pakeha identity of a cultural safety nurse educator. The author discusses identity in the context of a globalised world, and challenges the idea of a definitive Pakeha identity. There are multiple descriptions of Pakeha, all underdeveloped and inadequate for the purposes of cultural safety education. In this study, the author uses the heuristic process of Moustakas (1990) and Maalouf's (2000) ideas of vertical and horizontal heritage to locate and present the essence of the self. In keeping with the purpose of cultural safety education, the author considers her ethnic cultural self as described by Bloch (1983) and explores Helms' (1990) theory of White racial identity development. This thesis describes the position of one Pakeha in the context of teaching cultural safety in an undergraduate nursing degree programme in Aotearoa/New Zealand. For Pakeha cultural safety nurse educators the author argues that exploration of one's heritages and location of a personal Pakeha identity is pivotal to progressing the enactment of cultural safety in Aotearoa /New Zealand.

Abstract: Discourse about women assuming greater control over their childbirth experience has received much attention in contemporary childbirth and womens' studies publications. Research in the domain of childbirth has shown that a sense of control over one's birth experience is related to childbirth satisfaction. More specifically, studies have used Locus of Control measures and have found a significant relationship exists between expectations for control and choice of birth place. Choice of birth place features in some articles as a factor that determines the degree to which control can be exercised. Home, as a place of birth, is considered a setting in which a woman can have optimum control over her experience. Many women are discouraged from taking up this option, based on fears about safety. Reflection on why women continue to pursue a home birth against the wishes of their care giver rekindled and interest in Locus of Control. This study was undertaken to explore the relationship between urban women's choice of birth place setting and their scores on two different measures of Locus of Control (LOC). The aims of the study were: to test whether LOC scores predict choice of birth place for women who chose hospital, home or a birthing centre as their place of birth; to test which of the two LOC scales (Levenson's generalised measure or Wallston et al's more specific scale) is the most useful in predicting the influence of LOC and choice of birth place and to explore the relationship between choice of birth place LOC, demographic and contextual factors surrounding pregnancy. The method used in the study was a descriptive correlational design. One hundred and ninety four pregnant urban women who accessed a range of maternity care providers in the greater Auckland , Wellington , Christchurch and Dunedin cities responded to a “Birth Choice Survey” between April and June 1996. Tests of significance found significant differences for powerful others and chance Locus of Control among the three groups of women who chose hospital, home or a birthing center as a place of birth. Differences were significant at p = 0.05. No significant differences were ffound in the scores for internal Locus of Control for women in the three groups. Limitations in the sample sixe prevented linear discrimination being successful in predicting the influence and choice of LOC variables and choice of birth place for both scales. A classification tree was employed to identify key variables which might affect choice of birth place and indicated that women who were extremely happy with their birth place choice were more likely to be those who chose home birth. Locus of Control measures are interesting, and if used specifically, may be helpful in relation to understanding a women's choice of birth place. However general assessment of the contextual factors appears just as relevant. Implications of this study are the while women may differ in how they perceive their outcomes are determined, an overwhelming majority of women who participated in this study value their ability to make choices about their birth location. Identifying consumer perceptions about control and the contextual factors that influence women's choice of their birth place has the potential to clarify women's preferences for responsibility in their birth experience. Limitations of the study were addressed and included suggestions to improve response rates and thus generalizability of findings. Implications for further research were also considered

Abstract: Evidence within the literature highlights that staff within the general hospital wards are not necessarily equipped to assess and meet the needs of patients with mental health or behavioural problems. The author notes that this is cause for concern as a number of people requiring admission to the general wards often have a complex, interrelated combination of physical and mental health problems. Within New Zealand there have also been a number of changes to health care policies that have increased general nurses contact with mental health patients over the last decade. The Mental Health Consultation Liaison Nurse is an advanced nurse specialist who can meet this need. Having reviewed the literature and communicated with Mental Health Consultation Liaison Nurses in New Zealand and Australia, the author says it is clear that the availability of a mental health nurse within the district health board general wards would be advantageous to all. The role has been shown to positively influence the care of patients and benefit other health care professionals. It provides an improved system of care that is co-ordinated, integrated and responsive to the needs of patients and health care staff. The implementation of the Mental Health Consultation Liaison Nurse role has the potential to cut costs in relation to decreasing length of stay with untreated mental health issues, and reduce the cost of continued use of 'specialling' unnecessarily. Also of importance is the fact that such a position would assist the district health board to comply with the standards of health care provision as directed by the Mental Health Commission and the Ministry of Health. The author suggests that the introduction of the Mental Health Consultation Liaison Nurse role represents a change in traditional ways of providing general nursing and consequently there are a number of issues that may hinder its success. This dissertation aims to increase the visibility of mental health nursing and provide a resource for others debating the development and implementation of the Mental Health Consultation Liaison Nurse role.

Abstract: Family violence is common and there are significant long-term negative health effects from victimisation. Health professionals are now recognised as key providers of family violence intervention. The Hawke's Bay District Health Board HBDHB) launched a Family Violence Intervention Programme in the emergency department in 2002, in accordance with national directives. The Family Violence Intervention Programme includes routine questioning for partner abuse within social history assessments for all women 16 years and over who seek healthcare services. Nurses assumed responsibility for implementing this programme into emergency department practice. Establishing partner abuse screening in practice requires an organisational and attitudinal change. Achieving and sustaining this change can be difficult. Evaluation was considered an essential aspect of the systems approach adopted within the HBDHB Family Violence Intervention Programme to support change. The aim of this study was to identify the enablers and barriers to routine questioning in the emergency department one year after the programme was launched and the strategies to address these barriers. The staff who have responsibility for routinely questioning women were considered well placed to provide this information. The methodology selected was evaluation research using semi-structured interviews. The design included member checking and triangulation of the findings. Eleven emergency department staff members participated in five (two group and three single) interviews. The interviews revealed that routine questioning for partner abuse is difficult in the emergency department setting. Barriers to questioning exist and enablers can eliminate or minimise these. Enablers such as policy and training support routine questioning. Barriers identified included the lack of privacy and time. Participants suggested strategies to overcome these. These barriers, enablers and solutions were either personal or organisational in origin and all had a common theme of safety. An outcome of the study was the development of a model of barriers and enablers to ensure safety when routinely questioning women for partner abuse. This evaluation has utility within the HBDHB as it informs programme progression. However, the evaluation has wider implications. The experiences of the emergency department staff led to the emergence of key themes that may inform the development of comparable programmes. Introducing routine questioning requires a practice change; a multifaceted approach focusing on safety can assist staff to achieve that change.