Macklin, N. (2018). Hearing the patient voice: the importance of caring in care. Master's thesis, Dunedin, University of Otago.
Abstract: Backgrounds the primary health care initiative, the Transitional Care Nursing service, which aims to facilitate integrated care between primary, secondary and community health care services. Explores whether support in the form of the Transitional Care Nursing service influences the experience of patients who receive assistance during the transition between hospital and home. Conducts qualitative, semi-structured interviews with 12 patients whose responses are thematically analysed. Highlights the characteristics of care offered by Transitional Care nurses that describe the person-centred care patients received.
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Officer, T. N. (2018). Nurse practitioners and pharmacist prescribers in primary health care: A realist evaluation of the New Zealand experience. Doctoral thesis, Victoria University of Wellington, Wellington.
Abstract: Investigates how nurse practitioner and pharmacist prescriber roles are developing in NZ primary health care, and what is needed to better support the future development of these roles. Employs a qualitative research design involving semi-structured interviews of (1) policy, training, and advocacy stakeholders; (2) primary health-care nurse practitioners, pharmacist prescribers, and general practitioners; and (3) patients of advanced practitioners and carers of patients using such services.
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Lally, E. (2014). Symbiotic relationships in patients' engagements with practice nurses. Doctoral thesis, Victoria University of Wellington, Wellington.
Abstract: Records from patient perspectives the nature of the engagements patients have with practice nurses which influence patients' health and well-being. Posits this mutually-beneficial close association as a form of symbiosis. Surveys 15 patients from seven rural and urban general practices in NZ about aspects of the participants' relationships and engagements with nurses, analysing the results using Narrative Inquiry methodology.
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Cavit, L. (2021). Exploring factors that influence vaccination uptake for children with refugee backgrounds: An interpretive descriptive study of primary healthcare providers' perspectives. Master's thesis, Auckland University of Technology, Auckland.
Abstract: Examines those factors associated with access to, and uptake of immunisation services. Conducts semi-structured interviews with primary healthcare nurses and GPs across seven resettlement locations. Proposes strategies to improve age-appropriate vaccination among refugee children after resettlement in NZ, based on five themes from the data: resettlement priorities; knowledge about refugees; learning to use the health system; communication between caregivers and health providers; culturally and linguistically appropriate services.
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Fletcher, S. (2021). “It's one less thing I have to do” : does referring patients to a co-located psychology service impact on the well-being of primary care health providers?.
Abstract: Investigates wheether the impact of a co-located psychological service to which Primary Care Providers cn refer patients with mild to moderate mental health needs, would impact on the well-being of the providers at work. Describes Focused Acceptance and Commitment Therapy (FACT) services delivered by psychologists working in a a large primary care practice in the lower North Island. Conducts interviews with GPs, nurse practitioners (NP) and registered nurses (RN), analysing the data using thematic analysis. Finds an inverse relationship between the FACT service and the well-being of staff.
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Holdaway, M. A. (2002). A Maori model of primary health care nursing. Doctoral thesis, Massey University, Palmerston North.
Abstract: Identifies how traditional nursing practice in Maori communities may be enhanced. Highlights the need for nursing to broaden concepts of health, community, and public health nursing, to focus on issues of capacity-building, community needs, and a broader understanding of the social, political, cultural, and economic contexts of the communities primary health-care nurses serve. Explores how health is experienced by Maori women during in-depth interviews using critical ethnographic method, underpinned by a Maori-centred approach. Articulates a model of health that is a dynamic process based on the restoration and maintenance of cultural integrity, derived from the principle of self-determination.
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Adams, S. (2017). Nurse practitioners in rural primary health care in New Zealand : an institutional ethnography. Ph.D. thesis, Massey University, Auckland.
Abstract: Critically examines the work required to establish nurse practitioner (NP) services in rural primary health care in NZ, using the institutional ethnography approach to the inquiry. Explores the work and experiences that nurses undertook to become NPs delivering rural primary health care services. Considers how these were institutionally-shaped and coordinated. Conducts interviews with a total of 13 NPs and four NP candidates.
