Abstract: This thesis explores the theoretical notions of suffering and caring within the nurse patient relationship in the context of emergency nursing. It includes a small pilot study that aimed to assess the feasibliity of a major research project, by describing the impact of vicarious traumatisation in emergency nurses, specifically in relation to their self capacities. This pilot study utilised a descriptive, correlational design. Data was collected by using the Inner Experience Questionnaire (IEQ) a twenty four-item questionnaire developed by Dr Pearlman (1995), and a profile sheet which identified demographic details. Twenty-seven emergency nurses participated in this pilot study. The IEQ was assessed for internal reliability by applying the Cronbachs alpha and utilising a focus group to gain insight into the usability and relevance of the questions. The internal reliability of the IEQ suggests that it may be an appropriate tool to measure disruption of self capacities in the population of emergency nurses. Although the results are limited, and conclusions cannot be drawn, findings suggest a correlation between the variables of age, experience, nursing qualifications and a history of personal trauma and the IEQ. There is evidence that emergency nurses are affected psychologically when caring for the victims of trauma in emergency departments and the IEQ has the potential as a tool to be integrated into future emergency nursing studies. A multidimensional methodological approach is recommended to capture the many contours of the complex phenomena of vicarious traumatisation and the emergency nurse.

Abstract: This thesis explores the process of an annual appraisal strategy, 'clinical conversation', from the perspective of seven nurses who were assessed using this technique. The findings demonstrate that clinical conversation is a strategy which facilitates reflection, both as a solitary exercise and with others, to ensure that learning from experience is optimised. The research used a qualitative interpretive approach informed by the model of Grounded Theory espoused by Strauss and Corbin. All eight nurses who were assessed using the clinical conversation strategy were advanced practitioners working within the scope of sexual and reproductive health. Two of the actual appraisals were observed and seven of the nurses were interviewed within eight weeks of being assessed. The outcome of the clinical conversation was primarily one of learning; the acquisition of new insights into self as practitioner. The learning was facilitated through the process of narration; telling the story of clinical practice. Three distinct narrative cycles were identified, each an experiential learning episode. The experience of undertaking a variety of assessment activities created a narrative with self and triggered an internal reflective thinking process; the experience of working with a peer created an additional narrative, a mutual dialogue reflecting back on practice; the experience of sharing practice with an assessor created a further and final narrative, a learning conversation. Each narrative can be seen as a catalyst for change. Primarily, the nurses felt differently about themselves in practice, the way they saw themselves had shifted. Such a change can be described as an alteration in perspective. These alterations in perspective led all nurses to identify ways in which they would change their actual clinical practice. In this way the nurses attempted to align their espoused beliefs about practice with their actual practice. The author notes that the study shows that each nurse responded differently to each narrative learning cycle: for some the conversation with the assessor was more of a catalyst for change than for others. In this way clinical conversation may be flexible enough to respond to a variety of differing learning styles. Learning was person specific which is an imperative for the continued professional development of already highly skilled clinicians. The implication of the research is that whilst clinical conversation was designed as a tool for appraising clinical competence, its intrinsic value lies in supporting the professional development of nurses.

Abstract: This thesis explores the issues surrounding the elderly remaining in their own environment and why remaining 'at home' becomes so essential for them. There are many elderly people who have moved to residential care settings on the advice of others. The author explores the implications of such moves through the stories of several elderly persons, and her own experiences as a nurse working with the elderly in institutional care.

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 describes the maternity system in Wellington between 1950 and 1970 particularly from the perspectives of consumers and midwives. Four women consumers who experienced maternity in Wellington and two midwives who worked in Wellington's maternity hospitals during this period provided their oral testimonies as the main primary sources for this study. The author's experience of being a student nurse and a consumer in Wellington and other primary and secondary sources are used to substantiate, explore and explain the topic. The study traces the socio-political changes in New Zealand maternity from 1900 to 1970 creating a backdrop against which Wellington's maternity system, including the women, the hospitals, the workforce, maternity practices and the childbearing process are illuminated using the insights of women and midwives who experienced them. The oral testimonies of the six participants described positive and negative aspects of their maternity experiences, but the three strong themes that arose from their accounts included 'being alone', 'lack of autonomy' and 'uncaring attitudes'.

