Abstract: This research examines how nurses negotiate the context of the Intensive Care Unit (ICU) while working with families. The action research described in this thesis developed through a series of meetings and conversations where the conversations supported the reflexive intent of the research. In commissioning the research, the design of the meetings and conversations were as a series of overlapping actions. Data collection and data analysis occurred in the action research by meetings, reflective conversations, ad libitum observations, and in a research journal. Conceptual maps explain the progress and findings of the research in this thesis while categories distilled from the conversations also support the findings in the research. The Family Action Research Group that was established within this project proposed a Family Assessment Form for the family to provide an assessment of themselves and the patient. Implementing this assessment tool demonstrated that clear information was needed for the family in the ICU. Findings in this research focus on developing action research and family care in ICU. Findings also focused on the role of the researcher being of and not being of the context where action research is undertaken. Recommendations include staff examining relationships for potential asymmetries and seeking ways to address these to support families and staff. Suggested strategies for developing action research in a clinical context include detailed planning, clear focusing, transparency of data, and working to explain change initiatives through the research are also included.

Abstract: Explores family-inclusive practice in Adult Community Mental Health in a District Health Board. Focuses on what adult community mental health nurses and clinical managers consider to be barriers and facilitators to family-inclusive practice. Explores community mental health nurses' and clinical managers' perspectives of family-inclusive practice through semi-structured interviews using a descriptive qualitative design.

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: Grounded theory methodology has guided the grounded theory methods used to explore the acute care paediatric nurses' perspective of what they do when a child has had a severe accident. The research was initiated from the experience of nursing children in the context of a rehabilitation centre and wondering how acute care nurses promoted a child's recovery after a severe unintentional injury. Many avenues were used to search international and New Zealand literature but the scarcity of literature related to what acute care paediatric nurses do was evident. Nursing children in the acute care ward after a severe accident is complex. It encompasses nursing the family when they are experiencing a crisis. It is critical that the acute care nurse monitors and ensures the child's physiological needs are met, and the nurse “works with” the child to maintain and advance medical stability. Nursing interactions are an important part of “working with”, communication is the essence of nursing. This research has focussed on the nurses' social processes whilst caring for the physical needs of the child and interacting with the family and multidisciplinary team when appropriate. An effective working-relationship with a nurse and family is founded on trust. Grounded theory methods supported the process of exploring the social processes of “building trust” whilst “working with” families in a vulnerable position. Nurses rely on rapport to be invited into a family's space to “work with” and support the re-establishment of the parenting role. The “stepping in and out” of an effective working-relationship with a family is reliant on trust. Nurses build trust by spending time to “be with”, using chat to get to know each other, involving and supporting the family to parent a “different” child and reassuring and giving realistic hope to help the child and parents cope with their changed future. A substantive theory of the concept of “building trust to work with” has been developed using grounded theory methods. The theory has been conceptualised using the perspective of seven registered nurses working in paediatric acute care wards that admit children who have had a severe traumatic accident.

Abstract: This chapter firstly offers background information in relation to palliative care and the role of women as providers of care in the home setting. Secondly, it discusses a study that evolved from a trend the author observed as a district nurse providing community palliative care in rural New Zealand and from New Zealand literature; that the majority of carers of the terminally ill in home-settings are women. The aim of this research study was to offer insights into the requirements of caring for a dying person at home and provide information to assist nurses working in the community and other women who take on the caregiver's role.

Abstract: The stories of the women who live and work in rural settings in New Zealand have begun to reveal unique contributions that they have made to their families and community. This research study evolved from a trend the researcher observed as a district nurse providing community palliative care in rural New Zealand; that the majority of carers of those who are terminally in home-settings are in fact women. This qualitative study aimed to explore through guided conversational interviews the experiences of four women who have cared for their terminally ill partners who have subsequently died. The study investigated if these women's experiences were comparable to that of other women in existing palliative care literature. This research project focused particularly on elucidating the women's experience of intertwining the role of partner and caregiver. Heidegger's hermeneutic philosophy informed the methodology because he focused on what it meant to 'be' rather than 'how we know what we know'. The project focused on the meanings the women made of this dual role in their lives. Women already in the role of partner were now faced with the added responsibility of caregiver to meet the complex needs of their loved one. Usually they had no training to prepare them for this experience. The study reveals ways in which the visiting palliative care nurse becomes very important to them. The women's own voices reveal the high level of respect for their partners and address the harsh realities, revealing poignant and striking concerns in their lives. These stories are shared with the intent of enriching nurses' and other health professionals' understanding of the women's experiences. The author notes that understanding these women's experience is not only a way of honouring these remarkable women but more widely it will inform and possibly transform practice through guideline and policy refinement.

Abstract: This book presents the reflective account of an actual nursing practice situation (a woman living with chronic asthma).The author provides a descriptive narrative and then delves deeper into the narrative to obtain greater understanding of what she calls “strife” in chronic illness and the best nursing practice to assist its resolution.