Abstract: Postnatal depression is a term used loosely to describe disorders of mood and distressing symptoms for women in the postpartum, yet it has its own distinct symptoms. It is thought to affect between 10 and 20 percent of new mothers in New Zealand. In order to deliver effective nursing care that has a positive impact on the health of women who experience postnatal depression, nurses need knowledge and theory to underpin practice. This study explores the experience of four women who experienced postnatal depression and the care they received from a nurse. A postmodern feminist position informed the research project. Women became actively involved in a focus group to explore their experiences. A thematic analysis of the focus group transcripts revealed the women's experiences of care from nurses and health professionals as not always helpful. The themes that arose from the analysis were knowledge, perception, care and self. Knowledge examined the women's and significant others' knowledge of postnatal depression as well as women's own knowledge of themselves. Perception identified the women's beliefs of and views on mental illness, as well as their expectations of motherhood. Care as a concept was examined as to how it was provided by nurses. This encompassed a lack of care and, in contrast, supportive care as impacting on the women's individual experiences. Self described the experiences of a loss of self as women experienced their distress in the postpartum, and that a regaining of self was identified by women as difficult, and this is where they required support. The themes are discussed and critiqued with literature that identifies the nursing role with women who experience postnatal depression. There are recommendations for ongoing research and development of the nursing role in order to promote the health and wellbeing of women in the postpartum.

Abstract: A study to examine the effects of pre- information ( what a Nurse learns about a patient before they meet) on clinical inference and Nursing actions, in a simulated Nurse- Patient situation. It was hypothesized that the nature of the pre-information will influence the way the patient is perceived and the resulting Nursing actions. The research was conducted in an obstetrical setting. There were 55 subjects within three groups. Two groups comprised student midwives and the third group was of second year comprehensive Nursing students near completion of clinical experience in maternal and child health nursing. A 5 minute videotape sequence of a role played post natal patient was made for use in the research. All subjects were given the same initial pre-information, viewed the videotape and gave written description of what they saw on the videotape and their response ( as the Nurse in the situation). This data provided a base line for each subject. Subject were then given additional pre-information concerning the patient's physical condition, her baby's condition or formed part of the control group ( receiving no additional information) The procedure was repeated. These responses were then compared with the base line for each subject. Responses were coded by means of content analysis. Group data was analysed using multivariate one way analysis of variance graphical display. The results indicated support of the hypothesis that the nature of the pre-information does influence the way in which a Nurse perceives a patient and resulting Nursing actions. Implications of these findings for Nurses are discussed

Abstract: There has been a great deal written about the efforts of the nursing profession to achieve full professional status but little about individual nurses' aspirations in seeking this goal. A group of 6 co-researchers, myself included, looked at this perceived gap in nurses' dreams for the profession.The philosophical underpinnings of the research were feminist and reflected postmodern feminist and some radical feminist concepts. This philosophical positions guided our research to uncover the knowledge of how we actively construct ourselves into dominant social values. This means we were searching for how our dreams were constructed and how we reflected the values of society in the way we produced our dreams. Peace and Power (Chinn & Wheeler, 1989) was used to guide the group interaction and Memory-Work (Hague, 1987) for data collecting and analysis. The co-researchers wrote individual stories about their dreams for the nursing profession. Collective analysis of the stories occurred in order to uncover the was in which the dreams were constructed. From this collective analysis the individual co-researchers redrafted their stories. Each redraft contained new insights, motives and actions of ourselves and others, forgotten experiences and inconsistencies, as a means of identifying and questioning dominant ideologies. The aim was to move towards empowerment through making the unconscious conscious.Four common dreams emerged from analysis of the stories: the first was that individual nurses want full professional status and autonomy; the second asked the nurses to care and support each other; a high standard of patient and nursing-focussed care was the third dream; and the fourth was for continuing education and knowledge to be shared between nurses. Although the dreams were common across the group it was found that the dreams varied in their construction. The dreams for each group member reflected multiple realities that emerged from different contexts, influenced by historical and socially dominant cultural values.Through studying and theorising our dreams for the nursing profession, we increased our understanding of how they were shaped so that we were able to initiate change and make our dreams become a reality. This has implications for the nursing profession. We live our lives collectively, as nurses and women, as others influence our being and reality. Although others influence us, it is each individual nurse who contributes to actively construct her/himself in to the dominant cultural values held by society and therefore up to each individual to initiate change. If nurses are able to make dreams a reality then positive changes will occur within the profession; I.e. decreased staff turnover, increased morale and increased quality in patient care

