Abstract: The aim of this study was to determine whether hospital-based, home care, and district nurses identify a core set of organisational attributes in the nursing work environment that they value as important to the support of professional practice. Survey data, collected in 2002 2003 from 403 home care nurses in the United States and 320 district nurses in New Zealand, were pooled with an existing data set of 669 hospital-based nurses to conduct this descriptive, nonexperimental study. The importance of organisational attributes in the nursing work environment was measured using the Nursing Work Index-Revised (NWI-R). The authors found that at least 80% of hospital-based, home care, and district nurses either agreed or strongly agreed that 47 of the 49 items comprising the NWI-R represented organisational attributes they considered important to the support of their professional nursing practice. Mean importance scores among home care nurses, however, were significantly lower than were those of the other two groups. The authors conclude that the overall, hospital-based, home care, and district nurses had a high level of agreement regarding the importance of organisational traits to the support of their professional practice. The intensity of the attributes' importance was less among home care nurses. Further research is needed to determine whether this set of organisational traits, measured using the NWI-R, is associated with positive nurse and patient outcomes in home care and district nursing practice, as has been shown in acute care settings.

Abstract: This thesis looks at the prospect of developing and implementing case management as a model of care for complex patients in an acute medical setting. An extensive literature review was conducted to explore the concept of case management and to identify the role of the case manager, including the qualities and qualifications required for the position. Clinical pathways are a tool used in case management so these are also included in the literature review. As the author had been involved in the development of the first clinical pathway for Hutt Valley Health, this is used as an example to clarify how case management and clinical pathways can be used in conjunction. A discussion chapter examines the advantages and disadvantages of case management which shows that it can be an effective and efficient model of care through the development of clinical pathways. The ethical implications of case management are also considered. The thesis concludes with recommendations for the continued development of case management as a model of care to improve the quality of care for both patients and the organisation. During the course of the thesis, other areas that are worth further investigation have also been identified, such as the relevance of case management to different cultures. The thesis suggests that a proposal for case management for complex patients in the acute care setting is developed along with a job description for the role of the case manager.

Abstract: This study sought to determine the attitudes, beliefs and values towards clinical work organisation of students entering undergraduate medicine, nursing and pharmacy programmes in order to frame questions for a wider study. University of Auckland students entering medicine, nursing and pharmacy programmes completed a questionnaire based on that used by Degeling et al. in studies of the professional subcultures working in the health system in Australia, New Zealand, England and elsewhere. Findings indicate that before students commence their education and training medical, nursing and pharmacy students as groups or sub-cultures differ in how they believe clinical work should be organised. Medical students believe that clinical work should be the responsibility of individuals in contrast to nursing students who have a collective view and believe that work should be systemised. Pharmacy students are at a mid-point in this continuum. There are many challenges for undergraduate programmes preparing graduates for modern healthcare practice where the emphasis is on systemised work and team based approaches. These include issues of professional socialisation which begins before students enter programmes, selection of students, attitudinal shifts and interprofessional education.

Abstract: This study investigated the safety of working environments of a group of urban district nurses. Six district nurses were interviewed and participated in a focus group. The findings focus on the risks associated with client behaviour and with the organisational structure in which district nurses work. Recommendations for primary, secondary and tertiary prevention of harm to nurses working in isolation in the community are presented. The author describes her personal background in district nursing, which prompted the study.

Abstract: The aims of the study were to provide a deconstructive analysis of the concepts of risk and risk management, and to explore the historical context of mental disorder and the concept of risk, the clinical context of risk assessment and management, the cultural, political and economic context of risk, and the impact on mental health nursing and consumers of mental health services. This is undertaken by providing a critical review of the history of mental illness and its relationship to risk, examination of government policy on clinical risk management, analysis of a risk assessment model and a discussion of the political and economic factors that have influenced the use of risk assessment and management in clinical practice. The concept of risk and its assessment and management have been employed in the delivery of mental health services as a form of contemporary governance. One consequence of this has been the positioning of social concerns over clinical judgement. The process employed to assess and manage risk could be regarded as a process of codification, commodification and aggregation. In the mental health care setting this can mean attempting to control the actions and behaviours of consumers and clinicians to best meet the fiscal needs of the organisation. The authors conclude that the mental health nursing profession needs to examine carefully its socially mandated role as guardians of those who pose a risk to others to ensure that its practice represents its espoused therapeutic responsibilities.

Abstract: The authors trace a series of theoretical explorations, centered on the concept of cultural safety, with corresponding methodological implications, engaged in during preparation for an intensive period of fieldwork to study the hospitalisation and help-seeking experiences of diverse ethnocultural populations.

Abstract: This article explores the incorporation of western knowledge with kaupapa Maori in the delivery of health care. It presents a fictional kaupapa Maori service, as a tool to explore the change process and influence that organisational culture and leadership styles have on a process of integrating a kaupapa Maori nursing service. The importance of continual evaluation through quality assurance measures was also conveyed.

Abstract: This thesis explores the shared experiential journeys of four Pukorero (participants) who successfully completed detoxification and recovery programmes from AOD addiction. Three questions were used to guide the research process to enable the Pukorero to identify positive aspects of their individual detoxification and recovery programmes, surface any barriers and issues they experienced, and clarify the support they received throughout the process. Kaupapa Maori and narrative inquiry was adapted to undertake this study to capture the essence of Maori thinking and reality regarding AOD. Through the use of thematic analysis the data findings of the study reflect the views from each Pukorero of Wairua, Whakapapa and Whanau as key to their successful recovery. This supports the notion that a pathway of detoxification, recovery and hope exists to enable Maori and others to take the journey to reclaim their own health and well-being, and the health and well-being of whanau, hapu, iwi, and Maori community. In honour of these Pukorero, kaumatua, tipuna, whanau, hapu, iwi, Maori katoa, and to celebrate kaupapa Maori and narrative inquiry [as the preferred methodological approach], the use of our tino ataahua reo integrated with English throughout the thesis demonstrates the interwoven connections between the two cultures enshrined in Te Tiriti o Waitangi that comprise the nation of Aotearoa me Te Waipounamu of New Zealand.