Abstract: This feminist study is an exploration of the subjectivity of women working as nurses within the gynaecological ward. Gynaecology has a long history as a unique area of concern to the health practitioners of any given period. However, the author suggests, recently with the development of modern gynaecology, this specialty has become based on male knowledge and male texts, women either as patients or nurses appear voiceless within this canon. Major tests within nursing mirror a medical construction of gynaecology, with the women involved in the discourse again absent from the literature. To explore the nurses' reality within the gynaecological ward, the author has undertaken a feminist interpretive study. To contribute to this debate the author drew on certain specific notions from feminist and postmodern epistemologies. These notions of the Other, difference, the body and discourse provided a unique way of viewing the practice of the nurses in this gynaecological setting. These epistemological concepts were then interwoven with feminist strategies to undertake the research. Through the process of feminist praxis, which included the author working alongside the nurses and conducting in-depth interviews, three areas of general concern to the nurses emerged. Firstly the relationships, that is their relationships with each other as nurses and with their women patients. Secondly, the difficulties inherent in nurses' practice in this setting due to the nature of the experiences of the women they were nursing. These difficulties arose in relation to two particular situations, nursing women experiencing a mid-trimester termination and nursing women with cancer. Thirdly, the relationship with/in the medical discourse and individual doctors which, according to nurses, had a major impact on their work. This study contributes to nursing knowledge by providing a forum for the voices of women as nurses, who nurse women in the gynaecological ward, to be heard. The author concludes that nursing and feminism have much to offer each other and share an emancipatory goal of positive action to support and assist people in their lives.

Abstract: The research on which this thesis is based involves both a private narrative and a public narrative, with the story of cultural safety, and the history, theory and the future direction gathered into one qualitative work. The work is divided into three sections. The first is entitled, Ko Wai Matou? The Private Narrative. This section seeks to explore the historical, social, educational, physical, emotional, political and moral influences and ephiphanies which brought about the personality which introduced cultural safety ideas into nursing and midwifery. Early nursing practice is investigated and examples from practice are used to illustrate learning and consolidation of the ideas which led to Cultural Safety Theory. The second section is entitled He Huarahi Hou: A New Pathway. This section explains the progress of the theory and its relationship to education pedagogy and to nursing practice. Comparison between the work of Madeline Leininger and the Transcultural Theory of Nursing and the New Zealand concept of cultural safety is undertaken. The role and application of the Treaty of Waitangi to the theory of cultural safety is explored in this section. The third section, entitled He Whakawhanuitanga: The Public Narrative, looks at the introduction of cultural safety into the nursing education system and its implementation. The public and media reaction to the inclusion of cultural safety in the national examination for nursing registration and the subsequent parliamentary response are noted. The interviews with nursing and midwifery leadership, Maori and pakeha key players in the process and consumer views of the ideas are documented and pertinent excerpts have been included. The work concludes with a discussion on the likely future of cultural safety as a theory and in practice and outlines several issues which represent a challenge to the viability of the concept in nursing and midwifery education. The author notes that the story of cultural safety is a personal story, but also a very public one. It is set in neo-colonial New Zealand, but has implications for indigenous people throughout the world. It is about human samenesses and human differences, but is also a story about all interactions between nurses and patients because all are power laden. Finally, she points out that, although it is about nursing, it is also relevant to all encounters, all exchanges between health care workers and patients.

