Abstract: This modified action research inquiry focused on the everyday, palliative care practice experiences of a group of district nurses. The intent was to develop an understanding of common issues of concern for this group of district nurses when providing palliative home care in a specific community context and to implement practical, achievable strategies in response to these local issues. Five district nurses identified four broad areas for action through four praxis group meetings and comprising one full cycle. These four areas have been named as methods of enhancing support for people and families, possibilities for creatively managing workloads, mechanisms to enrich working partnership with other palliative care providers and possible vehicles for supporting nurses' self care. Implementation of action from this action research project focused on enhancing care and outcomes for people and family served by this group of district nurses in their local community. This study illuminates everyday essences of the district nurse role and the elements articulated by this group in supporting their practice in one New Zealand community. This study also reveals some of the tensions and messiness when employing an action research methodology with nurses in the workplace. The author notes that this research focused on a little known area (palliative care delivered by district nurses in New Zealand) in a local community (a culturally vibrant and ethnically diverse yet with poor health and socioeconomic statistics). She goes on to say that it has resonance with other nurses, particularly those working in community settings who may experience similar issues and concerns. This research also offers important insights for nurses working in any practice setting.

Abstract: The subject of nursing leadership is approached by reviewing the literature of two prominent nursing theorists, Patricia Benner and Jean Watson, and the literature of transformational leadership. Common themes are identified. An exhortation is offered to nurses to consider that the caring characteristics of nurses are what is required in the corporate world of management. Chapter 1, questions whether nursing and management are different worlds or shared realities. It outlines the author's experience of practising as a manager in a complex organisation and the seeming barriers that exist between managers and nurses and management and nursing. A questioning of those barriers became the impetus for the review. Chapter 2, outlines the work of Patricia Benner and Jean Watson. Caring is identified as a core concept which is said to differ significantly from a conventional understanding of helping and is inextricably linked to a profound understanding of what it means to be human. Chapter 3, reviews the literature of contemporary managers who are exploring a transformed approach to leadership and management. Six themes are identified that are common to nursing theory and transformational leadership theory. Chapter 4, acknowledges that despite the similarities between nursing and contemporary management thought, there remains a gap between nurses and management. Rather than feeling optimistic about the future, and confident in assuming leadership roles, many nurses feel defeated and fearful about the future. It is suggested that this may be a consequence of bad experience of leadership, of loss of joy of caring and of failure to value the strength residing in the collective community of nurses. Nurses are encouraged to recognise that their knowledge and experience of caring and wholeness, healing, sharing and enabling, are the attributes that equip them to be leaders of the future health and corporate world.

Abstract: This study examines demographic data on the primary subject, the staff sister. Data on trainee nurses was also used to give meaning by comparing the two positions and to describe both sides of the staff-sister; trainee nurse relationship. Data on the staff sister's job, her present and future orientations, satisfaction and problems are included

Abstract: The New Zealand emergency department (ED) nurse is faced daily with the challenge of caring for patients of all ages with a wide variety of presenting complaints. Courses are available for ED specialty work such as trauma and paediatric assessment. However, this thesis argues, it is difficult to access updated and ongoing education in relation to caring for people with mental health problems who present to the emergency department. In addition to this education deficit, are the challenges of providing care in an overcrowded ED environment. The author goes on to say that such factors contribute to a perceived lack of confidence and sometimes ambivalence or frustration on the part of nursing staff in caring for this group. This may result in an inconsistent standard of care for the person with a mental health problem unless such issues are addressed. The aim of this research paper was to explore the education needs of ED nurses when caring for people with mental health problems. A literature review was undertaken to investigate the broad education strategies available to overcome these challenges. Diverse approaches were identified such as workshops, clinical guidelines, and mental health consultation-liaison roles. Research was also identified that examined ED nursing attitudes and their learning needs in relation to mental health. This paper concludes with a discussion of recommendations for the New Zealand setting with the intention of developing a more confident and competent nursing workforce, who are better prepared to care for the person with a mental health problem.

Abstract: Alleviating patient suffering, providing comfort and pain relief are all central to the philosophical caring position nurses have always espoused. Despite this, patients continue to suffer pain although we have the means to provide pain relief. The author notes that research has identified that nurses have a knowledge deficit regarding pain and its management, as well an erroneous attitudes, which combined are blamed for an inability to make significant progress in this area. This study was undertaken to uncover the contextual aspects of working within a New Zealand health care institution that affect nurses' ability to manage their patient' pain effectively. It highlights the difficulties and the complicated nature of working within an institution in the 1990's health care environment, where accountability for pain is absent and where pain is often under-assessed and under-treated. By using focus group of nurses, the author notes she was able to uncover constructions on nursing practice, which, she suggests, have been missing from the literature, but prevent nurses from implementing their knowledge. Using a constructivist research, she used nurse's stories and current literature to argue one way forward in, what she terms, the pain management debacle. This study revealed a diverse range of contextual factors that prevent nurses from using their knowledge. Many of the constraints on nursing practice are the results of complex organisational structures within health reform, which have significantly affected the nurse's ability to provide quality-nursing care. One of the most important factors limiting the management of the patient' pain is the inability of the nurse to autonomously initiate analgesia. While nurses are largely responsible for the assessment of pain, they are usually powerless to access necessary analgesia, without a medical prescription. The author argues that once an initial medical diagnosis has been made, nurses are usually left responsible for patient comfort and the management of pain. To do so effectively, nurses need to able to prescribe both pharmacological and non-pharmacological measures for the patient. Presently nurses are prescribing using a variety of illegitimate mechanisms, needing the endorsement of a doctor. To fulfil this role, nurses must be adequately prepared educationally and given the authority to either prescribe autonomously, of provided with extensive “standing orders”. While legislative changes in New Zealand in 1999 extended prescribing right to a few nurses within certain areas of care, the ward nurse is unlikely to gain prescribing rights in the near future. The author concludes that a way forward may be to encourage and further develop the use of protocols for managing pain via standing orders. Standing orders are common place within nursing practice today, have the support of the Nursing Council of New Zealand and are currently under-going legislative review. An institutional commitment to developing pain protocols for nurses would recognise the nurses active role and expertise in the management of pain and facilitate expedient relief for the patient.

Abstract: Up until the 1980s most of the historical writing about nursing and nurses in this country has been told from the points of view of past nursing leaders. The realities of day-to-day nursing in New Zealand general hospitals were relatively unknown.This thesis examines the experience of general hospital nursing between 1945 and 1960. The recollections of thirty-four nurses who nursed during this period have provided the key sources from which the major themes of this study have emerged. These themes, of dirty work, authoritarian control and discipline, and learning nursing are discussed within the context of an expanding hospital system and a shortage of nurses.The study demonstrates the vast differences between the recollections of nurses of the experience of nursing and the rather high-flown rhetoric of the nursing leadership.Changes to the amount of cleaning, the ;level of discipline and control, and ways in which learning nursing was organised were small and gradual and occurred in the late 1950s.Overall, though, nursing in general hospitals by 1960 ws almost unchanged from the 1930s.An ethos of selfless service, opposition to unionism, and Christian altruism was till dominant amongst the nursing leadership. Nurses in training still worked a six day week, were expected to stay on duty until the work was done, and were supervised closely in, on and off duty time