Abstract: This thesis concerns an investigation of the tripartite arrangements between the government, the nursing and the medical sectors in New Zealand over the period 1984 to 2001 with a particular focus on primary health care. The start point is the commencement of the health reforms instituted by the Fourth New Zealand Labour Government of 1984. The thesis falls within a framework of critical inquiry, specifically, the methodology of depth hermeneutics (Thompson, 1990), a development of critical theory. The effects of political and economic policies and the methodologies of neo-liberal market reform are examined together with the concept of collaboration as an ideological symbolic form, typical of enterprise culture. The limitations of economic models such as public choice theory, agency theory and managerialism are examined from the point of view of government strategies and their effects on the relationships between the nursing and medical professions. The influence of American health care policies and their partial introduction into primary health care in New Zealand is traversed in some detail, together with the experiences of health reform in several other countries. Post election 1999, the thesis considers the effect of change of political direction consequent upon the election of a Labour Coalition government and concludes that the removal of the neo-liberal ethic by Labour may terminate entrepreneurial opportunities in the nursing profession. The thesis considers the effects of a change to Third Way political direction on national health care policy and on the medical and nursing professions. The data is derived from various texts and transcripts of interviews with 12 health professionals and health commentators. The histories and current relationships between the nursing and medical professions are examined in relation to their claims to be scientific discourses and it is argued that the issue of lack of recognition as a scientific discourse is at the root of nursing's perceived inferiority to medicine. This is further expanded in a discussion at the end of the thesis where the structure of the two professions is compared and critiqued. A conclusion is drawn that a potential for action exists to remedy the deficient structure of nursing. The thesis argues that this is the major issue which maintains nursing in the primary sector in a perceived position of inferiority to medicine. The thesis also concludes that the role of government in this triangular relationship is one of manipulation to bring about necessary fundamental change in the delivery of health services at the lowest possible cost without materially strengthening the autonomy of the nursing or the medical professions.

Abstract: This text begins with a discourse analysis of the Diagnostic and Statistical Manual of Mental Disorders (fourth edition, 1994 – DSM -IV- to illustrate the discursive construction of mental disorder. The analysis identifies how productivity, moderation, entariness and rationality are constructed by this psychiatric discourse as the fundamental attributes of normality. It is argued that this discursive construction of normality has particular implications for the subject positions available to women.The text explores how those subject positions are constituted by analysing the narratives of women who have been diagnosed as having a mental disorder. Its object is to explore how the categories 'mental disorder' and 'women' are constituted; the effect this has on some women's experiences; and to offer a feminist interpretation of those experiences. The text explores the meaning of these women's experiences and proposes that their responses can be regarded as tactical responses to the non-recognition, or disconfirming recognition, accorded to the subject positions available to them.The women's tactical responses although taking different forms, reveal some commonalities in their responses to a lack of recognition for their performances: shame regarding the body which marks them as women; a sense of meaningless and emptiness in the available performances; a sense of themselves as objects for the use of others; passive performances as self-protective tactics; a need to suppress anger; and a tension between cultural expectations of normality and their own subjective experiences. The tactical responses that these women had employed take the form of over-conformity, withdrawal and resistance. They reflect that Sass (1992:58) describes as attempts to escape the 'form of the real'. It is the women's body which establishes her engendered subjectivity and it is through the body that the tensions related to her expected performances emerge. Each women's tactical response is imbued with multiple and sometimes contradictory meanings that may represent their ambivalence in relational to the cultural expectations for productive, moderate, unitary and rational performances. To enable the meaning of the women's distress to emerge it is necessary that it be recognised by interpretations that reflect their multiple and contradictory form.Alternative readings of these women's tactical responses position the desire for recognition as central. It proposes that it is necessary to pay attention to both the literal and figurative functions of language. The possibility of 'advancing our understanding of social life' (Gergen, women constructed as mentally disordered. These readings of the narratives require an understanding of the context and construction of the narrator's life and opens up the possibility for multiple understandings that do not necessarily privilege productivity, moderation, unitariness and rationality.By attending to the significance of the women's narratives this text proposes that the DSM-IV's (1994) construction of mental disorder of effectively marginalises women's experiences of their culturally determined subject positions. It acknowledges the need to understand how women symbolize their distress in a way that creates and communicates meaning