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Norris, K. A. (2022). A position in the making: A Bourdieusian analysis of how RN prescribing influences collaborative team practice in New Zealand. Doctoral thesis, Auckland University of Technology, Auckland.
Abstract: Examines designated registered nurse (RN) prescribing among community health nurses. Aims to understand how RN prescribers interact with other members of the health care team and to identify the social processes at play. Employs Bourdieu's 'Theory of Practice' to explore health care teams as competitive social spaces where health professionals vie to establish social position and authority. Recruits three health care teams representing primary health and specialty practice for interviews and observation. Highlights three themes from the data: social topography, working with an RN prescriber; and patterns of communication.
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Davies, D. C. (2006). Practice nurses' perceptions of their contribution to the care of individuals with chronic health conditions. Ph.D. thesis, , .
Abstract: Table of Contents: 1. Background and overview; 2. Research design and method; 3. Literature review; 4. Preparation of the individual for an appointment at the general practice; 5. Care provided by the practice nurse at the general practice; 6. The giving of information; 7. A discussion of the dualities of the contribution of practice nurses to the care of individuals with chronic conditions; 8. Study summary and conclusions.
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Lilley, S. (2006). Experiences of mentoring in primary health care settings: Registered nurses' and students' perspectives. Ph.D. thesis, , .
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Desmond, N. (2007). Aspects of nursing in the general practice setting and the impact on immunisation coverage. Ph.D. thesis, , .
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Sheridan, N. F. (2005). Mapping a new future: Primary health care nursing in New Zealand. Ph.D. thesis, , .
Abstract: The aim of the study was to determine the practice of nurses employed in integrated care projects in New Zealand from late 1999 to early 2001. Integrated care was a major health reform strategy that emphasised primary health care as a means to improve service provision between the health sectors. An investigation of nurses' practice sought to determine the extent to which primary health care principles had been adopted in practice, as a comprehensive primary health care approach has been advocated globally in the management of chronic conditions; the leading cause of disability throughout the world and the most expensive problems faced by health care systems. The philosophical basis of the research was postpositivism. The study employed a quantitative non-experimental survey design because it allowed numeric descriptions of the characteristics of integrated care projects to be gained for the purpose of identifying nurses' practice. The unit of inquiry was the integrated care project, and 80 comprised the study population. Data were obtained on projects from expert informants (n=27) by telephone survey using a structured interview questionnaire developed by the researcher. Data obtained from interviews were statistically analysed in two stages. First, data were produced to comprehensively describe the characteristics of integrated care projects and nurses practice. The 'Public health interventions model' was used as a framework to analyses the interventions (activities) and levels of population-based practice of nurses. Following this, the social values embedded in nurses' practice were determined using 'Beattie's model of health promotion' as a framework for analysis. A strong association was found between nurses' practice in projects and strategies used in integrated care, such as information sharing, guideline development and promotion, and case management, and projects with an ethnic focus, low income focus, chronic condition focus, and well-health focus. Whilst nurses undertook interventions most frequently at the individual practice level they were also strongly associated with the small proportion of interventions that were undertaken at the community level. The majority of interventions by nurses reflected the health promotion value of health persuasion, indicating a paternalist and individual-oriented philosophy. Nurses were engaged in two interventions that indicated a collective-oriented philosophy – coalition building and community development, the latter reflecting health promotion values of negotiation, partnership and empowerment. The study demonstrated that nurses' practice in projects was predominantly centred on individual-focused population-based practice suggesting the need for a framework to assist nurses to transition their practice to include more activity at the community and systems levels. Without a reorientation of practice, nurses will remain limited in their ability to achieve health gains for populations. In response to this conclusion, and drawing on research results and reviewed literature, a new model, The 'Primary Health Care interventions model' was constructed. Recommendations include advocacy for the acceptance of the model by the health funder, professional nursing bodies, health organisations, educational institutions, nurses, communities, and individuals.
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Miles, M. A. P. (2005). A critical analysis of the relationships between nursing, medicine and the government in New Zealand 1984-2001. Ph.D. thesis, , .
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.
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Thompson, L. E. (2006). Profession and place: Contesting professional boundaries at the margins. Ph.D. thesis, , .
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.
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