Abstract: This thesis investigates the relationship between language, 'discourse' and professional knowledge and power in a specific context; that of surgical nurses' “talk” about their work managing pain in hospitalised patients. This thesis argues that the work of 'caring for' hospitalised surgical patients who report pain is influenced by discourses which are predicated on different readings/understandings of the body/patient, and from which different knowledge is constructed. Of interest to this thesis are the discourses of biomedicine and nursing, and their role in constructing a particular reality/ies which determine the ways in which surgical nurses talk about their work managing pain. Using the method of critical discourse analysis, the “texts” of transcribed audio-taped conversations with four registered nurses working in surgical specialties were analysed to uncover 'discourses of pain management'. The results of the analysis indicate that the biomedical construction of pain, and approaches to pain management, remain the dominant influence over surgical nurses' practice. There was evidence of nursing discourses with an emphasis on nurse-patient relationships also playing a role. These discourses were critically examined for what they reveal about relations of professional knowledge and power in this specific context of the nurses' practice. The implications for nursing and nursing research are considered significant because the study critically (re)presents a different perspective on, and reality for surgical nurses' pain management practices. In so doing, it elucidates an explanation for, and understanding of, why surgical nurses take care of patients reporting pain in particular ways.

Abstract: The objective of this meta-analysis was to assess the effectiveness of pentoxifylline as an adjunct to compression bandaging in the treatment of venous leg ulcers. The CENTRAL registers of the Cochrane Peripheral Vascular Diseases and Wounds Groups were searched – each register is routinely updated by extensive searches of electronic databases, handsearching of relevant journals and conference proceedings, and contact with product companies and experts in the field. The drug's manufacturer was contacted and the references of review articles and all obtained trials were scrutinised for further citations. Randomised controlled trials published in any language comparing pentoxifylline and compression with placebo in adult participants with venous ulceration were included. Trials must have reported a meaningful objective outcome (rates of healing, proportions healed, time to healing). Details from eligible trials (independently selected by two reviewers) were extracted and summarised by one reviewer. A second reviewer independently verified extracted data. Eleven clinical trials were identified. Five trials compared pentoxifylline with placebo (compression standard therapy). Six trials were excluded. Pentoxifylline and compression was more effective than placebo and compression (RR 1.30, 95% C1 1.10-1.54) and was robust to sensitivity analyses. The greater number of adverse effects (46 reports) occurred in the pentoxifylline group, although this was not significant (RR 1.12, 95% C1 0.77-1.62); 34 percent of adverse effects were gastro-intestinal. Seven of 21 reported withdrawals were for adverse effects. In conclusion, pentoxifylline appears an effective adjunct to compression bandaging in the treatment of venous ulcers. The absence of cost-effectiveness data suggests it not be employed as a routine adjunct, but it could be considered as for those patients not responding to compression therapy alone. The majority of adverse effects are likely to be tolerated by patients.

Abstract: For nurses to have control over their practice they need to have input into policy development. Nurses having control over their practice has been linked to nursing empowerment. Therefore the question explored in this research project is: What can nurse leaders do to encourage an empowering environment for nurses working in the mental health area? The literature reviewed for this project includes empowerment, power, the history of nursing in relation to women's role in society, oppression and resistance, and literature on Critical Social Theory as the underlying theoretical and philosophical position which informs the research process. In order to answer the research question a single focus group was used to gather data from a group of registered nurses practising in mental health. Focus groups as a data collection method produce data and insights that would be less accessible without the interaction found in the group. The key themes to emerge from the data analysis were: power is an important component of empowerment and power relationships; and at a systems level, professional, organisational, and political influences impact on feelings of empowerment and/or disempowerment. These key themes are discussed in relation to the literature and the broader social and cultural context of the mental health care environment. The contribution this research makes to nursing includes a list of recommendations for nurse leaders who aim to provide an empowering environment for nurses practising in mental health.