Abstract: The subject of nursing leadership is approached by reviewing the literature of two prominent nursing theorists, Patricia Benner and Jean Watson, and the literature of transformational leadership. Common themes are identified. An exhortation is offered to nurses to consider that the caring characteristics of nurses are what is required in the corporate world of management. Chapter 1, questions whether nursing and management are different worlds or shared realities. It outlines the author's experience of practising as a manager in a complex organisation and the seeming barriers that exist between managers and nurses and management and nursing. A questioning of those barriers became the impetus for the review. Chapter 2, outlines the work of Patricia Benner and Jean Watson. Caring is identified as a core concept which is said to differ significantly from a conventional understanding of helping and is inextricably linked to a profound understanding of what it means to be human. Chapter 3, reviews the literature of contemporary managers who are exploring a transformed approach to leadership and management. Six themes are identified that are common to nursing theory and transformational leadership theory. Chapter 4, acknowledges that despite the similarities between nursing and contemporary management thought, there remains a gap between nurses and management. Rather than feeling optimistic about the future, and confident in assuming leadership roles, many nurses feel defeated and fearful about the future. It is suggested that this may be a consequence of bad experience of leadership, of loss of joy of caring and of failure to value the strength residing in the collective community of nurses. Nurses are encouraged to recognise that their knowledge and experience of caring and wholeness, healing, sharing and enabling, are the attributes that equip them to be leaders of the future health and corporate world.

Abstract: Effective nursing prioritisation of the patient need for care is integral to daily nursing practice but there is no formal acknowledgement or study of this concept. Utilising the retroductive research strategy of critical realism, this thesis explores the nursing literature for the tacit knowledge of the discipline about nursing prioritisation and proposes a 'fit' for nursing prioritisation of the patient need for care within the bigger picture of nurse clinical decision-making. The tacit knowledge discerned within the literature indicates that nurses use discretionary judgment and ongoing assessment to determine the relative importance of the many aspects of individual patient situations as they unfold. Such nursing prioritisation takes place concurrently between the competing or even conflicting needs of the several individual patient presentations within the nurse's caseload. Varied frames of reference within different practice settings create specific imperatives on this dynamic and non-sequential process. Starting with an initial set of studies in the 1960s, study of clinical decision-making in nursing has created a significant body of knowledge encompassing a range of approaches. Nursing prioritisation of the patient need for care is most readily discerned in the interpretive perspective and in the plain language descriptions of nurse decision-making. Within the selected literature it is apparent that nursing prioritisation of the patient need for care is an advanced skill of nursing that is developed in practice and honed through experiential learning.

Abstract: This project undertakes a critique and review of a decade (1990-2000) of available New Zealand literature to reveal the current state of nursing informatics utilisation in nursing practice. Since the early 1990s, nurses from diploma and baccalaureate nursing programs have been graduating with knowledge and skills in nursing informatics. Yet, when scrutinising the two main nursing publications for New Zealand, the author found scant publication of articles that pertain to this topic area of nursing. Competencies as product of the 1989 Guidelines for Teaching Nursing Informatics are a key consideration in this discussion, including ways in which the articles may reflect the content or intent of the Nursing Informatics curriculum as prescribed in these guidelines. This commentary discusses how nursing informatics has evolved in New Zealand nursing practice, situating its growth, or lack of, in the context of concurrent sociopolitical influences as well as conditions created by national and international nursing trends. Several recommendations are discussed to guide the future direction of nursing informatics for nursing education and practice in New Zealand.

Abstract: Practice development, situated at the nurse-patient interface, is a crucial aspect of professional development as a whole. The Nursing Development Unit (NDU) is one model of structured clinical practice development. NDU have their origin in a desire to provide the best possible care for patient through the support and development of autonomous therapeutic nurses. All possible sources of NDU-related literature from 1983-1999 were reviewed to determine the effectiveness of the NDU model. The purpose of the research was to establish the role of the parent organisation in supporting the ongoing viability of NDU; to describe the key processes and activities of NDU that are instrumental in the development of nursing practice; to clarify the role of the NDU in contributing to improved patient outcome; and finally to identify the critical indicator of successful NDUs for their application in the New Zealand context. The study found that British nursing journals have played a large part in promoting the NDU model. The pioneering units were given positive coverage and this has by and large continued. Accreditation systems have been important in maintaining standards and providing a generic framework for implementation. The trend is now towards internal funding from the parent organisation. The review identified a number of key features for the successful establishment of NDUs. NDUs appear to have under emphasised the development of socio-political acumen in the nursing staff. However, the NDU does offer a model for the development of confident, assertive, autonomous professionals. The NDU model values nursing as professional practice. The author concludes that the NDU model has stood the test of time, and demonstrated the ability to be at the vanguard of contemporary practice development. The model is flexible and its potential is maximised when it is tailored to meet the need of the parent organisation. The model has been successfully established in Australia, and has the potential to be adapted and refined for the New Zealand context.