Abstract: This study investigates the way that medical, nursing and institutional discourses construct knowledge in the specific context of Not-for-resuscitation (NFR)in a New Zealand general hospital where NFR guidelines are available in the wards and from the regional ethics committee. The thesis argues that there are ranges of techniques that staff use to construct NFR knowledge, enacted through various forms of speech and silence, which result in orderly and disorderly experiences for patients nearing death. The study was conducted through a critical analysis of the talk of health professionals and the Chairperson of the Regional Ethics Committee.

Abstract: This study investigated the safety of working environments of a group of urban district nurses. Six district nurses were interviewed and participated in a focus group. The findings focus on the risks associated with client behaviour and with the organisational structure in which district nurses work. Recommendations for primary, secondary and tertiary prevention of harm to nurses working in isolation in the community are presented. The author describes her personal background in district nursing, which prompted the study.

Abstract: This study investigated nurse educators' conceptions of critical thinking used in making judgment related to nursing. Twelve nurse educators from a large nursing school in an urban environment in New Zealand participated in this qualitative study. A semistructured questionnaire was used to explore the nurse educators' conceptions of critical thinking. The study found that the participants viewed rational, logical thinking as a central focus of critical thinking. However, in addition to these traditional perspectives, the nurse educators also included in their conceptions views more commonly held by feminist writers. These aspects focused on attention to intuition, subjective knowing, attention to context, emotions, and caring.

Abstract: This study identifies, describes and generates a theoretical explanation of what it means to be a Nurse educator in New Zealand in the 1990's. It explores individual experiences within the broader social context. Sixteen participants from three Schools of Nursing in New Zealand were interviewed over a four month period. Constant comparative analysis of data eventuated in the identification of four conceptual categories named as : being a teacher, settling down, finding a place and coping with change. They were then drawn into the core category – Being – in- Becoming. Being – in- Becoming, means in this study, that a person is the Nurse teacher simply because that person has taken on the work of a teacher. In being a teacher, the person is adapting, changing and learning how to become a teacher. Being – in- Becoming, is a process which is on going, never ending, and constantly changing. The essence of this study is that the teacher's experience of Being – in- Becoming. is influenced by personal development and the way the person comes to 'know' about the world of Nursing education who is also intimately connected to the way Nursing curriculum is defined and experienced by individual teachers. These findings have implications for Nursing education , in recognition of teacher's concerns, background meanings and problems which influence a person's experience of being a Nurse educator. Expectations that feelings should be 'managed' therefore ignored is consistent in a group which claims caring as the essence of Nursing practice. Excessive workloads are constantly cited as a major problem for worker. The organisation has the responsibility to acknowledge the human experience of those who work within this area and to undertake to respond in ways which can improve the situation for all

Abstract: This study focussed on nursing practice in action. The research goal was to identify nursing-relevant dimensions within a person's experience of being a hospital patient undergoing elective surgery. In order to discover and conceptualize the underlying processes which are present as patients are nursed through this experience, an open question was posed – What is happening here? A qualitative research method ws the most appropriate means of discovering an answer to this question.The particular method chosen was the grounded theory approach developed by Glaser and Strauss. Data were collected in five surgical wards of a large city hospital over a period of five months. The research participants were twenty-one patients and the nurses involved in their care. Primary sources of data were interviews and the nursing records. These were augmented by field notes and accounts of observed incidents relating to the care of each patient.Using the inductive strategies of the grounded theory method, numerous descriptive concepts were generated during the data analysis. These were ordered within an integrating social process derived from anthropology. By this means a founded theory in the form of a theoretical framework – the Nursed Passage – was developed. Within this passage the patient is the passage and nursing is translated into action through the agency of the nurse.The Nursed Passage is a patterned partnership with three key elements. Firstly, the temporal element, characterised by ongoing movement and constant change, is conveyed in the sequence of phases or stages. Secondly the participative element is portrayed as a patterned relationship in which both nurses and patient are actively involved in progressing the patient through the passage. Finally, the contextual element recognises complex factors within the nursing environment which have an impact on the shape of the relationship between patient and nurse.This theoretical framework, generated from the reality of nursing as it occurs in one setting, assigns a specific shape to the encounter between nurses and patient. It identifies the contribution nursing alone can make to optimise each patient's hospital experience. In this way it both complements and facilitates the work of medical and other colleagues with whom nurses work. Thus it serves to revalue nursing in terms that can maximally utilise the registered nurse's knowledge and skill for the benefit of all concerned. Consequently, it has the potential value for nursing practice, education and research

