Abstract: This thesis explores the customary kaupapa of Matauranga Maori or Maori knowledge, which the author identifies as the appropriate technique to determine how health care should be maintained by and for Maori. The research highlights the need to meld these kaupapa with that of a contemporary Maori viewpoint, to focus more on a deeper enhancement of these kaupapa, and develop an understanding of the social, cultural, educational, political and economic contexts these concepts have on Maori as a people. This research identified six Maori registered women nurses, who shared their experiences regarding Matauranga Maori and its importance to their nursing practice. Over a period of one year, in-depth conversations unfolded and produced data on what Matauranga Maori involves and how the six participants in the study believe it influences their nursing practices. All were currently practicing nurses within various health settings such as psychiatric and comprehensive nursing. From the inception of this study, the focus was to introduce Matauranga Maori as the epistemological framework of choice. The author notes that the findings of this research indicate that a collection of key kaupapa, namely whakapapa, whanaungatanga, te reo Maori, wairuatanga, tuurangawaewae, manaakitanga and rangatiratanga are crucial to the health and wellbeing of Maori as a people. These kaupapa enable Maori to determine and strengthen their worldview, which in turn reflects the concept of being Maori thereby contributing to the health and status of their whanau, hapu and iwi. She goes on to say that the findings support the view that there is a substantial collection of kaupapa, which are inherent in Matauranga Maori as being able to provide a framework for theoretical research. These kaupapa will provide a framework for nursing practice and educational curricula that will develop and maintain nursing standards to meet the needs of Maori.

Abstract: The purpose of the research was an evaluation of practice exemplars as a reflective process in teaching and learning about cultural safety. Six Maori, two Pacific and five Pakeha students, ranging in age from 30 to 40, took part in the research. The research findings revealed five sub themes: personal safety, power/ powerlessness, reflection, teaching and learning and cultural safety. The presentation, while acknowledging that cultural safety shared some commonalities with culture care theory, highlighted differences between the two. These included that cultural safety was explicit in identifying the inherent power of the nurse in health care relationships; related to the experience of the recipient of nursing care, and extended beyond cultural awareness and sensitivity; provided consumers of nursing services with the power to comment on practices; and contributed to the achievement of positive outcomes and experiences for them. It outlined the characteristics of a culturally safe nurse as a nurse who had undertaken a process of reflection on her/his own cultural identity and who recognised the impact their personal culture had on client care.

Abstract: The aim of this paper is to increase neuroscience nurses' awareness of how the head is perceived as sacred by some cultures. This article will outline a definition of culture, discussion around the sanctity of the head for some cultures, the cultural significance of common neuroscience interventions, the use of traditional healing methods, and prayer. Examples will be provided of how nursing interactions and interventions affect some cultures, looking primarily at a Maori and Pacific Island perspective. The focus of this paper is within a New Zealand paediatric setting.

Abstract: The authors conduct an audit of medical activity at Christchurch Hospital, a 650 bed tertiary centre, between 2230 and 0800 hours. They measured the volumes of tasks requiring completion overnight and identified the competencies required for this as well as the level of teamwork that existed. They found several organisational areas of concern, that indicate new approaches are required to staff the “hospital at night,” and an Out of Hours Multidisciplinary Team is recommended. Specific issues included the lack of teamwork from the Resident Medical Officers (RMOs), with some overextended while others were inactive. House officer tasks were largely generic rather than specialty specific; there was no formal handover from the afternoon or day shifts and the level of hospital medical staffing did not reflect the activity levels over the time period studied. The researchers also recommend an urgent review of the beep policy. A third of the admissions were to General Medicine, and basic medical activities (including admitting, reviewing, and prescribing drugs and fluids) for patients admitted under all specialties represented the majority of the night workload. Medical registrars had reduced some of the traditional multiple clerking by admitting patients themselves.

Abstract: This paper reports on a study to explore how nurses in a secondary care environment understand medication administration safety and the factors that contribute to, or undermine, safe practice during this process. Data were collected in 2005 using three focus groups of nurses that formed part of a larger study examining organisational safety and medication administration from a nursing perspective. A narrative approach was employed to analyse the transcripts. Participants had good understandings of organisational culture in relation to medication safety and recognised the importance of effective multi-disciplinary teams in maintaining a safe environment for patients. Despite this, they acknowledged that not all systems work well, and offered a variety of ways to improve current medication practices. These findings highlight the meaningful contribution nurses can make to patient safety and emphasise the importance of including the nursing voice in any quality improvement initiatives.

Abstract: This article explores some of the functions of psychiatric diagnosis and the implications this has for mental health nursing care. It critiques the psychiatric diagnosis as a categorisation process that maintains oppressive power relations within society, by establishing and enforcing normality through gender, culture and class biases. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders is used to illustrate some of the inherent biases in the diagnostic process. The author argues that mental health nursing practice needs to demonstrate an awareness of the power relations inherent in any diagnostic process and make attempts to redress these at both the individual and sociopolitical levels. To create a true patient-centred partnership in mental health nursing, the nursing focus should be on the patient's experience rather than the psychiatric diagnosis with which the experience is attributed. NB this is a reprint of article first published in Journal of Advanced Nursing, 2000 Mar; 31(3), 583-9.

Abstract: This research is a study of the experiences of four cultural safety educators in nursing education in Aotearoa, New Zealand. Action research methods assisted the participants to implement change in their practice and gain positive personal involvement in the study. Reflective diaries provided the major tool in this process as participants were able to achieve at least one action research cycle by identifying issues, planning action, observing the action, and reflecting. The findings of the research revealed that the participants not only coped with everyday stressors of teaching but were also required to formulate knowledge for cultural safety. For the Maori participants, their stress was confounded with recruiting and retaining Maori students and macro issues such as commitment to their iwi (tribe). Lack of support to teach cultural safety was identified to be a key theme for all participants. An analysis of this theme revealed that many issues were organisational in nature and out of their control. Action research provided a change strategy for participants to have a sense of control of issues within their practice. Recommendations include the following: support for cultural safety educators to have a dialogue on a regular basis, the introduction of nurse educator programmes, paid leave provisions for educators to conduct and publish research so that a body of knowledge can be developed, and that Maori cultural safety educators be recognised for their professional and cultural strengths so that they do not fall victim to burnout.

Abstract: This study sought to determine the attitudes, beliefs and values towards clinical work organisation of students entering undergraduate medicine, nursing and pharmacy programmes in order to frame questions for a wider study. University of Auckland students entering medicine, nursing and pharmacy programmes completed a questionnaire based on that used by Degeling et al. in studies of the professional subcultures working in the health system in Australia, New Zealand, England and elsewhere. Findings indicate that before students commence their education and training medical, nursing and pharmacy students as groups or sub-cultures differ in how they believe clinical work should be organised. Medical students believe that clinical work should be the responsibility of individuals in contrast to nursing students who have a collective view and believe that work should be systemised. Pharmacy students are at a mid-point in this continuum. There are many challenges for undergraduate programmes preparing graduates for modern healthcare practice where the emphasis is on systemised work and team based approaches. These include issues of professional socialisation which begins before students enter programmes, selection of students, attitudinal shifts and interprofessional education.