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: Making the transition to an area of specialist nursing practice is challenging for both the learner and staff who are responsible for education and skill development. This study uses grounded theory methodology to explore the question: “How do nurses learn critical care nursing?” The eight registered nurses who participated in this study were recruited from a range of intensive care settings. The criteria for inclusion in the study included the participant having attained competency within the critical care setting. Data was collected from individual interviews. This study found that nurses focus on two main areas during their orientation and induction into critical care nursing practice. These are learning to do (skill acquisition) and learning to be (professional socialisation). The process of transition involves two stages: that of learning to do the tasks related to critical care nursing practice, and the ongoing development of competence and confidence in practice ability. The relationship of the learner with the critical care team is a vital part of the transition to competency within the specialist area. This study identifies factors that influence the learner during transition and also provides an understanding of the strategies used by the learners to attain competency. These findings are applicable to educators and leaders responsible for the education and ongoing learning of nurses within critical care practice. The use of strategies such as simulated learning and repetition are significant in skill acquisition. However attention must also be paid to issues that influence the professional socialisation process, such as the quality of preceptor input during orientation and the use of ongoing mentoring of the learner.

Abstract: The author notes that responses to questions from dying people and their families are as individual as each nurse, patient, family member, or situation. This is well recognised and an unspoken truth in palliative care practice. This paper explores the subjective nature of knowledge in palliative care generated through capturing moments of practice and subsequent reflections. This demonstrates how the author uses her model of care to open a space that enables the person and their family to find meaning from their experience and articulate what they need at the time. The author identifies her interest in the paradoxical reality of knowing and not knowing and describes how that paradox contributes to her role in supporting individuals' needs within their realities.

Abstract: This thesis focuses on the experience of being human as process in order to reveal being. Illness and health are seen as reflections of this process of revelation. This work argues that health and illness are physical expressions of consciousness and therefore an outcome of what a human being has thought. In this way, this work shows how thought/intent serves to create life in the moment. In this understanding lies the potential to change reality, to change life. The thesis identifies self-responsibility as the key to changing consciousness. Taking responsibility for the creation of one's reality eliminates the human tendency to blame another for what is experienced in life. To that end, this work argues, we are each free to choose what is felt in response to life. In so doing, we can become conscious that life is a choice, that is to be approached from either the position of perfection, or excellence. The author proposes that, in the understanding that human beings are the creators of their reality, it is possible to conceive of care in nursing that is directed at changing thinking/thought. Such change would be to focus on the excellence of life, and in that way enact care in nursing that is an enabling through a process of being that is an emotional allowance in response to life. To this end, this work is titled Nursing as an Aesthetic Praxis. The aesthetic is emotion and feeling. Praxis, is presented in its dialectical relationship of thought and action that is then bound to emotion and feeling in such a way that it illuminates the nature of thinking. This way of thinking, this work shows, is transformatory. Where transformation is a process of being that as a state of excellence is one of incremental human freedom accompanied by incremental responsibility.