Abstract: In 2003 the Health Practitioners Competence Assurance Act was introduced and established separate regulatory authorities for nursing and midwifery. This study is designed to explore the experiences of dually registered practitioners affected by this divide, as now there are two separate and possible paths, and two corresponding sets of competencies to fulfil. The design for this qualitative descriptive study utilised the written and oral narratives of three practitioners affected by this professional regulation and demonstrated its impact on their career development. Individual storytelling, as narrative, provided a theoretical lens aiding insight into their experience and pattern of decision making. In addition, symbolic consideration of the study data was provided by collective storytelling via the perennial myth of the hero journey. Shifting professional ground following the Health Practitioners Competence Act 2003 generated a focus for the inquiry into practitioners' modes of adjustment. For the practitioners in the study, transition between the occupational roles of nursing and midwifery comprised the possible career trajectories. A status passage, as the process of change from one social status to another, is described and includes the transitional experience of anticipation, expectation, contrast, and change. The author suggests that the findings from this research provide illumination of the nuances of professional decision making as a lived experience, and highlight how these practitioners dealt with shifting meaning, values, awareness, choices, and relationships. Aspects of group agency and identity, change management, and professional role transition were revealed. Life pattern, revealed through narrative, was an important research construct for exposing the ways in which the participants negotiated change, and displayed the function of their thinking and reasoning through dilemmas. Perception of individual and group identity revealed attitudes of esteem to the dominant discourse, and exposed dynamic tension between work patterns and life stage. Renegotiating arrangements of personal and professional commitment resulted from this dynamic interplay, and the relationship to stress and burnout was explored.

Abstract: This dissertation explores the issues affecting the exposure of isolated rural nurses working in New Zealand to violence from members of the local community, including the visiting public. Discussion on the collaborative role with the New Zealand Police is thematic in the issues presented. Challenges presented include the unique community dynamics of the Stewart Island nursing practice on the Island, with scope of practice, isolation and practice issues included. Role definition, present-day health-care delivery, the potential for violence including causation and reporting are presented. Incident management and risk strategies, including de-escalation are rationalised and described. Evidence for the nurse-police inter-service relationship along with issues including confidentiality and legislation are reviewed. Recommendations and conclusion are provided. The thread and theme of the dissertation is to encourage discussion within nursing circles on the provision of satisfactory safety standards for nurses working in remote isolated parts of New Zealand.

Abstract: This study explores how registered nurses working within the acute surgical ward environment of a New Zealand hospital communicate changes in a patient's condition. The purpose of this research study was to examine the processes, communication techniques and behaviours that nurses use, in order to determine the critical requirements for registered nurses to effectively communicate changes in patients' conditions to doctors. The critical incident technique developed by Flanagan (1954) was adapted and used to explore incidents that occurred when six registered nurses working in acute surgical wards communicated a change in a patient's condition to a doctor. Communication is an integral part of everyday activity. This study has shown an assessment process occurs before communication can take place. A nurse's concern for a patient's condition initiates the assessment process. A judgement is formed from the nurse's concern that a patient's condition has changed. Judgements take into account multiple ways of knowing including pattern recognition, empirical knowing and intuition. Institutional protocols also affect judgements and the ability of a nurse to ensure support is received for the patient's well being. The communication process is initiated for two reasons, to support the patient, and to support the nurse in providing care for the patient. Significant in determining the need for support is the action required that might be outside the nurse's scope of practice. The response should address the nurse's concern and take into account the importance of the relationship, trust between all parties, respect of each other's positions and knowing team members and their capabilities. Understanding these aspects of the communication process should enhance nurses and doctors abilities to effectively communicate regarding a change in a patient's condition.

Abstract: The prevalence of allergic disease has increased significantly in western countries over the last decade. However, the author points to the availability of specialist allergy services in New Zealand being limited to the large cities, resulting in a lack of, or fragmentation of, the allergy-related services in smaller regions. As a public health nurse in Otago working with a rising number of families with severely food allergic children, the author had become aware of the challenges many parents face in accessing accurate information about their child's allergy and the negative impact this has had on them and their child. The purpose of this dissertation is to explore how an Allergy Nurse Specialist (ANS) led service could improve the experiences and health outcomes of the families and children with severe food allergies living in Otago. A critical analysis of the literature on allergy nursing, advanced nursing roles, and related food allergy issues was conducted and applied to the Otago region. Drawing on the 'Nurse with a Special Interest in Allergy' model of nurse-led allergy care outlined by Cross (2005) and the existing Otago District Health Board's (2004) clinical nurse specialist role, the author proposes that an ANS-led model of care, incorporating advanced nursing practice, primary care access and multidisciplinary collaboration could complement the existing allergy related services in Otago. The focus of the ANS's care will be on facilitating timely access to accurate assessment and advice for families regarding the management of their child's food allergies.

Abstract: Death education encompasses many complex realities, for both the students and lecturers involved. This quantitative research explored the experiential and didactic preparation of nursing students through a content analysis, of one New Zealand, three year Bachelor of Nursing programme, in relation to death education. The Otago Polytechnic Bachelor of Nursing programme incorporates compulsory and optional courses, with the courses taught as an integrated programme with a progressive, sequential approach. This approach builds on content, deepening understanding from year to year, as well as providing opportunities for experiential learning and broadening of understanding. The literature review discusses three dominant themes of undergraduate death education: education, death, and transition. The data collection tool incorporates eighteen key terms, ten teaching methods and ten assessment methods. The programme and individual course documents, which define course content, teaching and assessment were scanned and analysed. The findings initially showed limited evidence of death education in course documents, however deeper analysis of the documents showed further evidence over the three year programme. The existence of death education is implied rather than overt throughout many course documents, through the use of broad practice statements. Content analysis is one way of shedding light on programme content in relation to death education. Limitations of the content analysis approach mean measuring experiential and didactic learning is not fully achievable from documentation analysis only. Further development of Bachelor of Nursing death education is an ongoing challenge, with current programmes very full and possibly lacking the capacity to increase content. Bachelor of Nursing programmes are discussed, highlighting the need for student focused learning with emphasis on acquiring and processing information, rather than mastery of content.

Abstract: There is limited nursing research as to how mental health nurses work with client stories. Furthermore mental health nurses have not been asked how they would define a client story within their practice. Client's stories allow promotion of the storyteller's experience leading to increased self awareness by supporting growth, and personal development of the individual through exploration of their experience. While listening and working with these stories, mental health nurses are able to interpret, reframe and validate the experiences and meanings disclosed over time. Three community mental health nurses were interviewed about how they identified client stories within their clinical practice. They explained how they created an environment for stories to be told, and worked to enhance meanings, and view alternative possibilities by 'carrying' the story until the client was ready to explore it. By working and understanding stories, mental health nurses were able to work collaboratively with the client to provide humanistic care. Themes of therapeutic relationship, purposeful use of self, and narrative as therapy were identified within the nurse's stories, providing an understanding of how mental health nurses practice. This study was framed by narrative inquiry and influenced by Riessman and Polkinghorne. Core stories are presented from the analysis of the nurses stories about how they defined 'story' and worked with the client stories.