Abstract: Cultural safety is taught in all undergraduate nursing programmes in Aotearoa/New Zealand. There is a predominance of Pakeha nurse educators in teaching this content. There is little explanation of what being Pakeha entails. This perpetuates a silence and continues the dominant hegemonic position of Pakeha in Aotearoa/New Zealand. This study suggests that as Pakeha cultural safety nurse educators we examine our dominance and critique the delivery of cultural safety education. This autobiographical study undertakes to explore the Pakeha identity of a cultural safety nurse educator. The author discusses identity in the context of a globalised world, and challenges the idea of a definitive Pakeha identity. There are multiple descriptions of Pakeha, all underdeveloped and inadequate for the purposes of cultural safety education. In this study, the author uses the heuristic process of Moustakas (1990) and Maalouf's (2000) ideas of vertical and horizontal heritage to locate and present the essence of the self. In keeping with the purpose of cultural safety education, the author considers her ethnic cultural self as described by Bloch (1983) and explores Helms' (1990) theory of White racial identity development. This thesis describes the position of one Pakeha in the context of teaching cultural safety in an undergraduate nursing degree programme in Aotearoa/New Zealand. For Pakeha cultural safety nurse educators the author argues that exploration of one's heritages and location of a personal Pakeha identity is pivotal to progressing the enactment of cultural safety in Aotearoa /New Zealand.

Abstract: The author notes that it is widely accepted that there is a global shortage of nurses, and there are many studies in the health workforce literature about the negative aspects of nurse work environments, nursing workloads, decreased job satisfaction of nurses and the impact these have on patient health outcomes. In the past five years there has also been international and New Zealand-specific research into the effects of health restructuring on nursing leadership, retention of nurses, and on patient care. Much of this research has shown that countries with very different health care systems have similar problems, not only with retention of qualified nursing staff due to high levels of job dissatisfaction, but also with work design and the provision of good quality patient care in hospitals. This dissertation explores the many detrimental effects on nurses and nursing leadership, of extensive, and continuing, public health restructuring in New Zealand. The context of this dissertation is New Zealand public hospitals, with references pertaining to medical and surgical areas of nursing practice. Health reforms have negatively impacted on patient care delivery systems, patient health outcomes, and retention of educated nurses in the workforce. In order to resolve these issues, coordinated efforts are required in New Zealand district health boards to develop and sustain effective nursing leaders, who will promote and assist in the development of strong, healthy organisational cultures to retain and support professional nurses and the ways in which they wish to practise.

Abstract: There are a number of factors recognised as significant for nursing staff retention. These include, a lack of organisational care, bullying (commonly referred to as horizontal violence), and high workload acuity. However, there does not appear to be any indication that these factors influence the retention of nurses within the speciality of acute perioperative nursing. A descriptive study using postpositivist methodology and triangulation of methods was designed to answer the question: What are the critical factors that influence staff retention in an acute perioperative environment? Forty-eight perioperative nurses answered a questionnaire in relation to individual needs, provision of nursing care and administration and management. Four nurses subsequently participated in a focus group interview that explored in more depth, the survey data related to the following characteristics: Educational opportunities; Level of workload acuity; Rostering flexibility; Management; Established policies/Quality assurance; Graduate orientation programs and Professional relationships in an acute perioperative setting. Data analysis revealed that > 90% of respondents agreed that these characteristics are important for job satisfaction and influence staff retention in an acute perioperative environment. A sense of belonging appears to be the most important theme that emerged from the qualitative data. Job satisfaction and staff retention are attained when nurses have a sense of belonging in the workplace. To achieve this nurses need to identify barriers, develop their communication and leadership skills and determine the ideal professional practice model. The author suggests that the themes “Finding time” and increased “sick leave”, in relation to workload acuity are new findings that provide a platform for future research.

Abstract: Plunket nurses are New Zealand child health nurses who work in the community with the families of new babies and preschool children. Their work is called child health surveillance and this is considered to involve routine and unproblematic practices which are generally carried out in homes and clinics in the context of a relationship with the child's mother (Ministry of Health 1996; Royal New Zealand Plunket Society 1997). However, evidence in the literature that surveillance can have implications for power relations throws doubts on official claims that the relationship between the mother and nurse operates as a partnership (Trout and Polaschek 1996). The purpose of this thesis was to explore the way in which surveillance is constituted within the discourses of Plunket nurses and to examine these discourses for any implications of unequal power relations. Foucauldian discourse theory and poststructuralism, which informed this thesis, provided the opportunity to challenge assumptions about power and knowledge in the child health context. Analysis of the discourses generated by interviews with five Plunket nurses revealed that, contrary to the claims in the official literature, the relationship between the Plunket nurse and the mother is not that of an equal partnership but is constituted in various and unexpected ways. It was through the nurses' discourses of surveillance that the power relations underpinning this relationship were surfaced. While these discourses suggested that many mothers who use the nursing service are actively involved on their own terms, there are a number of women for whom the surveillance activities of the nurse have been shown to be particularly intrusive (Mayall 1986; Clinton 1988; Bloor and McIntosh 1990; Knott and Latter 1999). It may be primarily this unwelcome surveillance which accounts for the considerable number of women who, the statistics show, cease using Plunket services particularly in the early months. It is perhaps for this reason that the nurses in this study locate themselves as being caught between divergent discourses of support and surveillance. Findings indicate that the resolution of this dilemma by abandoning surveillance practices might improve maternal satisfaction with the Plunket nursing service. The author concludes that a child health service responsive to mothers' stated needs rather than institutional requirements or the nurse's own agenda could lead to a more open and equal relationship between mother and nurse. This relationship would be likely to benefit mothers and babies and, at the same time, enhance both nursing practice and nurses' satisfaction with their work.