Abstract: This nursing study seeks to understand the experience of one group of people with chronic renal failure using renal replacement therapy, Pakeha men living on home haemodialysis. It is based on the assumptions that people living on dialysis have distinctive experiences that are characterised by common concerns reflecting their shared position as subjects of renal illness and therapy. In order to understand the experience of people living on dialysis, this study develops a critical interpretive approach, seeking the participant's own interpretation of their individual experiences. The experiences are then reinterpreted them from a critical standpoint, recognising that they can only be adequately understood by contextualising them. This enables the researcher to discern the common perspective underlying them in contrast to the dominant professional viewpoint in the renal setting. The concerns identified include symptoms from chronic renal failure and dialysis, limitations resulting from the negotiation of the therapeutic regime into their lifestyle, their sense of ongoingness and uncertainty of living on dialysis, and the altered interrelationship between autonomy and dependence inherent in living on dialysis. The study suggests that the individual accounts can be understood as resulting from the interaction of the various dimensions of their own personal social locations, including their gender and ethnicity, with the concerns of client discourse, reflecting their common position as people living on dialysis. The author concludes that one implication of this understanding is that the role of nursing in the renal setting can be articulated as a response to the experience of the person living on dialysis. The nurse can support the renal client in seeking to integrate the requirements of the therapeutic regime into their personal situation.

Abstract: Nursing in New Zealand has been a recognised profession for one hundred years. Throughout this time the profession has made a significant contribution to the health of communities, nationally and internationally. Despite the obvious effort and achievement, the author suggests that the evidence of this contribution is not well known. She goes on to say that nurses, now as never before, are challenged to show how they 'add value' and to explain why nursing expertise is essential to safe service delivery. Finding a way to communicate this contribution has been identified as one of the most important issues facing the profession. This thesis explores the concept of contribution and presents a model, the 'Contribution Model', to show how nursing can articulate the action and achievements that show how nursing professionals have and will continue to contribute to health gain in New Zealand. Through the application of the 'Contribution Model' and framework presented in this thesis, nursing is shown to have made a contribution to health gain by using the broad range of knowledge, skills and experiences in a wide range of settings, to provide care wherever and whenever required. Case studies and scenarios from history, observation and prediction are used to show how the actions and achievements of nursing meet the expectations of individuals, the community and society: past, present and future.

Abstract: The purpose of this hermeneutic phenomenological was to unveil a deeper meaning and understanding of gerontology nursing, thus contributing to its value and worth as a speciality area of nursing. Conversations with four gerontology nurses were taped, transcribed and then analysed using van Manen's (1990) approach to researching lived experience. From the analysis, four cardinal elements emerged: true acceptance, personal knowing, being present, and being alive. Those four cardinal elements were reworked and further analysed to reveal three central aspects or essences of gerontology nursing. These essences were the centrality of temporality, the interconnectedness of human relationships, and the significance of the lived body. Temporality is demonstrated by nursing application of objective, or clock time, as well as subjectively in regards to the lived time of the clients. Interconnectedness is the lived human relationship between nurse and client and is represented by commitment, presencing/giving of self, connecting, and knowing the client holistically. The third essence is corporeality, which is portrayed by the gerontology nurses' distinguishing characteristics and their perception of the lived body of the nursed. The final analysis unveiled caring for the body, the act of seeing, and the joy of care as emergent essences of gerontology nursing. Language of nursing in relationship to 'basic nursing care' is critiqued for its potential to devalue gerontology nursing and, by association, old people.

Abstract: This paper focuses on the history of Plunket nursing and Truby King's ideology and other dominant ideologies, during the years 1905 – 1920. To provide a context, the paper explores the development of a new nursing speciality – Plunket nursing, that became part of the backbone of a fledgling health system and the New Zealand nursing profession. Correspondingly, Truby King presented the country with a vision for improving infant welfare underpinned by his eugenics view of the world and his experimentation with infant feeding. The author argues that nurses were drawn to the work of the newly created Plunket Society and that the Society had lasting influence on the development of nursing in New Zealand.

Abstract: This thesis presents an explorative study of the place of caring in bioethics. Through the examination of various sources of literature from the disciplines of nursing, feminist theory and ethics, and bioethics, a case is developed that argues for a valid respected place for caring, as an ethic of care in bioethical decision-making. The case is built by providing evidence to support the fundamental importance of caring to human life, health, relationships, and survival at the broad societal level. This is presented from the feminist and nursing perspectives, along with a critique of the negative aspects of caring practices. The next stage of the case presents a layout of the discipline of bioethics, using an historical perspective to illuminate the influences of bioethics' deep past, as it still affects the discipline in the present. The development of contemporary bioethics' current status is presented along with critiques from bioethicists themselves, and nursing and feminist theory and ethics. In the case at this point, from a bioethical perspective, two major predicaments appear to prevent an ethic of care obtaining a valid place in ethical decision-making in bioethics. These are the justice/care duality, and the conflict between different conceptions of care and autonomy. The bioethical objections and arguments put forward regarding these predicaments are examined and refuted, and the author suggests a case is established for the inclusion of an ethic of care in bioethical decision-making.