Abstract: This study explores the the experience of nursing a person, or people, form cultures other than one's own. Informed by the tradition of philosophical hermeneutics, and drawing specifically on some of the notions articulated by Hans-Georg Gadamer and Charles Taylor, it seeks to understand everyday nursing practices within their cultural and historical context.Against a background of Maori resurgence, nurses in New Zealand have been challenged in Aotearoa-New Zealand to recognise and address racism in their practice. Meeting the health needs of all people has long been important in nursing yet the curricular changes implemented in the early 1990s to enhance nursing's contribution to a more equitable health service created uncertainty and tension both within nursing, and between nursing and the wider community.In this study, I have interpreted the experiences of seventeen nurses practising in an increasingly ethnically diverse region. Personal understandings and those from relevant literature have been used to illuminate further the nature of cross-cultural experience from a nurse's perspective. The thesis asserts that the notions of prejudice, paradox and possibility can be used to describe the experience of nursing a person from another culture. Prejudice refers to the prior understandings that influence nursing action in both a positive and a negative sense. Paradox relates to the coexistence and necessary interplay of contradictory meanings and positions, while possibility points to the potential for new understandings to surface from the fusion of past with present, and between different interpretations. As New Zealand nurses negotiate the conflicts essential for ongoing development of their practice, the play of prejudice, paradox and possibility is evident at intra-personal and interpersonal levels as well as in relation to professional and other social discourses. This thesis challenges nurses to persist in working with the tensions inherent in cross-cultural practice. It encourages continuation of their efforts to understand and move beyond the prejudices that otherwise preclude the exploration of new possibilities.

Abstract: This study explores the phenomenon of the relationships between practitioners and families who have a child with a chronic illness. Using a heremeneutic phenomenological method informed by the writings of Martin Heidegger [1889-1976] and Hans-Georg Gadamer [1900-2002], this study provides an understanding of the meaning of 'being in relationship' from the perspective of both families and practitioners. Study participants include ten family groups who have a child with a chronic illness and twelve practitioners from the disciplines of nursing, medicine, dietetics, physiotherapy and speech therapy who work with children with chronic illness. Narrative audio-taped interviewing was the means by which the participants told their stories about times that relationships worked well and when they did not. These stories uncover the every day realities of 'being in relationship' and provide another understanding of the relationship between family and practitioner.The findings of this thesis suggest that chronic childhood illness 'throws' families and practitioners together into a web of relationships that must work for the sake of the child. The relationship is primarily conducted between adults. Children are usually excluded. In order to understand and manage the child's illness, practitioners and families 'go around' and act 'in-between' relationships. While the quality of the relationship from the family perspective is not essential to the chronic illness journey, relationships are more successful when practitioners recognise the uniqueness of each family web. The nature of the relationship is often simple, yet it co-exists with complexity. This thesis proposes that a 'companion relationship' between practitioners and family may offer a more effective and satisfying way of working. It also challenges practitioners to consider the voice of children within health care relationships.

Abstract: This study explores the phenomenon of a personal exploratory field visit to HIV programmes in Malawi and how that informs the author's future plans to work cross-culturally with HIV. He uses hermeneutic phenomenology with the guidance of Heidegger and Gadamer, and draw on Ackermann, Hill, Maluleke, Moltmann, and Thielicke for theological direction. This study analyses how personal formation takes place and how the meaning of that experience can inform future cross-cultural interaction. The data of this study is drawn from a range of people interviewing 'me'. This includes a pre and post interview in relation to the author's three week exploratory visit to Malawi, and recorded daily reflections during the visit. Upon return he was interviewed about the experience by ten people from the following areas: nursing, counselling, development, theology, business, medicine, clergy, an Expatriate Malawian, and a women working from a Maori paradigm. These interviews focused on the author's experience with questions framed from the interviewer's specialty area. The transcripts become further data for this study. The findings of this thesis suggest that people wishing to work cross-culturally need to understand their motivation for their work, and understand who they are before entering a foreign land. This transformative journey also needs to continue as part of the process of working with people because we can only be effective with change if we are listening and hearing the other's perspective. It is in being open to this difference between persons that we continue to find ourselves. While perhaps we have a tendency to want to make everybody like us, we can only grow into our full potential in relationship with truly different others. Tensions experienced demonstrate that there is a complex need to understand how the context controls how HIV is perceived. This requires uncovering some of the deeper issues of HIV and culture, and knowing how to conceptualise these in both positive and informative ways. This thesis asks four key questions for the global-co-worker to work through before embarking on cross-cultural mission: 1. How do you know you should go?; 2. How are you going to make a difference?; 3. Who are you going to be?; and 4. What will sustain your involvement? The author's own experience has drawn me into a deeper awareness of the need for a vital connectedness of faith, hope and love underpinning the everydayness of such an experience.