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: A survey was used to reach as many nurses as possible involved with nursing in “rural” areas throughout New Zealand and to build a profile of nurses involved in the provision of healthcare beyond the urban centres. The contact also sought to inform nurses of the rural healthcare project and encourage them to contribute their experience to the development of health services in the new health service structure. Data is presented on the characteristics and employment conditions of nurses and access to resources including information technology. The inadequacy of information on the rural nurse workforce is identified: nurse roles are historically defined yet employment patterns are changing according to the workforce demands of new structures, and the existing definitions of rural health service design and delivery are only in terms of general medical practices and on-call coverage. Recommendations are made for definitions of “rurality” and “rural nurse” that will allow a more useful depiction of the nurse workforce.

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.

Abstract: Critical Comparative Nursing Assessment (CCNA) is a theory about how the competence of completing Bachelor of Nursing students in New Zealand is determined. Semi-structured, audio-taped interviews and field notes were used to collect data from twenty-seven nurses with experience in undertaking competency assessment. A Glaserian grounded theory approach was used to guide the data collection and analysis. This utilised the processes of constant comparative analysis, theoretical sampling and saturation to generate a middle range substantive grounded theory. This is presented as a model consisting of four emergent categories that explain how nurses formulate professional judgements about competence. These are a) gathering, which describes the processes used to collect evidence of practice to inform decisions; b) weighing up, which explains how evidence is analysed using the processes of benchmarking and comparative analysis; c) judging brings into focus the tensions inherent in making professional judgements about competence and how nurses formulated these, and d) moderating, which describes the processes nurses use to validate decisions and ensure that professional responsibilities and public safety are upheld. The basic social psychological process of comparing integrates these categories to explain how nurses resolve the tensions associated with making decisions about competence. This research presents a new way of viewing and understanding how nurses assess competence. It identifies where the challengers and tensions related to the assessment of competence lie and suggests strategies that if implemented, the author suggests could further enhance the validity and reliability of assessment outcomes.

Abstract: The author uses his personal and professional experience to explore the application of Cognitive Behavioural Therapy in caring for people who experience psychosis. Psychosis can be a life-threatening illness; about one in ten young men with psychosis will take their own lives. Much of the progress in treatment has been predicated on a biological explanation of psychosis. The late 1990s have seen increasing interest in psychological approaches in the treatment of psychosis; not withstanding that this treatment does not work for all people. The first aim of this research report is to develop understanding about Cognitive Behavioural Therapy, through exploration of its origins and examining the theoretical basis and reviewing the evidence that may support its use. The second aim is to explore the evidence around mental health nurses' training and use of Cognitive Behavioural Therapy, by critically examining some of the major UK and Australian reports. The author considers that Cognitive Behavioural Therapy is theoretically and pragmatically compatible with contemporary nursing practice, and will have increasing prominence for New Zealand mental health nurses.

Abstract: This research explores why and how nurse educators teach for social change. Critical feminist educators provide a useful framework for theorising about teaching for change that addresses issues of hegemony, agency, praxis, individual voice, difference, justice and equity. Six women Pakeha/Tauiwi nurse educators from throughout New Zealand volunteered to participate in this research and share their lived experiences of teaching for social change. In-depth conversations over two years unfolded new and rich material about how and why these six women continue to teach the evaded subjects, like mental health, women's health, community development and cultural safety. All teach in counter-hegemonic ways, opening students' eyes to the unseen and unspoken. Among the significant things to emerge during the research was the metaphorical construct of shape-shifting as an active process in teaching for social change. It revealed the connectedness and integrity between life as lived and the moral imperative that motivates the participants to teach for difference. Shape-shifting was also reflected in other key findings of the study. As change agents, the participants have had significant shape-shifting experiences in their lives; they live and work as shape-shifters within complex social and political structures and processes to achieve social justice; and, they deal with areas of health practice where clients are socially and politically displaced. The research also generated new methods for gathering life-stories and new processes for analysis and interpretation of life-stories. It is hoped that this research will open pathways for other nurse educators to become shape-shifters teaching for social change.

Abstract: The Primary Health Care Strategy (PHCS) has a stated commitment to defined populations who suffer disproportionately from ill health. This thesis examines whether some prevailing discourses actually decrease the focus on health inequalities. A study of the nursing and medical media found that it focused predominantly on professional and industrial issues, leaving health workers focused mainly on their own professional interests, rather than considering the effects on health inequalities. She goes on to suggest that current Ministry of Health discourse values decentralised community health decision making. This may gloss over factors in community health which are affected by Government policy such as employment policy, and thus should be dealt with centrally by legislation. These factors have been found to be the most pertinent in health inequalities. So while models of community partnerships may seem to place communities as agents in their own health, this downplays the determinants of health which are beyond their control. Having shown that discourse can decrease the focus on health inequalities due to other professional and political drivers, the author then looked at health initiative concepts which are effective, efficient and equitable given the current set up of PHOs and nursing innovations.