Abstract: Reports the findings from research designed to investigate the role of the clinical nurse specialist (CNS) and how it is defined by New Zealand District Health Boards (DHBs). Identifies the current requirements and expectations of the CNS role and how it is defined in practice. Collects 15 CNS job descriptions from 8 DHBs, subjecting them to thematic analysis yielding 4 key areas of the CNS role.

Abstract: Recent changes to the way that health services are provided and issues related to the rural health workforce are creating an international crisis in the availability of rural maternity care. International trends show a workforce decline in rural general practitioner obstetric specialists and rural midwives, as well as a decline in rural births. The aim of this study is to highlight the maternity needs of rural New Zealand women. Further, it discusses how the changes to maternity services in New Zealand, over the last sixteen years, have impacted on the rural nurse and midwife role and therefore on service provision. This information is intended to identify issues that could be used as the basis for development of a uniquely rural model of maternity care.

Abstract: Nursing literature reflects that nurses have been exploring and experiencing the process of clinical supervision for well over a decade. Nurses in the United States, United Kingdom, Scandinavia, and Australasia have written much over the past fifteen years. However, the author notes that nurses grapple with what clinical supervision is within nursing development and disquiet continues to emerge in the literature. This literature review expands on themes that surround this disquiet. These centre on continued confusion and lack of clear definition; whether psychotherapy is implemented under the guise of clinical supervision, who uses it, and the dearth of empirical evaluation of its effectiveness. The lack of significant empirical evidence of its ability to assist practitioners to deliver improved patient/client care continues despite claims of improved professional and personal development, therapeutic relationship, and occupational stress management. These claims come from both supervisees and supervisors. The manner in which clinical supervision is portrayed in nursing in that it is frequently referred to as a support system, rather than one of learning a complex set of communication skills is also highlighted. The continued debate on what model(s) best suit nurses, or whether line management should provide clinical supervision as a means to ensure quality standards and control over nursing practice and optimal patient care is discussed. Whether nursing should stop borrowing from other fields and develop their own model(s) is also raised. Two emerging stances focus on a process that is practice-based as identified by senior staff and management, or one that continues along the lines of what psychotherapy has developed with practitioner-identified developmental needs. These issues raise many questions for further development in nursing, one being are nurses developed enough in their self-awareness to understand what they are to adopt into their practice? Authentic voices from those nurses experienced in the practice of providing and receiving clinical supervision, are shaping therapeutic practice for nurses in the future, and continue to sharpen the debate. Some reference to unpublished data and local practice in the Wellington area have been included as a stimulus for further incorporation of clinical supervision in local practice development.

Abstract: This article looks at the concept of autonomy particularly in relation to the population of older persons living in residential care settings. It examines the values underpinning the exercise of personal autonomy and notes how individual autonomy may be enhanced or restricted. The implications for gerontological nursing practice are outlined and suggestions offered as to how personal autonomy for older persons living in residential care may be preserved and promoted.

Abstract: This thesis arises from the author's experience of several years of working in the emergency department and being exposed to workplace violence from patients and their families. Emergency nurses in New Zealand experience workplace violence every day. Registered nurses and the institutions in which they work manage workplace violence to varying degrees and in an ad hoc manner. The author notes that New Zealand has no national guidelines, or consensus on the management of workplace violence in the health sector. This research explores emergency nurses' encounters during their work when they have experienced workplace violence. The purpose of this study is to demonstrate the experience and the consequences when nurses are confronted with episodes of violence while working in the emergency department. The essence of this research is gaining an understanding of how registered nurses have managed workplace violence and the impact of that violence on themselves, their colleagues, and the patients in the emergency department. Recommendations are made regarding nationally consistent guidelines, education on the management of workplace violence, improved security, and emergency department design. The discussion concludes with suggestions for further research on workplace violence in the health sector

Abstract: Explores the humanistic values of professional nurses practising in medical ward environments and how these values are lived in day-to-day nursing practice on three medical wards in NZ using observations, focus groups, interviews, a burn-out survey and theoretical application. Challenges the nursing profession to acknowledge and address the visibility of nursing values in contemporary practice, as well as acknowledge the dissonance that exists between the values of nursing and the values that drive healthcare delivery.

Abstract: This thesis looks at the prospect of developing and implementing case management as a model of care for complex patients in an acute medical setting. An extensive literature review was conducted to explore the concept of case management and to identify the role of the case manager, including the qualities and qualifications required for the position. Clinical pathways are a tool used in case management so these are also included in the literature review. As the author had been involved in the development of the first clinical pathway for Hutt Valley Health, this is used as an example to clarify how case management and clinical pathways can be used in conjunction. A discussion chapter examines the advantages and disadvantages of case management which shows that it can be an effective and efficient model of care through the development of clinical pathways. The ethical implications of case management are also considered. The thesis concludes with recommendations for the continued development of case management as a model of care to improve the quality of care for both patients and the organisation. During the course of the thesis, other areas that are worth further investigation have also been identified, such as the relevance of case management to different cultures. The thesis suggests that a proposal for case management for complex patients in the acute care setting is developed along with a job description for the role of the case manager.