Abstract: Reviews the international literature on paramedic preparedness to provide palliative and EOL care in in the community, and applies it to the NZ context. Finds that paramedics would like improved education and better integration with traditional care providers, encompassing patients, family, whanau and carers. and that they stress the psychological, spiritual and cultural needs of their patients.

Abstract: In this project the author reveals how she is observing and thinking as she cares for people who are dying. She records her reflections and insights and reveals that there is life right up to the moment of death, having observed terminally ill patients choosing the precise moment to die. She describes her observations of these moments by using poetry and stories, and explores the implications for her practice as a result. The author presents her reflections using an individualistic, reflective and exploratory perspective which is informed by the work of nursing scholars. This paper is framed using the metaphors of a journey and a window to indicate the reflective process that the author used to journal her observations in practice over time.

Abstract: The focus of this research was to explore the migrant family's experience in palliative care. In writing this thesis, the author notes that it became evident that cultural safety was a connection that warranted further study in relation to end-of-life nursing care as was illustrated by the intergenerational case study of this migrant family in New Zealand. The use of the case study method of qualitative research enabled the voice of the migrant to be heard and the story of the migrant family's experience to be showcased. The uniqueness of this family's palliative care experience was around the religious and cultural needs and migration as a process of transition from a previous society to a new one. Palliative care was defined by the family approach with strong community support and empowered by culturally safe and appropriate nursing practice. End-of-life illness is a time when cultural perspectives are challenged for patients and their families and religious and cultural practices take on a new priority, regardless of how they have lived life previously. As a migrant nurse living and working in the New Zealand context, the author identifies as an important factor, the nurse-patient interaction as an encounter between two cultural perspectives, the patient's and the nurse as bearer of her own culture. Acknowledging this factor is an important step in developing a culturally safe approach to practice, an approach that proved to be a major ingredient in planning and caring for this patient and his family in end-of-life illness. This study and thesis explores the underpinnings of culturally safe palliative nursing care and identified 'reflexive bracketing' as a useful practice in the process.

Abstract: The delivery of palliative care within contemporary New Zealand society is discussed, in the light of the recent publication of The New Zealand Palliative Care Strategy (2001). The viewpoint taken is largely descriptive rather than prescriptive, being based on a literature survey of international research and academic theory, which is also informed by the author's professionally gained knowledge. Four different perspectives, comprising a mix of providers and recipients of care are investigated: those of central government planning; specialist palliative care units; aged-care complexes; and patients, family and whanau. As an area of healthcare which current demographic projections indicate will become increasingly significant, the provision of palliative care to residents of and patients within aged-care complexes receives special attention. A metaphor of “parallel travellers” on “parallel journeys” is used to provide a thematic basis to the paper. The lived experiences and perceptions of each group of “parallel travellers” are explored. Difficulties in defining and evaluating palliative care, the implications of main-streaming, the scope of palliative care provision, the educative role of specialist palliative care providers and the current focus on mechanistic outcome measures are discussed. It is contended that the values and goals, both explicit and implicit, of the four specified groups may not at present be sufficiently congruent to optimise the effective provision of palliative care from the point of view of all concerned. While adequate resourcing and a genuinely collaborative approach among healthcare providers are both acknowledged to be critical, the potential for palliative care nurse practitioners to be appointed to the role of “care co-ordinator” alluded to within The New Zealand Palliative Care Strategy (2001), is also seen as pivotal. Insights from a postmodern perspective are offered as one possible way of achieving greater congruence.

Abstract: This qualitative study focuses on van Manen's theory of the 'lived experience' in relation to two families and asks the first thesis question. What is the value of music in the care of someone who is dying? Over the course of their loved one's illness these families provided music in the patients home as part of their care. The study also captures the experiences of two nurses who work in the palliative setting, and their use of music in providing holistic care to their patients. Their experiences relate to the second question. How can nurses be assisted in introducing music into their planned care of patients? The results demonstrate the effectiveness of using taped music for someone who is dying, and the reduction in symptoms, such as anxiety, and pain. It also highlights the importance of the individual's choice, and the special moments that can be achieved for both patient and families when music is used in a caring, supportive environment. This encourages communication, especially in the sharing of emotions. This study may be the first qualitative study in New Zealand, that addresses the value of music in palliative care, therefore there is a need for continued research into this therapy as a treatment modality as part of planned care in palliative nursing.

Abstract: This study drew upon the theoretical insights of Michel Foucault to provide a discursive analysis of the term euthanasia, and the issues surrounding the “right-to-die”. It involved an analysis of primary texts from; nursing, general, and legal literature as well as the media between the years 2002-2004. Drawing upon data researched, the study analyses the main discourses regarding the practice of euthanasia for terminally ill individuals. The two competing discourses that emerged were what the author termed the sanctity-of life-discourse and the right-to-die discourse. The aim of the study was to uncover the discourses understanding of “truth” regarding the right-to-die. The analysis revealed that a small percentage of cancer sufferers (5%) die with their pain insufficiently treated and the right-to-die discourse claims that no individual should have to suffer needlessly, asserting the individuals right to autonomy. Directly opposing this is the sanctity-of life-discourse which states all life is sacred and nothing can justify euthanasia as an acceptable practice in society. These findings indicate the need for effective palliative care and pain management when caring for the terminally ill individual. The legal, ethical and moral implications of euthanasia are many and this study discusses the effects these may have on health professionals involved with the care of terminally ill patients. The study revealed an increasing deployment of the right-to-die discourse in the media and revealed concerns regarding the nursing profession's lack of preparation to deal with euthanasia if it becomes a legal option in end of life care.

Abstract: This research illuminates the challenges of living well within one's own family as a nurse caring for her own relative who is dying of a cancer-related illness. Developing a deeper awareness of the consequences of this caring work has been the central focus for inquiry in this research. Nursing requires epistemologies that encompass new ways of understanding how we live within our own families and communities and practice as nurses. The theoretical framework that guides this research interprets the French Philosopher Michel Foucault's (1926-1984) critical history of thought as an ethical project for nursing. It uses conceptual tools developed in his later writing and interviews to draw attention to how discursive knowledge and practices constitute subjectivity in relations of truth, power and the self's relation to the self. The first aspect of the analysis, landscapes of care examines the techniques of discourse as relations of power and knowledge that constitute nurse family members as subjects who have relationships with their own families and other health professionals. The second aspect analyses care of the self and others as self work undertaken to form the self as a particular kind of subject and achieve mastery over one's thoughts and actions.As an exploration of the complex and contradictory subjectivities of the nurse family member, this research illuminates the forms and limits of nursing practice knowledge. It shows how nursing is practised, and the identity of the nurse is created, through intellectual, political and relational work, undertaken on the self in relation to others, as modes of ethical engagement.

Abstract: Addresses the concerns of health professionals working collaboratively in palliative care. Conducts 25 interviews wit 23 participants to arrive at a theory of sharing time to explain the social process of collaboration while individually managing and maintaining their own areas of concern. Explains the concept of health professionals making time in their work days for and with each other to find common ground.