Abstract: This study, which is undertaken in the Southland area, explores the effect of the increasing specialisation of nursing services in what is a rural/urban environment. It is indicated in the literature that systemic changes in health, such as the health reforms, and the increase in the use of technology have meant that nurses are required to function in disease oriented roles rather than according to their more traditional generalist roots. A significant event, which also affected nursing scope of practice, was the transfer of nurse education to the tertiary education institutions environment from the hospitals in the mid 1970s. The traditional nursing hierarchy and its nurse leadership role disappeared and the adoption of specialist nurse titles increased, and identified with a disease or disorder, for example 'diabetes' nurse. The increase in specialist categories for patients contributed to the nurse shortage by reducing the available numbers of nurses in the generalist nursing pool. The nurses in this rural/urban environment require generalist nurse skills to deliver their nursing services because of the geographical vastness of the area being a barrier to specialist nurses. Workforce planning for nurses in the rural/urban then must focus on how to reshape the nursing scope of practice to utilise the existing resources. This study explores how key areas of health services could be enhanced by reclaiming the nurse role in its holistic approach, in mental health, public health, geriatric services and psychiatric services.

Abstract: The authors report a survey of all nurses working in hospitals included in the International Hospital Outcomes Study of staffing and patient outcomes in New Zealand's secondary and tertiary hospitals from 1988-2001. The survey examines the way in which the hospitals have been restructured and analyses patient outcomes. Research has identified links between how nursing is organised in a hospital and that hospital's patient outcomes.

Abstract: Hospice nurses in New Zealand provide supportive care to patients of settings. In doing so, the hospice nurse and team are likely to have an ideal of a “good death” that guides their practice.A 'good death“ is one where symptons are well controlled without over medicalisation, where there is an acceptance of death by the patient and loved ones and where appropriatepreparation and completion of unfinished business has occurred. The death itself is peaceful and the loved ones are present. However, patients or their families do not always accept the treatment or care that the nurses offer to facilitate the best quality of life and a ”good death“ for the patient. This may leave the nurses involved feeling distressed and confused, as they are confronted with the conflict between the patients' path and the nurses' ideals.This study employs critical incident technique to explore how nurses respond and feel when the patients decline the treatment or care the nurse feels will improve their quality of life and eventually lead to a ”good death“. The findings illustrate a broad range of treatment or care that is declined by either patients or their families in the first instance. This study uncovers a number of action responses nurses use in these situations, which demonstrate acceptance of patient choice but also need to help the patient experience a ”good death". In addition it demonstrates that nurses experience a gamut of emotional responses to such situations, some of which are painful for the nurse and have the potential to cause stress. Recommendations are made which may assist nurses limit the distress they experience when patients of their families decline the treatment or care, and empower nurses with further strategies to use in such situations

Abstract: Hope is considered an elusive, vague, over-used, and ambiguous concept in nursing practice which lacks clarity, but hope is essential to the quality of life in the terminally ill. Therefore, hope is an important concept to research further. A gap in nursing research has been identified in the area of hope in terminal illness. The aims of this research were to clarify the concept of hope as perceived by patients with a terminal illness; to develop hope as an evidence-based nursing concept; and to contribute new knowledge and insights about hope to the relatively new field of palliative care. Utilising Rodgers' (2000b) evolutionary concept analysis methodology and thematic content analysis, 17 pieces of research-based literature on hope as perceived by adult patients with any terminal illness pathology (from the disciplines of nursing and medicine) have been reviewed and analysed. Hope's attributes, antecedents, consequences, social-cultural variations, temporal variations, surrogate terms, and related concepts have been considered. An exemplary case of the concept in action is presented along with the evolution of the concept hope in terminal illness. Ten essential attributes of the concept were identified in this research: positive expectation, personal qualities, spirituality, goals, comfort, help / caring, interpersonal relationships, control, legacy, and life review. The evolution of hope in terminal illness has evolved from patients hoping for a prosperous healthy future to an enrichment of being is more important than having or doing. Patients' hopes and goals are scaled down and refocused in order to live in the present and enjoy the time they have left with loved ones. Hope in the terminal phase of one's illness is orientated in the past and the present, hope in the here and hope in the now. The author concludes that by completing all the steps to Rodgers' (2000b) evolutionary view of concept analysis, a working definition and clarification of the concept in its current use has been achieved, providing a solid conceptual foundation for further study. Recommendations are made for hope-enhansing strategies, that may help to maximise the quality of life of terminally ill patients in the future.

Abstract: Home Based Treatment in acute mental health care is a relatively new phenomenon in New Zealand, although it has been utilised successfully overseas for many years. This paper considers factors that are integral elements of its successful implementation, specifically considering the relationship of nursing care to crisis intervention methodology. It describes how Home Based Treatment fits with contemporary crisis services and how the adherence to crisis intervention models can enable nurses to create a clearly defined recovery perspective in their practice. The author notes that service users in New Zealand and overseas have openly voiced their concerns around the discrepancies between how services have traditionally been delivered and how they wish services to be. He suggests that, as an alternative to inpatient care, Home Based Treatment is an option that promotes recovery and self determination. It is also an arena in which nurses can deconstruct the traditional power relationships between themselves and clients to create a new and invigorating way of practicing.

Abstract: Highlights how women challenged the concept of 'medicalised mothering' during the period 1945-2000, and how these views affected the development of the Well Child/Tamariki Ora Health book, or Plunket book. Analyses how the language of the book reflects tensions between competing discourses and knowledge sources among mothers and health professionals.

Abstract: Presents the findings of an integrative literature review exploring the possibility of applying Historical Trauma Theory to nursing practice. Uses Kaupapa Maori research methodology to apply Historical Trauma Theory to health care practice, in a Maori context. Considers how trauma theory can be used to support Wilson and Barton's Te Kapunga Putohe nursing model.