Abstract: Te watea taupuhipuhi, the space of symbiosis is a framework for nursing practice. It examines the notion of the nursing presence as holding continuity and multiplicity of viewpoint in space of symbiosis. The author developed a teaching-learning situation as an introduction of key ideas in his work where the Maori word “ako” becomes the catalyst of a particular pedagogy that outlines the central notions of symbiosis. Thus, he notes, his work realises that symbiosis occurs not only on the clinical arena of nursing but in the teaching – learning environment as well, his own space of symbiosis. Four rites of passage coalesce a totality of experience within the space of symbiosis, revealing that the central role of the nursing presence is to surface meaning and sense for all of experience which can be fearful, mysterious, paradoxical and chaotic. These four rites of passage are described as the interpretive, integrative, transformations and transcendent. The twelve dynamics of nursing from the axle around which a praxis of nursing revolves. An analysis of those twelve dynamics in rite of passage is situated within narratives taken from the author's nursing practice. He also draws extensively from Maori ontology and autobiography in positioning his exposition within this local context.

Abstract: Computerised technology has become a way of life. As nurse graduates enter a computer driven health care system we have a responsibility as nurse educators to ensure that they are computer familiar as borne out by the recent discussion papers released by the Nursing Council of New Zealand (2000a), which define the requirements for the practitioner of the future. Concurrently there is a call from the discipline of nursing for practitioners who have a form of knowledge that will bring about change within the socio-political context of the discipline as an outcome of critically reflective knowledge skills. Jurgen Habermas' (1971) treatise on knowledge and human interests, which offers a multi-paradigmatic approach to three forms of knowledge culminating in the emancipatory form provides a conceptual framework for many under-graduate pre-registration nursing curricular in Aotearoa-New Zealand. This thesis explores the author's ideas about contemporary undergraduate pre-registration nursing preparation in Aotearoa-New Zealand, associated knowledge outcomes, and the consequent links with contemporary computer-mediated communication (CMC) technologies. It positions a framework for integrating CMC technologies and the action of critically reflective practice as a learning journey. The framework is hypothetical and pragmatic. It emerges from the exploration of the thesis and is posited as a way toward integrating CMC technologies within extant undergraduate pre-registration nursing curricular in Aotearoa-New Zealand. The learning journey is comprised of three dimensions, learning-for-practice, learning-from-practice and learning-with-practice and draws on four different cyber constructs: being, knowing, relating and dialoguing. Knowing, relating and dialoguing are ontological positions taken in relation to being. The learning journey sustains some derivation from Habermasian (1971) based conceptual framework. There is a need for nurse educators to consider this in relation to contemporary CMC technologies. The author hope that this framework will serve those with an interest in nurse education and who are interested in a future using CMC technologies within the realities of nursing practice and education.

Abstract: In this research two nurse-patients have engaged in a conversation about their experience of 'being nursed'. The project sets out to address the following questions: How might our experiences as nurses who have been hospitalised be drawn upon to influence positive changes in nursing practice? What effect might our experiences of hospitalisation have on us as nurses and on our nursing practice? The study utilises narrative as inquiry and the method of story telling and auto/biography to tell the stories of Maria (a pseudonym) and the researcher herself. This interpretive research has been informed by the feminist process and sits within a postmodern framework. Maria's stories were audio taped and transcribed before being prepared for analysis using 'core story creation', and the process of 'emplotment' (Emden, 1998b). The author's reflective topical autobiographical narrative was constructed through the processes described by Johnstone (1999). Three distinct qualities emerged from both experiences. The first, 'knowing as nurse-patient' contains the three sub-themes of 'having knowledge', 'expectations of being nursed', and 'knowledge gained'. The second distinct quality 'being nursed' contains the two sub-themes of 'feeling safe and cared for' and 'presencing'; and the third, 'not being nursed', contains the four sub themes 'feeling vulnerable', 'invisibility of nurses', 'getting out' and 'feeling let down'. The sub-theme 'getting out' includes three additional sub themes of 'wanting to get out and not wanting to be there', 'leaving and the need for closure' and 'not wanting to go back'. The author notes that nursing does make a difference to patient care. However, for patients to receive therapeutic care, new graduate nurses must be preceptored/mentored by experienced nurses in supportive programmes. Suggestions for further research have been identified.