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 thesis concerns the Professional Development Programme at Lakeland Health. In New Zealand, such programmes were introduced as a mechanism to openly recognise the clinical expertise of nurses. Clinical Career Pathways were introduced to nursing in North America in the 1970's at a time of nursing shortage. Prior to their inception, nurses wishing to develop their careers had to move to administration, management or education. The programmes recognised and rewarded expertise in practice. A qualitative, descriptive approach (using focus groups) was used with Registered Nurses to gather their perceptions of what helps nurses enroll in the Professional Development Programme. The ideas and insights of nine Registered Nurses were clustered around three main categories: The People (fear; being struck; motivation; feedback; peer support; ways of learning); the Programme (relevance; flexibility; Bachelor's Degrees; implementation; supporting information; fairness); the Place (time; regular and accessible; support from nurse leaders; management). These perceptions are discussed in more detail in the context of nursing at Lakeland Health and of Clinical Career Pathways in New Zealand. The findings are helpful for the evaluation and future development of the Professional Development at Lakeland Health. The research contributes to our understanding of what helps nurses enroll in a Clinical Career Pathway, and emphasises the importance of the People, the Programme and the Place.

Abstract: The purpose of this study is to examine aspects of the behaviour of Nurses towards persons with alcohol related problems. Similarities and differences in helpful and unhelpful behaviour as perceived by providers and users of care are identified using the behaviour to alcoholism management ( B.R.A.M.) scale. The research covers two phases. In phase One 27 Registered Nurses and 12 members of Alcoholics Anonymous completed critical incident questionnaires which furnished a list of helpful behaviours and a list of unhelpful behaviours. These have been analysed and a set of descriptive statements prepared which constitutes the B.R. A.M. scale. In Phase Two this has been administered to 67 Registered Nurses and 46 members of Alcoholics Anonymous and the results assessed. The findings show that Nurses and Problem Drinkers view the same behaviour as helpful. There is however a significant difference between the two groups on the types of behaviour they consider to be unhelpful. This finding has consequences for those who provide care for problem Drinkers and for Teachers and students in education programs for Nurses

Abstract: This thesis explores the shortage of general hospital nurses in post World War II New Zealand between 1945 and 1955. Historical inquiry is used to identify the causes of the shortage and the response to the shortage by the Health Department, hospital boards and nurse leaders. Christchurch Hospital, administered by the North Canterbury Hospital Board, is used to illustrate the situation at one large, public, general hospital. Primary sources provided the majority of material which informed this thesis. Two themes emerge regarding the causes of the shortage of nurses: those that were readily acknowledged by nurse leaders and other health professionals at the time, and those which were less widely discussed, but which contributed to the nature of nursing work appearing less attractive to potential recruits. In response to the shortage the Health Department, hospital boards and the New Zealand Registered Nurses Association mounted several recruitment campaigns throughout the decade. As the shortage showed no sign of abatement the focus turned from recruitment to retention of nurses. While salaries, conditions and training were improved, nurse leaders also gave attention to establishing what nurses' work was and what it was not. Nurse leaders and others promoted nursing as a profession that could provide young women with a satisfying lifelong career. Due to these efforts, by 1955, this episode in the cycle of demand and supply of nurses had begun to improve.

Abstract: Based on qualitative research conducted in New Zealand and the Western Isles with rural primary care nurses and Family Health Nurses respectively, this thesis explores the ways that nurses construct flexible generalist professional identities that challenge traditional inter and intra-professional boundaries. Rhetoric of 'crisis' is often utilised to raise political awareness of the problematic, but in fact, rural general practitioner recruitment and retention has been documented for about a hundred years. For about the same length of time nurses have been providing primary health care services in rural and remote places, often working alone. In the New Zealand case, rural primary care nurses negotiate the boundaries between nursing and medicine, those within nursing itself, and also those between nursing a paramedic work. Nurses perform this boundary work by negotiating self-governing 'appropriate' and 'safe' professional identities. In the Western Isles case, the introduction of the newly developed role of Family Health Nurse serves to highlight the problematic nature of inserting an ostensibly generalist nursing role beyond the rural.

Abstract: This thesis represents an appreciative enquiry to identify features of effective verbal communication between nurses and patients. Using a method developed by the Language in the Workplace Project (Stubbe 1998) two nurse participants recorded a small sample of their conversations with patients as they occurred naturally in clinical practice. These six conversations constitute the main body of raw data for the study. The data was analysed using a combination of discourse and ethnographic analysis. Experience in nursing, particularly insider knowledge of the context of district nursing, helped me to uncover the richness of meaning in the conversations. The subtle interconnections and nuances could easily have been missed by an outside observer. The study has shown that in their interactions with patients, expert nurses follow a pattern in terms of the structure and content of the conversations and it is possible to identify specific features of effective nurse-patient communication within these conversations. The most significant of these are the repertoire of linguistic skills available to nurses, the importance of small talk and the attention paid by nurses to building a working relationship with patients, in part, through conversation. The findings have implications for nursing education and professional development.

Abstract: The chapter explores the process of nursing practice and how it contributes to health, derived from research undertaken in New Zealand. It presents the nature of nursing research as if practice – the researcher as if practitioner – establishing a foundation for the development of nursing knowledge that would make a distinct contribution to health and health care. It includes the philosophy and practicalities of nursing through the use of a case study of nursing a family with complex health circumstances.