Abstract: Maternal child care in New Zealand has traditionally been given by a variety of providers from the private and public sector. The reorganisation of the health services has effected all forms of health delivery including maternal and well child care or well child care services. Contracting of services in a competitive environment has been an important feature of the reorganisation process. Ashton (1995) notes that the system of contracting has facilitated the introduction of new approaches to health from new provider groups, which are not necessarily based on primary health care principles. This has led to confusion for providers and consumers alike. In 1996 a new national schedule which described the services recommended for maternal and child care was introduced called WellChild/Tamariki Ora. A questionnaire based on this schedule was administered to a sample of 125 parents of children under five years of age in Hawkes Bay to investigate issues relating to the provision and receipt of well care services.Descriptive data showed that the major providers in the present study were doctors. There were significant differences found in the number of services received by the less educated, the unemployed, single parent families, and Maori and Pacific Island people.Perceptions about the helpfulness of services received were not related to ratings of the child's health. Parents who received a greater number of Family/Whanau support services rated their children's health more highly. Findings are discussed in relation to the previous literature and recommendations are presented with particular emphasis on the implications for nursing and the role of nurses in providing well child care services

Abstract: Work-related back pain among nurses is a problem of significant proportion. Nurses have a high rate of back pain compared to the general population and other occupational groups. There has been little reduction in the rates of nurses back pain and solutions to this complex problem continue to be elusive. Many quantitative studies have been undertaken examining and identifying the risk factors contributing to a high risk of back pain among nurses. Few of these studies focus on the complexities and context of the nurses physical and social environment. An exploration of these factors may assist to explain why interventions have not been successful and why the risk of back pain among nurses remains high.This study, using a qualitative methodology, explores nurses views and perceptions of the factors that they believe contribute to nurses having a high risk for work-related back pain. In-depth interviews were conducted with nurses working in previously identified high risk areas asking them about their perceptions of the risk factors and the activities that lead to risk situations for back pain. The strongest theme to emerge from the participant interviews was that it is the work demands from nursing that create and expose nurses to high levels of risk. Other risk factors identified were environmental hazards, equipment management and the physical work environment. The interview responses were analysed using two theoretical models of risk. The Health Belief Model examines risk behaviour using a cognitive psychological approach and the Social Model of Risk views all behaviour as influenced by the social environment. Both models offer explanations as to why nurses take actions that place them at risk for back pain. This study highlights the main ideas and concerns raised by the participants. It makes recommendations for managing the problem of work-related back pain in the nursing profession, and suggests areas where more research is needed

Abstract: This study considers the influence of legal status, interactive processes, and mediating factors upon patient perception of coercion, within the context of admission to mental health services in New Zealand. The admission experiences of 69 involuntary inpatient psychiatric admissions and 69 informal admissions are compared using the MacArthur Admission Experience Survey. The influence of demographic, clinical and situational variables on the experience are considered. The results indicate there is a strong significant difference in the perception of coercion between involuntary and informal patients, with legal status having predictive value in relation to patient perception of coercion. Patient perception of procedural justice is strongly negatively correlated with perception of coercion. Perception of negative interactive processes is strongly felt by involuntary patients. This experience is not fully explained by identifiable incidents throughout the admission process. In the New Zealand context, there remains a need to highlight the aspects of procedural justice which could be improved in order to reduce patient perception of coercion. Current methodology focuses on the experience of admission rather than the expectation of that experience. This point needs to be considered in relation to the experience of Maori (the indigenous people of New Zealand)

Abstract: Aim: To determine the feasibility of establishing a nurse practitioner-led, family focused, primary health care clinic within a primary school environment as an alternate or complementary way of addressing the health needs of 'at risk' children and families to the services already provided by the public health nurse.Method: Utilising needs analysis method, data was collected from three sources – known demographic data, 17 key informant interviews and two focus group interviews. Questions were asked regarding the health needs of the community, the perceptions of participants regarding the role of the public health nurse in order to determine if a public health nurse would be the most appropriate person to lead a primary health care clinic, and the practicalities of establishing a clinic including services participants would expect a clinic to provide. Analysis was descriptive and exploratory.Results: A wide range of health needs were identified from both the demographic data and from participant interviews. Findings also showed that participant's understanding of the role of the public health nurse was not great and that community expectations were such that for a public health nurse to lead a primary health care clinic further skills would be required. Outcomes from investigating the practicalities of establishing a nurse practitioner-led clinic resulted in the preparation of a community-developed model that would serve to address the health needs of children and families in the area the study was undertaken.Conclusion: Overall findings indicated that the establishment of a nurse practitioner-led, family focused, primary health care clinic in a primary school environment is feasible. While a public health nurse may fulfil the role of the nurse practitioner, it was established that preparation to an advanced level of practice would be required. It is likely that a similar model would also be successful in other communities in New Zealand, however the health needs identified in this study are specific to the community studied. Further community needs assessments would need to be completed to ensure health services target health needs specific to the communities involved.

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: This study aimed to identify how graduates perceived their clinical performance during their first year of practice. A convenience sample of 30 graduates was surveyed after 3 months and 7 months in practice, using an adapted form of a questionnaire devised by Ryan and Hodson (1992). The results showed that over time, graduates generally required less direction in all areas of clinical competence. After 7 months in practice, the majority of the graduates rated their performance in nursing skills, communication skills, and professionalism at the expected level or above. However, some still required direction with using theory and research in practice, with meeting client's psychosocial needs and with teaching clients. In the leadership competency, after 7 months, most graduates saw themselves functioning at the expected level related to client care and needed less direction in unit management skills. However, many of the unit management skills were rated as 'not applicable' indicating that new graduates are not initially placed in a management role. Implications for nursing education and limitations of the research are discussed.