Abstract: The author points to the oppression of colonisation living on in the daily lives of colonised people, and goes on to say that it is vital for nurses to understand the effects of that oppression, as well as the restrictive impacts, and dislocation from one's land and culture to-day. Nurses come from both the descendants of colonisers and the colonised. This thesis is a journey and a quest for insights into the impacts and significances of colonisation by looking at historical and socio-political contexts that have bearing on the health of colonised people who remain mostly powerless and marginalised. It is prompted in response to a cultural safety model which advocates that nurses should become familiar with their own background and history in order to be culturally safe in practice. This reflective autobiographical account is a personal effort and provides the foundation for an exploration of issues during nursing practice encounters, from a colonised ethnic minority perspective. The method was informed by Moustakas research approach and Johnstone's Reflective Topical Autobiographical process. The selection of specific events are deliberate, to make visible some of the many barriers that exist within our health structures as pertinent issues for non-dominant cultures that remain on the margin of our society. Maori issues provide a contrast and became a catalyst for the author while working for kaupapa Maori services. The intention of this thesis is to generate new knowledge about what it means to be a nurse from an ethnic minority working in a kaupapa Maori mental health service, and to encourage other nurses to explore these issues further. Some recommendations are made for nurses in the last chapter.

Abstract: The author's art project “Posthuman Pathology” is a postmodern examination of the resolutely modernist culture of critical care medicine. She uses conceptual art practices in conjunction with the techniques of anti-aesthetics in order to dismantle, open out and critique ideas which are foundational to the culture of critical care.

Abstract: The function and implementation of clinical supervision in the practice setting presents a number of challenges for new graduate programmes for registered comprehensive nurses. There have been numerous reports and papers promoting its benefits as important and providing the impetus for change. Clinical supervision has been well established as part of social work, counselling, psychotherapy and psychoanalytic practice, and in mental health nursing and midwifery. Its utilisation for graduate nurses is clearly important and should be seen as integral to professional practice. This study evaluated a programme of clinical supervision as a component of a new graduate nurse programme in a secondary health care practice environment. The clinical supervision component aimed to support graduate registered nurses' transition from the role of student nurse to staff nurse in the context of professional clinical practice. This report is also intended to inform the ongoing provision of clinical supervision at Hutt Valley District Health Board. The evaluation process was guided by the work of Owen (1990) and used utilisation focussed evaluation as the framework on which to undertake the evaluation. A mix of quantitative and qualitative methodology was used to collect and analyse the data. Data were collected from nurse graduates of the new graduate programme using a postal questionnaire that covered three areas; clinical supervision, the Hutt Valley District Health Board new graduate programme and an evaluation of stakeholder roles. Twelve of the new graduates responded to the survey. Findings suggest clinical supervision provided professional support and assisted the new graduate in the identification of education needs. Difficulties associated with accessing the structured component of the new graduate programme and clinical supervision were highlighted. The recommendations made to Hutt Valley District Health Board to improve the programme include considering accessibility, consumer rights, acceptability, a comprehensive approach, the Treaty of Waitangi, efficiency and a coordinated approach.

Abstract: The low numbers of nurses attracted to work in mental health is a concern particularly with the increased demand for mental health services. Strategies are required to increase recruitment to this less popular area of nursing to ensure that a high quality of care is provided for people suffering from mental illness. The World Health Organisation is aware that this area of health has been neglected and that it is time to promote mental health. This study aimed to examine the influences involved in nurses choosing to work in this area. A descriptive survey using a questionnaire was given to seven groups of new graduates enrolled in the New Graduate Mental Health Nursing programme through five educational institutes. At the time of writing there were no published studies around this topic in New Zealand. This study will attempt to inform nurses, the Nursing Council of New Zealand, tertiary institutions and the government of New Zealand that there is evidence of a need to develop and change practices to address the predicted workforce decline.

Abstract: The objective of this paper is to establish if there is any documented research and literature evidence that describe what the presenting clinical symptoms of Mai Aitu is, and also to explore an alternative frame-work to assess Pacific Islanders who present to mental health in crisis. As a community mental health nurse in the Crisis Assessment and Treatment Team (CATT), the author reports being confronted almost every day with an increasing number of Pacific Islanders presenting in crisis with symptoms consistent with the well documented signs of psychosis. For instance, symptoms like hallucinations, delusion and paranoid ideation which are also well known for describing schizophrenia. Her concern is that mental health nurses may be compromising their practice, the safety of the Pacific Island population and possibly the credibility of the profession with what appears like a lack of knowledge and awareness regarding the clinical symptoms of some Pacific Island mental illness. In Tonga it is called Avea Avanga, in Fiji it is referred to as Lialia, in Samoa it is known as Mai Aitu. The author notes that the issue becomes apparent when Samoan clients present in crisis with what appears to be psychosis but the fanau believe their love one is not mentally unwell, that he or she is simply suffering a traditional Samoan illness. Therefore they insist he or she be treated at home, instead of through admission to the psychiatric hospital, and also that they be seen by a Samoan healer instead of a psychiatrist.

