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: By describing and gaining insight into one rural nurse's experience working with dying people in a highly, remote rural area, this project seeks to advance nursing practice. Key findings indicate that, through community partnership and teamwork, nurses can act to assist rural people by: increasing public awareness of health resources; exposing barriers to access; and identifying different health service needs. The author makes a case that some rural nurses may feel insufficiently prepared for rural nursing. To understand death and dying, key ideas from Kuebler-Ross's (1969) framework for dying are examined: denial, fear of dying, spirituality, hope, depression and how to die well. Nurses require a blend of end-of-life and rural nursing postgraduate education and skills, to manage well. Key findings imply that dying people can be helped by: improving function and independence to promote autonomy; encouraging faith, hope, and love within the person's personal concept of spirituality; listening to dying people, to oneself, to one's own reactions, and knowing oneself. Parse's theory (1981) indicates nurses can help rural dying people by the following key factors: encouraging the person to live life to the full while dying; accepting humans cannot be separated from their perspectives, circumstances or environments; focusing on quality of life from the person's perspective: encouraging the person to live life fully while dying; and offering new possibilities. The author goes on to say that Parse's human-universe-health process aids nurses to live their beliefs indicating Parse's theory could guide and advance nursing practice.

Abstract: Rural nursing in the remote context of South Westland is shaped by factors common to rural nursing practice world-wide including geographical and professional isolation, living and working in a small community, providing health care to rural people and the broad, generalist and advanced scope of nursing practice. Tourism is a major industry in the townships in the proximity of the two accessible glaciers in South Westland. The practice of the nurses in these areas is significantly affected by tourists seeking health care and by providing a health service for the large number of migrant seasonal workers who service the tourist industry. Tourists seek health care from the nurses across the full spectrum of health problems and their expectations of the health care required may exceed the service that can be provided. The nurses are challenged to advance their practice to find the personal and professional resources to provide a safe service. This includes the challenge of cultural safety and personal safety. The tourist industry brings significant numbers of young people as seasonal/temporary workers to the glacier areas. This imposes a youth culture onto the existing rural culture. Nursing practice has expanded to include the specialist practice of youth health care that includes the problems of alcohol and drug misuse, sexual and reproductive health, and youth mental health. This work is drawn from the experience of the nurses working in the glacier communities. The impact of the tourism industry on their rural nursing practice includes the increasing volume of work that challenges the viability of the service, the advanced scope of practice required to meet the health needs of tourists and the seasonal tourist industry workers, and challenges to personal and professional safety.

Abstract: The author describes transitional care as undertaken within the Waikato District Health Board health care environment. Transitional care supports people moving between acute health care (inpatient) and primary health care (home). It is a rehabilitative model based in smaller, predominantly rural communities to enable the older person to actively work towards recovery of functional ability within their own environment. Research indicates this rehabilitation model is applicable to the rural situation and satisfaction levels of the patients and caregivers tends to be positive.

Abstract: This chapter introduces national policies and strategies that promote interdisciplinary collaboration as a means of providing better access to health care for all communities. It identifies a role for advancing nursing practice as part of a collaborative approach to healthcare in rural areas. An increasing focus on collaboration as a concept within health practice during the last 10 years has become evident in policy documents from the Report of the Ministerial Taskforce on Nursing (Ministry of Health, 1998) to the Working Party for After Hours Primary Health Care (Ministry of Health, 2005). The emphasis would seem to be in response to political pressure to address health inequalities and an apparent assumption that interprofessional collaboration results in improved communication, fewer gaps in provision of care and more effective use of the limited health funds.

Abstract: This is the report of the analysis of data from an in-depth survey designed by Sue Dawson, previously Rural Health Researcher in the Centre for Rural Health, and follow-up interviews. The study purpose was to construct a definition of “successful design and delivery of rural health services” as a step towards a measurement tool. Participants were grouped as general practitioners, nurses and community representatives. A format for a participatory approach to evaluation of rural health services is derived from the criteria of success identified, with its relevance for the implementation of the new Government primary health care strategy explicit. This format provided the basis for a subsequent evaluation case study undertaken in a small rural forestry township by the Centre for Rural Health.

Abstract: This study describes rural, nurse-led health services provided by the Takapau Health Centre (Central Hawkes Bay) and its outreach, Norsewood & District Health Centre. The study looks at its model of service delivery through to 2002. It examines the establishment, development, funding and management of the service, along with the nursing practice and the healthcare people received. The book is a snapshot of nursing initiative and survival through a decade of change in health policy and service funding and delivery. The information was subsequently used to move the health centre service into the new paradigm of primary health care launched in the New Zealand Health Strategy.

Abstract: The author traces the development of the nurse practitioner role in New Zealand, which was finally introduced in 2001. It traces the key events, from early debates on the issue, the influence of the Centre for Rural Health, and a series of government investigations into nursing which noted the untapped potential of the nursing workforce and the lack of ongoing clinical career pathways. Barriers to rural nurses becoming endorsed as primary health care nurse practitioners are examined, and some of the solutions to this issue are explored. Relationships between nurse practitioners and the local general practitioners, and community resistance are areas that need management. Education is seen as a key response to many of these issues.