Abstract: This dissertation is a review of evidence underpinning the recommendations for pressure ulcer prevention from four national guidelines frequently used as a foundation for best practice. The focus is on grade-1 pressure ulcer prevention for “at risk” patients, in the acute environment. Rationale: Prevention is better than cure. While preventive strategies maybe effective are they supported by evidence? Results: The strongest evidence for best practice appears to be limited to an established fact that standard hospital mattresses should at least be replaced by high specification foam, pressure reducing mattresses for patients “at risk” or vulnerable to pressure ulcer development. Repositioning, skin assessment, skin protection and maintenance, traditionally the basis of pressure ulcer prevention, appear to have a paucity of strong supportive evidence. Further evidence is emerging on clinically important areas such as erythema and mattresses. Implications for Nursing: The organisational or ministerial support for education of the multidisciplinary team, especially nurses in risk assessment and prevention strategies. This support is required both in release time and finances for education and in adequate funding for preventive strategies. The author concludes that strong evidence to support the recommendations of the guidelines appears to remain limited, particularly in the acute environment. Expert opinion would appear to remain the basis for current best practice for pressure ulcer prevention. The volume and consistency of this evidence worldwide is substantial and adds validity to the recommendations. Best practice includes firstly risk assessment, skin assessment, maintenance of skin temperature, moisture, and condition, and the importance of repositioning, in conjunction with an appropriate support surface. However gaps remain in the supportive evidence in many of these fields. Advances in practice include pressure relief or reduction considerations for all surfaces the patients encounter. There appears to be no gold standard for prevention of pressure ulcer development.

Abstract: This study used an interpretive descriptive method to gain insight into and explore key issues for rural nurses working and living in the same community. Four Rural Nurse Specialists were recruited as participants. The nurses had lived and nursed in the same rural community for a minimum of 12 months. Participants were interviewed face to face and their transcribed interviews underwent thematic analysis. The meta-theme was: the distinctive nature of rural nursing. The themes identified were: interwoven professional and personal roles; complex role of rural nurses and relationships with the community. A conceptual model was developed to capture the relationship between the meta-theme and the themes. A definition for rural nursing was developed from the findings. This research identified some points of difference in this group of rural nurses from the available rural nursing literature. It also provides a better understanding of the supports Rural Nurse Specialists need to be successful in their roles, particularly around the recruitment and retention of the rural nursing workforce.

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.

Abstract: Huarahi whakatu describes a pathway for recognising the expertise of nurses working in kaupapa Maori mental health services and recommends a professional development programme that can lead to advancement along the pathway. An emphasis on dual competencies – cultural and clinical – underlies the rationale for regarding kaupapa Maori mental health nursing as a sub-specialty. Eight levels of cultural competencies and twelve levels of clinical competencies are used to differentiate career stages and it is recommended that movement from one level to another should be matched by increased remuneration. The report also contains a recommended professional development programme to support the operationalisation of the career pathway.

Abstract: Contents: Chapter 1 Kupu whakataki – introduction; Chapter 2 Raranga mohiotanga – literature review; Chapter 3 To te wahine mana tuku iho – theoretical framework; Chapter 4 Tahuri ki te rangahau – research methodology; Chapter 5 Whakaaturanga whakaoho – beginnings; Chapter 6 Kia pakari – positioning and contesting; Chapter 7 E ara ki runga wahine toa – standing and enduring; Chapter 8 Kua takoto te whariki.

Abstract: Through improved technology and treatment and ongoing de-institutionalisation, nurses will encounter growing numbers of people with disabilities in the New Zealand community and hospitals. Quality of nursing care is influenced by attitude and this study was to evaluate the effect of a curriculum change on the attitudes of two different streams of student nurses towards people with disabilities. During the year 2002 a focused disability unit was introduced to the revised undergraduate nursing curriculum of a major educational institution in New Zealand. The opportunity arose to consider student nurses' attitudes toward disabled people, comparing two streams of students undertaking two different curricula. A convenience sample of students completed Yuker, Block and Younng's (1970) Attitudes Toward Disabled Persons scale (ATDP) form B prior to and on completion of their relevant disability unit. No statistically significant difference in scores was demonstrated. A number of possible reasons for this are suggested.

Abstract: School staff are a conduit by which children and families can access the public health nursing service and the public health nurses can access children and their families. The author notes that, to benefit children, public health nurses need more than knowledge of health issues; they need to understand how to work well with staff from the education sector. A good professional relationship between public health nurses and school staff will therefore ultimately result in a benefit to children's health. This thesis reviews the literature using an interpretive lens to examine the position of public health nurses and schools. It argues that public health nurses need to access expertise from other sources besides nursing in order to develop and sustain the skills of relating professionally to staff from the education sector. It proposes collaboration as a model of public health nursing practice with school staff but recognises that further research on inter-sectorial collaboration is necessary.