Abstract: This thesis is about caring for males, especially those males who could be considered “difficult” to care for through their use of behaviours such as silence, anger or defensive humour. This thesis is positioned in the view that these behaviours are often expressions of distress, which typically distance males from those who attempt to care for them. The author suggests that the word “distress” more accurately reflects the theme of the thesis, and it is used throughout the work. This thesis explores the interface between gender issues, nursing practice and caring for males. It is informed by a review of relevant literature and data gathered from a focus group of nine registered nurses. The analysis is framed by questions that are developed from a series of reflections on my personal and professional life. Critical social theory, with its emphases on dominant dialogue, power and emancipation is used to inform and guide this analysis. What is most obvious is the contrast between themes arising from the literature and those arising from the focus group. It appears that the literature, in the main, is critical of males in regard to concepts of masculinity, issues related to gender, and men's health. Males are portrayed as arbitrators of their own misfortune, as deliberately choosing a lifestyle that reflects poorly on their health, their self-expression, and communication with others. Concepts such as power and control over others, both at a societal and individual level, often feature. Conversely, the literature is noticeably lacking in regard to information about the health related experiences of males and about caring for males. In contrast, the participants of the focus group frame their discussion in the positive. For example, they suggest that males are interested in their health but require an environment that supports this expression of interest. They support this by identifying a range of behaviours they believe are effective in caring for males. The participants also suggest that it is the registered nurse rather than the male who manages issues to do with power and control. The thesis concludes that creating and sustaining an environment supportive of, and sensitive to the needs of males, is an activity that requires considerable thought, skill and experience. These areas are not adequately addressed in academic dialogue, research activity, or in the education of registered nurses. The thesis suggests that this situation is inconsistent with an ethic of care and that nursing should make a priority of broadening its research and knowledge base to better understand and care for males.

Abstract: In this research paper for a Master of Nursing (Clinical), the author suggests that graduate nurses can successfully adapt to emergency nursing when supported with intensive domain-specific transition programmes to complement the national nursing entry to practice (NETP) programme in New Zealand. This outcome conflicts with the present traditional emergency department recruitment strategy that nurses must have two years acute care experience. The graduate believes they are prepared for practice for any healthcare setting but do need time to resolve the rift between theory and practice. This research project confirms the perpetuation of experienced nurses' perceptions that graduates are not work-ready but are unrealistically expected to hit the floor running following ad hoc orientation ranging from three days to four weeks. By creating domain-specific programmes with a minimum twelve-week staged rotation orientation package, graduate nurses can be nurtured as emergency nurses. The influential role of the organisation and experienced nurses is vital to limit reality shock and complement NETP. Preceptorship and mentorship programmes promote the graduates' confidence in themselves to become competent team members. Limits to this research are the non-differentiation between nurses new to emergency nursing and the graduate nurse in the published studies. Assumptions have therefore been made regarding successful transition in regard to newly qualified registered nurses in the emergency department. Further study and evaluation applicable in the New Zealand context is also recommended by the author where anecdotally only a few emergency departments are involved in socialising graduate nurses into the workforce regardless of the urgent need for more first-year-of-practice clinical placements.

Abstract: This dissertation focuses on the concepts of island, island-ness, and isolation. It aims to further advance the national and international literature relating to the health beliefs of island people as linked to the provision of primary health care services within New Zealand. New Zealand is an island nation made up of two main islands and numerous outlying islands, relatively isolated from the rest of the world by water. This geography means going anywhere from New Zealand involves traveling either “over” or “on” the sea. All people of New Zealand since the first inhabitants, whether residents or visitors, have arrived to New Zealand either by sea or more recently by plane. The population of New Zealand is 25% rural, with most of these rural dwellers residing in the South Island, and several of the smaller off shore Islands. This builds a sense of culture of the people, or tangata whanua (the people of the land), for whom there are degrees of island-ness, and the characteristics of this can be seen amongst the people of New Zealand. A further challenge which is discussed comes in the form of the “island penalty” which encompasses high transport costs, long distances to travel to main centres, lack of specialists and trained health workers, effects of migration and tourism, and communication difficulties. The more isolated people are, the tougher the challenges become. Most rural island populations are served by lay care workers, volunteers, and rural and remote nurses. Nurses are often the main health care providers to small island populations, and they demonstrate advanced nursing practice which is acknowledged internationally as meeting Nurse Practitioner competencies. As a group these nurses possess knowledge of the extrinsic and intrinsic factors involved in the health needs and health determinants of these island communities. Researching these advanced nursing roles adds to the body of knowledge around isolated and island communities. The author suggests that studying the concepts of islands, islandness, and isolation in relation to health beliefs will bring more understanding of services for the advanced rural nurse to consider in developing appropriate, accessible, affordable and adaptable Primary Health Care which is fair and equitable.

Abstract: Accent on Nursing services is on service to patients with job satisfaction of employees placed in a less worthy positions. Indices of low levels of Nurses' job satisfaction in some areas of our Hospitals in the Auckland Hospital Board indicate the established relationships between performance and morale is not always transformed into supervisory and management practise in the work situation. As recognition of job satisfaction needs is a prime factor in change, the research study is designed to measure through questionnaire and scaling methods the effect of a one week management training course on the attitudes of superiors to the job satisfaction needs of their subordinates

Abstract: In New Zealand, there is a festering debate over a theory-practice gap in nursing. Joint appointments present as a potential solution to this issue. Joint appointments refer to a variety of arrangements whereby concurrent employment occurs within an educational institution and a clinical setting.Advantages for the appointees include job satisfaction, and professional growth. Clinical credibility for nurse educators enables improved facilitation of student learning. In clinical areas, benefits in patient care are associated with the marrying of academic rigor with clinical practice. Some appointees input into staff development, act as consultants on nursing issues and undertake research. Disadvantages in the concept focus on role conflict (incongruity between the roles) and role ambiguity (lack of clarity concerning expectations). Success of the ventures depends upon the personal attributes of appointees; realistic expectations; flexibility to allow the concept to evolve; and support from colleagues and management.This research describes a case study of a joint appointment between a nurse lecturer and a senior staff nurse in an acute forensic psychiatry unit. Advantages, disadvantages and reasons for success are discussed in relation to the literature findings. The discussion focuses on the need to develop research methodology to further clarify potential benefits and advantages