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 study aimed to articulate how sexual identity impacts on the therapeutic relationship between the client and the lesbian nurse in psychiatric mental health nursing. There is little consideration given in the literature or in research as to how sexuality of the nurse impacts on nursing practice. Most attitudes held by the public and nursing staff are based on the assumption that everyone is heterosexual, including nurses. Fifteen lesbian psychiatric mental health nurses from throughout New Zealand volunteered for two interviews and shared their experiences of becoming and being a lesbian psychiatric mental health nurse. The stories they told give new insights into how these nurses negotiate and position their lesbian identity in the therapeutic relationship. To work therapeutically with people in mental distress the nurse uses personal information about themselves to gain rapport with the client through appropriate self-disclosure. Being real, honest and authentic are also key concepts in this relationship so the negotiation of reveal/conceal of the nurse's identity is central to ongoing therapeutic engagement. One of the most significant things arising from the research is that participants are able to maintain their honesty and authenticity in the therapeutic relationship whether they self-disclose their lesbian identity or not. This is because the experiences in their personal lives have influenced how the participants 'know themselves' and therefore guide how they 'use self' in their therapeutic nursing. The concept of a 'licensed narrative' has also been developed during this research reflecting the negotiated understandings between the researcher and the participants. Further, the use of NVivo a qualitative software package helps to track and make transparent the research processes. These two aspects make a unique contribution to the field of narrative inquiry.

Abstract: This descriptive case study was undertaken to provide an account of chemotherapy practice in a nurse-led clinic located within a rural New Zealand area. The researcher, an oncology nurse specialist, worked alongside colleagues for thirteen months to enable practice development. This clinic developed out of a need to have services closer to rural patients in order to address issues of equity, access, care integration and the fiscal and social constraints associated with the cancer burden of care. Capturing the range of data applicable to this case; the ability to conceptualise it as a service within its context was possible using case study research methods. Four nurses involved in the chemotherapy clinic were participants in this study. The findings of this study reveal that what could be perceived as barriers to outcomes and practice can in essence be turned into opportunities to develop new ways of caring for the patient and supporting nursing practice. These nurses view their practice as safe within the clinic despite resource constraints. They work in many ways to support each other and to cushion the patient from the impact of situational and contextual influences. Nursing practice was shown to evolve as a direct result of internal and external influences which were the impetus for nurses taking responsibility for their own competency. This study also explored what it meant to be an experienced nurse but novice in a speciality practice. It challenges previously held assumptions that, to deliver chemotherapy successfully, a nurse needs to be operating from a previously held body of oncology nursing knowledge. Many challenges are faced on a day to day basis in a rural practice environment to just maintain consistent care and promote good patient outcomes. The nurses are well aware of their role in contributing to patients' quality of life and the roles they take to meet the growing needs of the patient as a consumer. This study delves into the multifarious nature of this nurse-led clinic and discusses the processes and relationships that are forged to deliver care.

Abstract: This study describes rural, nurse-led health services provided by the Takapau Health Centre (Central Hawkes Bay) and its outreach, Norsewood & District Health Centre. The study looks at its model of service delivery through to 2002. It examines the establishment, development, funding and management of the service, along with the nursing practice and the healthcare people received. The book is a snapshot of nursing initiative and survival through a decade of change in health policy and service funding and delivery. The information was subsequently used to move the health centre service into the new paradigm of primary health care launched in the New Zealand Health Strategy.

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.

Abstract: This is the second of a series of research projects undertaken to present the contemporary picture of the nurse workforce and their work in rural settings to inform policy for development of rural healthcare. The document presents the findings of telephone interviews with nurses in different work rural work settings around the country discussing their practice. The analysis identified a framework of four models of nursing practice: two traditional models defined by the institutions employing nurses, and two emerging models defined by the new positions requiring nurses to respond directly to health need.

Abstract: This report presents the findings of the developmental evaluation programme for the three-year innovation project. It includes the model of the integrative nursing service scheme with mobile whanau/family nurses as the hub of healthcare provision for a new paradigm of service design and delivery spanning primary-secondary-tertiary sectors. The form of healthcare the local people received, the nature of the nursing practice and role, service delivery and employment parameters required to support the nurses in practice are presented. The service configuration model subsequently gave the structure to Lake Taupo Primary Health Organisation with the hub of family nurses with a mobile comprehensive practice.