Abstract: This study, which is undertaken in the Southland area, explores the effect of the increasing specialisation of nursing services in what is a rural/urban environment. It is indicated in the literature that systemic changes in health, such as the health reforms, and the increase in the use of technology have meant that nurses are required to function in disease oriented roles rather than according to their more traditional generalist roots. A significant event, which also affected nursing scope of practice, was the transfer of nurse education to the tertiary education institutions environment from the hospitals in the mid 1970s. The traditional nursing hierarchy and its nurse leadership role disappeared and the adoption of specialist nurse titles increased, and identified with a disease or disorder, for example 'diabetes' nurse. The increase in specialist categories for patients contributed to the nurse shortage by reducing the available numbers of nurses in the generalist nursing pool. The nurses in this rural/urban environment require generalist nurse skills to deliver their nursing services because of the geographical vastness of the area being a barrier to specialist nurses. Workforce planning for nurses in the rural/urban then must focus on how to reshape the nursing scope of practice to utilise the existing resources. This study explores how key areas of health services could be enhanced by reclaiming the nurse role in its holistic approach, in mental health, public health, geriatric services and psychiatric services.

Abstract: This study was undertaken to ascertain the opinions of nursing students at Wellington Polytechnic (now Massey University Campus of Wellington) about their current uniform worn on clinical placements. As the NZNO National Student Unit representative at Wellington Polytechnic, it was brought to my attention by my fellow students that the current uniform was not particularly functional. As a result of these comments I concluded the best way for students to voice their opinions further was to circulate a survey. The survey questioned the students about the current uniform and what they thought the future uniform might be. The survey was available for collection by students for a two week period in July 1998. Participation was voluntary and anonymous. It was approved by the Research and Ethics Committee, School of Nursing, Health and Environmental Sciences, Wellington Polytechnic. The results were that sixty percent of students supported a change in the current uniform. Most students chose a tunic top as their preferred option. If there was to be a change, students would be prepared to spend $20-49. Consequently permission has been granted by the Head of Department – School of Nursing to investigate a change to a tunic style top. The item will be trialed by those who wish to purchase it in 1999. I believe that it is of utmost importance that student satisfaction with their clinical uniform is assessed at regular intervals to ensure that the students take a pride in their presentation and the uniform serves the purpose for which it is intended

Abstract: This study was developed to explore the use of seclusion in an acute in-patient unit for people with mental illnesses. Investigation into this issue was considered important due to an identified large increase in seclusion use over the previous two years. The study used a qualitative research methodology with a descriptive and interpretive approach. Data collection included a retrospective file audit of patients who had been secluded over the past seven years, and one-to-one staff interviews. It also includes the author's personal reflections of seclusion events. The principle reason for using seclusion was violence and aggression in the context of mental illness. It was also used for people who were at risk of, or who had previously absconded from the unit. A recovery approach and the use of the strengths model was fundamental to nurses' way of working with patients in the unit. Nurses believed that the strengths process should be adapted to the person's level of acuity and to their ability to engage in this approach in a tangible way. Seclusion continues to be a clinical management option in the unit that is the subject of this study. However, in many circumstances there are other options that could be explored so that the utmost consideration is given to the dignity, privacy and safety of that person.

Abstract: This study was conducted to investigate the practise of Nurses when working with depressed patients in an In Care setting. A survey of the literature shows that the role commonly prescribed for nurses who work in psychiatric settings is one that emphasises a one- on -one relationship based on models of psychotherapy and focuses on individual illness, pathology, systems and psycho dynamics. It is suggested that this is not a role which most Nurses working in New Zealand psychiatric settings would be able to implement in practise. Three perspective's of Nursing practise were explored in the study. What Nurses were seen to do in practice. What they thought they should do as evidenced in results of an exercise to rank different possible interventions, and what patients said were helpful Nursing interventions. A framework was developed for the study which depicts the process of helplessness(depression) as the negative 'mirror -image' of the process of self care. Results were analysed within this framework to determine whether or not Nurses tended to support behaviours which were indicative of movement towards helplessness or encourage those which indicated progress towards self care by their interventions. There was little evidence of positive reinforcement for independent or coping behaviours with patients in the study sample. Further, the nursing practise showed little relationship to the role prescribed in the literature. The Nurses did demonstrate a warm caring friendly approach that seemed to stem from a more traditional 'succouring, mothering' view of Nurses' role

Abstract: This study uses a critical approach to analyse influences connected to opportunities for nurses to have their unique contribution to the health system recognised, and identifies a plan of action. The stories as told by four Northland nurses, identified the underlying principle of self-knowledge which, when connected to core values emerged as personal power with the language of possibility. Other factors which enabled opportunity recognition were labelled as: knowing the self, integrating core values from personal and professional qualities, connecting these to an intuitive plan, trusting it because it is value-based, using that plan to form goals and achieve direction. Integrating core values into goal setting enabled people to make choices that would enhance as well as protect their personal development. This study has implications for nurses as they seek out places where they can work well and for health planners to design systems where this can happen.