Abstract: This thesis traces the journey of the author's inquiry into family members' experience of the relinquishment of the personhood of a loved one with a dementia; a journey in which she reports that her own prior understandings were significantly challenged. The study was prompted by her experience of working in the area of dementia care and hearing, in the course of the working day, comments such as 'there's nobody there' made in relation to someone suffering from severe dementia. Such comments appear to imply that the person of the dementia sufferer in some way is no longer present. They are comments which relate to the very nature of personhood. The study takes impetus from the fact that the ways in which nurses view the personhood of dementia sufferers has significant consequences for the ways in which they respond to dementia sufferers and their families. This thesis, which retells the stories of four family members who each have a loved one with a dementia illness, reveals that rather than there being a unified concept of personhood in dementia, and in spite of the fact that particular understandings of dementia and personhood dominate our cultural conversations, in their day to day lives these four family members managed and made sense of their experience through particular and different ways of looking at the impact dementia has on the personhood of dementia sufferers. Not all did, in fact, relinquish the personhood of their family member. In their lived lives, the four research participants had recourse, each in different ways, to multiple discourses of personhood. For some, in addition to loss, there was also unexpected gain. This finding necessitated and shaped further inquiry into discourse and the role of discourse in shaping, constraining and opening up possibilities for meaning, and into the two substantive areas of dementia and personhood. Nurses work closely alongside the family of dementia sufferers who are daily faced with the challenge of managing and making meaning of that situation. It is critically important that they are able to recognise, validate and support the variety of needs that family members have. Nurses, whose education is traditionally based on a biomedical framework, are nevertheless often required to mediate between different understandings. Not only do they need currency of knowledge in the rapidly changing biomedical field of dementia, but they need also an understanding of the role and the power of discursive constructions of both dementia and personhood. Such understanding will provide insight into alternate ways of understanding these concepts. However, although such understanding is critical for nurses working in this area, the author suggests that nursing literature has not brought these discussions to the fore.

Abstract: This thesis is a philosophical inquiry that reflects a personal search for the meaning of ontological competency undertaken by the author after developing breast cancer. The text weaves together in creative synthesis, a collection of academic and personal writing undertaken during an MA (Applied) in Nursing degree process. Using the work of Dowling Singe (1999), Watson (1999), and Wilber (1985, 1990, 1991 & 2000), the thesis seeks, through the use of reflective autobiographical inquiry (Johnstone 1999a), to explore the personal meaning-making activities engaged in during this time to throw light upon the nature of nurse / nursing being. Exploring developmental schemata drawn from personal experience and illuminated by theory, nurses and nursing are challenged to become more self-reflective and self-aware. To facilitate the personal and professional growth that underpins notions of ontological competency, various aids in the form of maps and models are provided to support a transformative journey into awareness. From this position of expanding consciousness, the nurse / nursing is encouraged to reach beyond current paradigms, metaparadigms, epistemologies, and restrictive philosophies and to yield to the evolutionary imperative that seeks to prepare for a 21st century clinical practice where caring / healing becomes embodied enactment from “the Ground of All Being”.

Abstract: Because nurses work in a wide range of settings they are well-placed to provide support for smokefree environments. The aim of this research was: to assess the knowledge of cessation, attitudes towards smoking, the provision of smoking cessation advice and treatment, and attitudes to and management of smokefree workplaces in a sample of nurses with practising certificates in New Zealand; and to describe the prevalence of smoking in nurses using the 2006 New Zealand census. One thousand questionnaires were posted to a random sample of 1000 nurses (500 community-based nurses, and 500 hospital-based) from the New Zealand Nursing Council register of nurses with current practising certificates. Statistics New Zealand provided results from the New Zealand Census of Population and Dwellings, 2006, for nurses by gender, practice area and cigarette smoking status. Responses were received from 371 (37%) of the nurses. They were enthusiastic about and committed to including smoking cessation in their practice, and to learning more about helping clients who smoke. Nine out of ten felt that it was part of their responsibility to advise clients to stop smoking. Nearly nine out of ten said they would be happy to spend an extra five minutes with each patient who smoked if they could effectively intervene. Over half had not received training for effective evidence-based smoking cessation interventions but three quarters were interested in learning more about how to help people stop smoking. The respondents' knowledge of the health effects of smoking was high, but there were gaps in knowledge of effective smoking treatments and a wide misunderstanding that nicotine causes cancer and heart disease. These gaps may limit nurses' ability to intervene effectively. Nurses supported their smokefree work policies although a fifth did not report support with enforcing these. Results from the 2006 census showed that smoking prevalence among nurses has declined from 18% in 1996 to 14% in 2006. Smoking rates in mental health nurses (29%) remain higher than the New Zealand general population (21%, census data).

Abstract: The author looks at the value of using reflective storytelling as a teaching/learning tool in the hospice setting and examines constructs that provide a theoretical underpinning. She also outlines processes that support the implementation of storytelling practice and the creation of a safe space for storytelling. At the end of the chapter, discussion questions are provided by Janice McDrury.

Abstract: This paper reviews international and local nursing literature on preceptorship and mentoring. This includes an exploration of ways in which these two terms are defined, a discussion of the essential qualities needed to undertake such roles, and an examination of appropriate preparation and exploration of the ways in which registered nurses can be supported when engaged in providing these roles. At the end of the chapter, discussion questions are provided by Joc Parkes.

Abstract: This chapter introduces national policies and strategies that promote interdisciplinary collaboration as a means of providing better access to health care for all communities. It identifies a role for advancing nursing practice as part of a collaborative approach to healthcare in rural areas. An increasing focus on collaboration as a concept within health practice during the last 10 years has become evident in policy documents from the Report of the Ministerial Taskforce on Nursing (Ministry of Health, 1998) to the Working Party for After Hours Primary Health Care (Ministry of Health, 2005). The emphasis would seem to be in response to political pressure to address health inequalities and an apparent assumption that interprofessional collaboration results in improved communication, fewer gaps in provision of care and more effective use of the limited health funds.

Abstract: This chapter firstly offers background information in relation to palliative care and the role of women as providers of care in the home setting. Secondly, it discusses a study that evolved from a trend the author observed as a district nurse providing community palliative care in rural New Zealand and from New Zealand literature; that the majority of carers of the terminally ill in home-settings are women. The aim of this research study was to offer insights into the requirements of caring for a dying person at home and provide information to assist nurses working in the community and other women who take on the caregiver's role.