Abstract: This thesis explores the theoretical notions of suffering and caring within the nurse patient relationship in the context of emergency nursing. It includes a small pilot study that aimed to assess the feasibliity of a major research project, by describing the impact of vicarious traumatisation in emergency nurses, specifically in relation to their self capacities. This pilot study utilised a descriptive, correlational design. Data was collected by using the Inner Experience Questionnaire (IEQ) a twenty four-item questionnaire developed by Dr Pearlman (1995), and a profile sheet which identified demographic details. Twenty-seven emergency nurses participated in this pilot study. The IEQ was assessed for internal reliability by applying the Cronbachs alpha and utilising a focus group to gain insight into the usability and relevance of the questions. The internal reliability of the IEQ suggests that it may be an appropriate tool to measure disruption of self capacities in the population of emergency nurses. Although the results are limited, and conclusions cannot be drawn, findings suggest a correlation between the variables of age, experience, nursing qualifications and a history of personal trauma and the IEQ. There is evidence that emergency nurses are affected psychologically when caring for the victims of trauma in emergency departments and the IEQ has the potential as a tool to be integrated into future emergency nursing studies. A multidimensional methodological approach is recommended to capture the many contours of the complex phenomena of vicarious traumatisation and the emergency nurse.

Abstract: The question explored in this research project is: What are inpatient registered nurses' perceptions of the factors which influence therapeutic relationship development? The literature reviewed for this project includes the history of interpersonal relationships in nursing; therapeutic relationships; what constitutes these relationships. Also discussed is literature about phenomenology as the underlying theoretical and philosophical position that informs the research method. To answer the research question a single focus group was used to gather data from a group of registered nurses practising in inpatient mental health units. Focus groups as a data collection method produce data and insights that would not be accessible without the group interaction. The key themes to emerge from the data analysis were; time, environment, knowing / self-awareness, compassion and power imbalance / empowerment. These key themes are discussed in relation to the literature and the wider context of the mental health care environment. The contribution this research makes to nursing includes a list of recommendations to nurses, nurse leaders and managers who aim to provide therapeutic mental health unit environments.

Abstract: This study examines the discursive formation of professional nursing in one country, as revealed by the history of nursing in New Zealand. Michel Foucault's approach to historical research signifies a different level of analysis from conventional approaches, focusing not on the history of ideas but on an understanding of the present, a history of the present. A genealogical method derived from Foucauldian poststructuralism reveals how different understandings of nursing have occurred and have governed nursing practices and scholarship in different historical contexts. The archaeological investigation in this study reveals two moments of epistemic transformation, that is, two intervals of mutation and discontinuity. The Nightingale era in the 1880s precipitated the first epistemic shift – premodernism to modernism. The transfer of nursing education from hospital based training to the tertiary education sector, followed by the introduction of the baccalaureate degree, precipitated the second epistemic shift in the 1990s, the advent of postmodernism. Encompassing these two epistemes, six historical contexts are identified, where significant disruptions to the nursing discourses overturned previously held assumptions about what constituted a nurse. Each historical context is identified by specific discursive constructs. The first is colonial caring, the second the Nightingale ethos and the third heroic, disciplined obedience. In the fourth context, nursing is framed by, and within, discourses of skilled, humanistic caring, in the fifth, scientific, task focused managerialism, and in the 1990s, the sixth context, by multiple realities in an age of uncertainty.

Abstract: This study uses a critical approach to analyse influences connected to opportunities for nurses to have their unique contribution to the health system recognised, and identifies a plan of action. The stories as told by four Northland nurses, identified the underlying principle of self-knowledge which, when connected to core values emerged as personal power with the language of possibility. Other factors which enabled opportunity recognition were labelled as: knowing the self, integrating core values from personal and professional qualities, connecting these to an intuitive plan, trusting it because it is value-based, using that plan to form goals and achieve direction. Integrating core values into goal setting enabled people to make choices that would enhance as well as protect their personal development. This study has implications for nurses as they seek out places where they can work well and for health planners to design systems where this can happen.