Abstract: This thesis is about caring for males, especially those males who could be considered “difficult” to care for through their use of behaviours such as silence, anger or defensive humour. This thesis is positioned in the view that these behaviours are often expressions of distress, which typically distance males from those who attempt to care for them. The author suggests that the word “distress” more accurately reflects the theme of the thesis, and it is used throughout the work. This thesis explores the interface between gender issues, nursing practice and caring for males. It is informed by a review of relevant literature and data gathered from a focus group of nine registered nurses. The analysis is framed by questions that are developed from a series of reflections on my personal and professional life. Critical social theory, with its emphases on dominant dialogue, power and emancipation is used to inform and guide this analysis. What is most obvious is the contrast between themes arising from the literature and those arising from the focus group. It appears that the literature, in the main, is critical of males in regard to concepts of masculinity, issues related to gender, and men's health. Males are portrayed as arbitrators of their own misfortune, as deliberately choosing a lifestyle that reflects poorly on their health, their self-expression, and communication with others. Concepts such as power and control over others, both at a societal and individual level, often feature. Conversely, the literature is noticeably lacking in regard to information about the health related experiences of males and about caring for males. In contrast, the participants of the focus group frame their discussion in the positive. For example, they suggest that males are interested in their health but require an environment that supports this expression of interest. They support this by identifying a range of behaviours they believe are effective in caring for males. The participants also suggest that it is the registered nurse rather than the male who manages issues to do with power and control. The thesis concludes that creating and sustaining an environment supportive of, and sensitive to the needs of males, is an activity that requires considerable thought, skill and experience. These areas are not adequately addressed in academic dialogue, research activity, or in the education of registered nurses. The thesis suggests that this situation is inconsistent with an ethic of care and that nursing should make a priority of broadening its research and knowledge base to better understand and care for males.

Abstract: A qualitative framework was used to explore the nature and the quality of interactions between sole on-call primary health care rural nurses and secondary care doctors as a component of rural nursing practice and representative of the primary-secondary care interface. Crucial to patient centred care, the premise was that the quality of this interface would be variable due to multiple influences such as: the historical nurse/doctor relationship that has perpetuated medical dominance and nursing subordination; current policy direction encouraging greater inter-professional collaboration; and changing role boundaries threatening traditional professional positioning. A total of 11 nurses representing 10 separate rural areas participated in semi-structured interviews. Rural nurses typically interact with secondary care doctors for acute clinical presentations with two tiers of interaction identified. The first tier was presented as a default to secondary care doctors for assistance with managing primary care level clinical presentations in the absence of access to a general practitioner or an appropriate Standing Order enabling appropriate management. The second tier presented itself as situations where, in the professional judgement of the nurse, the client status indicated a need for secondary level expertise and/or referral to secondary care. The needs of the rural nurse in these interactions were identified as access to expertise in diagnosis, therapy and management, authorisation to act when intervention would exceed the nurse's scope of practice; the need to refer clients to secondary care; and the need for reassurance, encompassing emotional and professional issues. The quality of the interactions was found to be variable but predominantly positive. Professional outcomes of positive interactions included professional acknowledgement, support and continuing professional development. For the patient, the outcomes included appropriate, timely, safe intervention and patient centred care. The infrequent but less than ideal interactions between the participants and secondary care doctors led to professional outcomes of intraprofessional discord, a sense of invisibility for the nurse, increased professional risk and professional dissatisfaction; and for the client an increased potential for deleterious outcome and suffering. Instead of the proposition of variability arising from interprofessional discord and the current policy direction, the data suggested that variability arose from three interlinking factors; appropriate or inappropriate utilisation of secondary care doctors; familiarity among individuals with professional roles and issues of rurality; and acceptance by the primary care doctor of the sole on-call primary health care rural nurse role and the responsibility to assist with the provision of primary health care. Recommendations for improving interactions at the interface include national, regional and individual professional actions.

Abstract: This report presents selected aspects of an inquiry based on a conversation with Raeleen, a graduate of a post-graduate nursing programme. Raeleen talks about her experience of critical thinking during her post-graduate studies. The authors suggest that, through this conversation, it is possible to explore the nature of critical thinking and examine the important roles teachers can play in facilitating its development. Includes discussion questions prepared by Rebecca Hennephof that consider the relevance and impact of critical thinking on nursing practice.

Abstract: Conducts an exploratory case study investigating the experiences of third-year undergraduate nursing students in simulations, collecting stories about their experiences in the clinical environment, and highlighting the potential use of simulation as an alternate learning environment to foster the development of clinical judgement in nursing students. Considers two research questions: how do nursing students experience simulation as an environment for learning, and how do nursing students' learning experiences in simulation and clinical practice influence their development of clinical judgement skills? Conducts one-to-one interviews and observes simulations in the course of an exploratory case study.