Abstract: This research explores the issues and experiences of mental health nurses who experience or have experienced mental illness. This project was prompted by the author's concern for colleagues and friends in this situation. The research topic was approached using a mix of critical ethnography and action research principles. Five mental health nurses who all work for the same district health board were interviewed about their experiences of being mental health professionals with mental illness and the issues that arose from this. The themes that emerged from this research are: the reactions of nurse colleagues, the effects on participants' own mental health treatment, employer responses, professional experiences and issues and strategies for coping. Discussion and recommendations focus on the need for improvements to the responses that mental health nurses with experience of mental illness encounter in their workplace. Recommendations from this research encompass suggestions for both individual and organisational education, action and change.

Abstract: The original aim of the study was to find out through a questionnaire what child health/paediatric nurses in New Zealand/Aotearoa saw as their needs for post-registration education. Nurses were completing courses in the United Kingdom and returning to New Zealand/Aotearoa and realising that their nursing capabilities had improved. They became senior nurses with education responsibilities and exhibited political leadership among their colleagues in the field of child health/paediatric nursing. They were becoming increasingly concerned at the lack of any clinical courses in the specialty of child health/paediatric nursing to promote an appropriate standard of practice. It was intended that a research project about post-registration child health/paediatric education would assist concerned nurses to develop a programme. The time needed for such a project did not fit with a limited research paper. It was decided to reduce the project to a review of the literature on competence in nursing, with some comment on the specialty of child health/paediatric nursing. In order for nurses to find what they need to learn and know, an understanding of competence in nursing practice is required. Competence is defined as the ability of the nurse to carry out specific work in a designated area at a predetermined standard. Issues around competence, defining a scope of practice, development and assessment of competence, and regulation of nursing, are part of the context in which accountability for the practice of nurses sits.

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: Report to the Winston Churchill Memorial Trust on Professional Supervision for registered Nurses and Midwives, May 1998.
Objective of Project:
To explore the extent of the development of a model of clinical supervision for nurses in the United Kingdom.
Some of the key points that emerged:
- Clinical supervision is a strong and accepted part of nursing culture in Britain. While not mandatory and not available to, or accepted by, all nurses, it is nevertheless generally known about and discussed at main nursing forums
- The strong support and directives coming from nursing leadership is a major factor in the adoption of clinical supervision as a developmental, support and quality control
- The increasing availability of resource material, courses, and in particular the investment made by the Department of Health and the Scottish Home and Health Office in funding a 23 site evaluation project has stimulated implementation of clinical supervision

Abstract: As has been the case internationally, deinstitutionalisation of dual diagnosis (intellectual disability and mental illness) services has also occurred in New Zealand. Inpatient services have been redefined to respond to the more acute focus that has arisen out of this deinstitutionalisation process and nurses are having to redefine their roles in response. This study was undertaken to explore and describe the culture of nursing practice in a dual diagnosis inpatient unit in one psychiatric hospital. A focused ethnographic approach was used to triangulate data gathered from fieldwork observations, review of documents and semi-structured interviews. Schein's (1985) levels of culture model, was used to identify and explore the artifacts, values and assumptions evident in this nursing practice. Analysis presents three key themes categorised as 'communication', 'assessment' and 'safety'. While these key themes are shown to be evident in the everyday practice of the nurses, how these relate to the notion of 'dual diagnosis nursing' is not clear. Therefore, the author describes the major finding of this study as revealing a nursing culture holding tight to traditional psychiatric and psychopaedic nursing practices and struggling to develop a distinctive culture in the absence of a defined dual diagnosis knowledge base. The author concludes that these findings suggest an urgent need to provide nurses with support in gaining contemporary knowledge regarding dual diagnosis nursing. Support for nurses in advancing these areas then impacts on support for the patients. It is suggested that additional research is undertaken to assess the learning needs of the nurses in order to develop clinical practice guidelines for this area. Further recommendations are made to address system issues which are contributing to the gap in knowledge.

Abstract: This study explores the phenomenon of dilemma in paediatric practice. Using a hermeneutic phenomenological method informed by the writings of Heidegger [1889-1976] and Gadamer [1900-2002] this study provides an understanding of the meaning of 'being in dilemma' from the perspective of predominantly paediatric health care professionals but also families in New Zealand. Study participants include four families who had a child requiring health care and fifteen health care practitioners from the disciplines of medicine, nursing, physiotherapy, play specialist and occupational therapy who work with families and children requiring health care. Participants' narratives of their experiences of 'being in dilemma' were captured via audio taped interviewing. These stories uncover the everyday realities facing health professionals and families and provide an ontological understanding for the notion of dilemma. The findings of this study suggest that experience of dilemma for health professionals reveals a world that is uncertain and questionable where they are thrown into having to make uncomfortable choices and must live with the painful consequences of their actions. The consequences of being in such dilemma are having to find ways of living with the angst, or risk becoming too sensitive or desensitizing. For families the experience of dilemma reveals a similar phenomenon most evident in circumstances where they feel totalized by the impact of heath care encounters. This study has uncovered that the perspectives that health professionals and families bring to the experience of dilemma reveal different concerns and commitments and may be hidden from each other. This thesis proposes that health professionals and families need support in living with their own personal encounters of enduring experiences of dilemma.