Abstract: This thesis contains a collection of stories gifted by four New Zealand Retrieval Team nurses who are experienced in the transport of patients. These nurses are commonly called flight nurses and they assist in the transport of patients via helicopter, fixed-wing aeroplane, large commercial aeroplanes and ambulances. While their practice is not exclusively in the helicopter there is an emphasis on this mode of transport in this thesis. Flight nursing is a scope of nursing practice where the use, and visibility, of nurses' stories is rare. The specific context of this research is positioned in one tertiary intensive care unit in New Zealand but it is anticipated that the stories from four flight nurses and the author's subsequent thoughts on them will resonate with flight nurses in other regions. The stories were collected using a storytelling methodology that has been informed by qualitative and feminist perspectives. The stories were either gathered and shaped using interview and transcription techniques with the storyteller and the researcher, or written by the storyteller. The thesis has been written as a narrative and chronicles the journey to the point of receiving the stories and the lines of inquiry in which they subsequently directed the author. The stories are central to this research and appear in their entirety. The reader is encouraged to create their own meaning from the stories. The stories themselves have several common threads, which are planning, communication, teamwork and the unexpected. The threads underpinning the stories are not unique to flight nursing practice and have been discussed in other scopes of practice. One area the author has chosen to explore in more depth is the impacts of technology, privacy, narrative pedagogy and disenfranchisement on the visibility of flight nurses' stories. The other area she has chosen for discussion is advanced and specialty nursing practice as it relates to flight nurses. As a result of this discussion she proposes her own view for advanced and specialty practice in flight nursing.

Abstract: This thesis concerns an investigation of the tripartite arrangements between the government, the nursing and the medical sectors in New Zealand over the period 1984 to 2001 with a particular focus on primary health care. The start point is the commencement of the health reforms instituted by the Fourth New Zealand Labour Government of 1984. The thesis falls within a framework of critical inquiry, specifically, the methodology of depth hermeneutics (Thompson, 1990), a development of critical theory. The effects of political and economic policies and the methodologies of neo-liberal market reform are examined together with the concept of collaboration as an ideological symbolic form, typical of enterprise culture. The limitations of economic models such as public choice theory, agency theory and managerialism are examined from the point of view of government strategies and their effects on the relationships between the nursing and medical professions. The influence of American health care policies and their partial introduction into primary health care in New Zealand is traversed in some detail, together with the experiences of health reform in several other countries. Post election 1999, the thesis considers the effect of change of political direction consequent upon the election of a Labour Coalition government and concludes that the removal of the neo-liberal ethic by Labour may terminate entrepreneurial opportunities in the nursing profession. The thesis considers the effects of a change to Third Way political direction on national health care policy and on the medical and nursing professions. The data is derived from various texts and transcripts of interviews with 12 health professionals and health commentators. The histories and current relationships between the nursing and medical professions are examined in relation to their claims to be scientific discourses and it is argued that the issue of lack of recognition as a scientific discourse is at the root of nursing's perceived inferiority to medicine. This is further expanded in a discussion at the end of the thesis where the structure of the two professions is compared and critiqued. A conclusion is drawn that a potential for action exists to remedy the deficient structure of nursing. The thesis argues that this is the major issue which maintains nursing in the primary sector in a perceived position of inferiority to medicine. The thesis also concludes that the role of government in this triangular relationship is one of manipulation to bring about necessary fundamental change in the delivery of health services at the lowest possible cost without materially strengthening the autonomy of the nursing or the medical professions.

Abstract: This systematic review was conducted by the New Zealand Centre for Evidence Based Nursing, a collaborating centre of The Joanna Briggs Institute for Evidence Based Nursing and Midwifery. The aim was to present the best available evidence on interventions, which are effective in preventing or reducing the prevalence of complications associated with suctioning, in hospitalised adult patients with an artificial airway who are breathing spontaneously or are artificially ventilated and who require suctioning. The specific questions addressed were as follows: Which methods of suctioning reduce the prevalence of mucosal trauma or mucosal dysfunction, and promote the removal of respiratory secretions? Which techniques or methods are effective in reducing the occurrence of suctioning -induced hypoxaemia, during or following the suctioning procedure? Which techniques or methods are effective in minimising the haemodynamic or pulmonary complications associated with the suctioning procedure?