Abstract: This study explores the phenomenon of a personal exploratory field visit to HIV programmes in Malawi and how that informs the author's future plans to work cross-culturally with HIV. He uses hermeneutic phenomenology with the guidance of Heidegger and Gadamer, and draw on Ackermann, Hill, Maluleke, Moltmann, and Thielicke for theological direction. This study analyses how personal formation takes place and how the meaning of that experience can inform future cross-cultural interaction. The data of this study is drawn from a range of people interviewing 'me'. This includes a pre and post interview in relation to the author's three week exploratory visit to Malawi, and recorded daily reflections during the visit. Upon return he was interviewed about the experience by ten people from the following areas: nursing, counselling, development, theology, business, medicine, clergy, an Expatriate Malawian, and a women working from a Maori paradigm. These interviews focused on the author's experience with questions framed from the interviewer's specialty area. The transcripts become further data for this study. The findings of this thesis suggest that people wishing to work cross-culturally need to understand their motivation for their work, and understand who they are before entering a foreign land. This transformative journey also needs to continue as part of the process of working with people because we can only be effective with change if we are listening and hearing the other's perspective. It is in being open to this difference between persons that we continue to find ourselves. While perhaps we have a tendency to want to make everybody like us, we can only grow into our full potential in relationship with truly different others. Tensions experienced demonstrate that there is a complex need to understand how the context controls how HIV is perceived. This requires uncovering some of the deeper issues of HIV and culture, and knowing how to conceptualise these in both positive and informative ways. This thesis asks four key questions for the global-co-worker to work through before embarking on cross-cultural mission: 1. How do you know you should go?; 2. How are you going to make a difference?; 3. Who are you going to be?; and 4. What will sustain your involvement? The author's own experience has drawn me into a deeper awareness of the need for a vital connectedness of faith, hope and love underpinning the everydayness of such an experience.

Abstract: This paper is an analysis of the cultural and traditional factors that the author presents as essential considerations in the treatment of Samoan people who have been diagnosed with a mental illness. Just as important to any clinical diagnosis, is the spiritual nature of Samoan culture and traditions, which inform belief systems. A full understanding of these will explain how the traditional beliefs and cultural values of Samoan people have an impact on their perception of mental illness, its causes and cures. The thesis places emphasis on 'ma'i -aitu', the Samoan term for most ailments pertaining to the mind or psyche. The focus is on defining 'ma'i -aitu' as part of a Samoan world view and likewise a description of a similar type of manifestation in the Papalagi (western) context of a psychiatric disorder and how treatment and management is usually undertaken. The issues addressed in this paper aim to highlight the Samoan client's world view from a Samoan perspective of mental illness which then poses the question of how they can be managed holistically and appropriately under the Papalagi medical system. Furthermore, it questions if the traditional belief system of Samoans run deeper than originally thought and can the replacement thereof by a foreign culture be responsible for the increased mental problems in Samoans living in New Zealand? This paper emphasises the importance of integrating the western medical model and Samoan health models, for appropriate mental health service delivery to Samoan people.

Abstract: The objective of this meta-analysis was to assess the effectiveness of pentoxifylline as an adjunct to compression bandaging in the treatment of venous leg ulcers. The CENTRAL registers of the Cochrane Peripheral Vascular Diseases and Wounds Groups were searched – each register is routinely updated by extensive searches of electronic databases, handsearching of relevant journals and conference proceedings, and contact with product companies and experts in the field. The drug's manufacturer was contacted and the references of review articles and all obtained trials were scrutinised for further citations. Randomised controlled trials published in any language comparing pentoxifylline and compression with placebo in adult participants with venous ulceration were included. Trials must have reported a meaningful objective outcome (rates of healing, proportions healed, time to healing). Details from eligible trials (independently selected by two reviewers) were extracted and summarised by one reviewer. A second reviewer independently verified extracted data. Eleven clinical trials were identified. Five trials compared pentoxifylline with placebo (compression standard therapy). Six trials were excluded. Pentoxifylline and compression was more effective than placebo and compression (RR 1.30, 95% C1 1.10-1.54) and was robust to sensitivity analyses. The greater number of adverse effects (46 reports) occurred in the pentoxifylline group, although this was not significant (RR 1.12, 95% C1 0.77-1.62); 34 percent of adverse effects were gastro-intestinal. Seven of 21 reported withdrawals were for adverse effects. In conclusion, pentoxifylline appears an effective adjunct to compression bandaging in the treatment of venous ulcers. The absence of cost-effectiveness data suggests it not be employed as a routine adjunct, but it could be considered as for those patients not responding to compression therapy alone. The majority of adverse effects are likely to be tolerated by patients.