Abstract: The purpose of this literature review is to generate a picture of what is known and what needs to be investigated further about anaesthetic nursing in the perioperative nursing role in New Zealand, and to examine this in relation to international trends. Nurse anaesthetists in the United States are described in American nursing literature, and recognised as one of the four advanced nurse practitioner roles. In New Zealand, recent efforts to provide appropriate post-graduate education for the perioperative nurse have been challenged by other inter-professional interests, thus restricting the development of an expanded role. The author notes that this has caused concern for New Zealand's perioperative nurses who consider anaesthetic nursing is an integral part of perioperative practice. Anaesthetic nursing forms a substantial component of the basic competencies required of a registered nurse working in the operating theatres. Orientation programmes and ongoing education at all levels of professional development incorporate anaesthetic nursing competencies to provide continuity of patient care and support perioperative practice. Care of the patient undergoing anaesthesia is an area where nurses demonstrate their advanced assessment skills and clinical judgement and is included in perioperative specialist or nurse practitioner job descriptions. The Perioperative Nurses Association in New Zealand is concerned to develop postgraduate education in their area of speciality to support their application for 'College' status within the New Zealand Nurses Organisation. For this to happen in a cogent fashion, information and knowledge generated from research, are required to clarify perioperative nursing's current position and determine how practice can be shaped to best care for patients undergoing surgical interventions. Evidence from research supports nurses in the anaesthetic role by demonstrating that the preoperative visits and assessments they undertake can reduce patients' anxieties, decrease the need for pain relief and shorten hospital stays. This review includes literature sources that explore disparities between the development of New Zealand anaesthetic nursing and international models. The author suggests that information and understanding gained from conducting this review will allow future developments in anaesthetic nursing practice to be informed by previous initiatives and projects and identifies areas for further research.

Abstract: The research on which this thesis is based involves both a private narrative and a public narrative, with the story of cultural safety, and the history, theory and the future direction gathered into one qualitative work. The work is divided into three sections. The first is entitled, Ko Wai Matou? The Private Narrative. This section seeks to explore the historical, social, educational, physical, emotional, political and moral influences and ephiphanies which brought about the personality which introduced cultural safety ideas into nursing and midwifery. Early nursing practice is investigated and examples from practice are used to illustrate learning and consolidation of the ideas which led to Cultural Safety Theory. The second section is entitled He Huarahi Hou: A New Pathway. This section explains the progress of the theory and its relationship to education pedagogy and to nursing practice. Comparison between the work of Madeline Leininger and the Transcultural Theory of Nursing and the New Zealand concept of cultural safety is undertaken. The role and application of the Treaty of Waitangi to the theory of cultural safety is explored in this section. The third section, entitled He Whakawhanuitanga: The Public Narrative, looks at the introduction of cultural safety into the nursing education system and its implementation. The public and media reaction to the inclusion of cultural safety in the national examination for nursing registration and the subsequent parliamentary response are noted. The interviews with nursing and midwifery leadership, Maori and pakeha key players in the process and consumer views of the ideas are documented and pertinent excerpts have been included. The work concludes with a discussion on the likely future of cultural safety as a theory and in practice and outlines several issues which represent a challenge to the viability of the concept in nursing and midwifery education. The author notes that the story of cultural safety is a personal story, but also a very public one. It is set in neo-colonial New Zealand, but has implications for indigenous people throughout the world. It is about human samenesses and human differences, but is also a story about all interactions between nurses and patients because all are power laden. Finally, she points out that, although it is about nursing, it is also relevant to all encounters, all exchanges between health care workers and patients.

Abstract: The stories of the women who live and work in rural settings in New Zealand have begun to reveal unique contributions that they have made to their families and community. This research study evolved from a trend the researcher observed as a district nurse providing community palliative care in rural New Zealand; that the majority of carers of those who are terminally in home-settings are in fact women. This qualitative study aimed to explore through guided conversational interviews the experiences of four women who have cared for their terminally ill partners who have subsequently died. The study investigated if these women's experiences were comparable to that of other women in existing palliative care literature. This research project focused particularly on elucidating the women's experience of intertwining the role of partner and caregiver. Heidegger's hermeneutic philosophy informed the methodology because he focused on what it meant to 'be' rather than 'how we know what we know'. The project focused on the meanings the women made of this dual role in their lives. Women already in the role of partner were now faced with the added responsibility of caregiver to meet the complex needs of their loved one. Usually they had no training to prepare them for this experience. The study reveals ways in which the visiting palliative care nurse becomes very important to them. The women's own voices reveal the high level of respect for their partners and address the harsh realities, revealing poignant and striking concerns in their lives. These stories are shared with the intent of enriching nurses' and other health professionals' understanding of the women's experiences. The author notes that understanding these women's experience is not only a way of honouring these remarkable women but more widely it will inform and possibly transform practice through guideline and policy refinement.