Abstract: A Heideggerian Hermeneutical Analysis (HHA) approach was used for a study of returning registered nurse students (RRNS) from a nursing/health management context. In essence a descriptive interpretive study the intent has been to unveil the common meanings embedded in the lived experience of RRNS return to formal (advanced) studies. The phenomenon or issue of interest was pursued in the form of a question: What is meaningful and significant for participant RRNS in their everyday world on re-engaging in formal (advanced) nursing studies?Research from the RRNS viewpoint is scarce, so the focus of the study was to understand what RRNS themselves found to be the highlights of the experience. Participants included RRNS coming from a management background and, therefore, very much at the cutting edge of rapid and continuing change in health care provision. In addition to personal and professional reasons for returning to study, what the narratives disclosed was the compelling need experienced by the RRNS to increase understanding of changing requirements in the workplace. They looked for new possibilities to transform management of nursing/health services and for learning experiences favorable to that purpose. A key aspect of their concern related to the interactive nature of their lived experience as a RRNS with the entire context of their everyday world, that is, with the connections and relations between the study-work-homespace.Fourteen RRNS from an established university nursing programme participated in an expended non-structured interviews lasting 60 – 90 minutes. The interviews were held during 1993 in places selected by participants, some in the home but mostly in the work setting. With the consent of the participants interviews were audiotaped and then transcribed. The texts (transcriptions) were analysed hermeneutically using Heideggerian phenomenology, a particular tradition of philosophy whose concern is the meaning of Being. The concern is to make visible participants' experience of their 'world'. In this instance, it was the everyday 'world' of the participant RRNS and the lived meanings of what they experienced on return to formal (advanced) studies. Hence everyday lived experience is the focus of attention in Heiedeggerian phenomenology. In this research approach what is sought is understanding not explanation. It is a premise of phenemenology that, in general, an understanding of the meaning and significance of the lived experience can be required from the 'things' (the phenomena under study) themselves. Approaching a participant as an expert by virtue of directly experiencing the phenomenon, is basic to phenomenology. Hermeneutic analysis of the texts of the participant RRNS affirmed the authenticity of those assumptions.The study revealed several common or major themes, two relational themes and one constitutive pattern were identified through the process of textual interpretation. The constitutive pattern expressing the full complexity of the relations and connections between the themes, was found to be present in all fourteen texts; the nature of a constitutive pattern being 'that it's always there'. The constitutive pattern 'Nursing is Dwelling in Thoughtful Concern as Context Calls Forth', emerged as the major finding of the study. This pattern witnesses to the pragmatism that is inherent in nursing and commonly found in nurses' responses to the challenges presented by continuing and rapid change. For the participant RRNS nursing had become a way of engaging their energies in the workplace as appropriate to a given place, time and culture. The two relational themes accent particular aspects of the constitutive pattern. 'Nursing' is a whole pile of things'; and 'Curriculum: Reflective Openness' reveal the inherent meanings of the constitutive pattern. Firstly, that nursing is diverse in practice and has many dimensions; and,, secondly, that a curriculum befitting the diversity of nursing requires us to constantly challenge ad test the learning experiences we provide for RRNS.The fourteen participants traversed diverse pathways to acquire the understanding and skills required for altered health care structures. Adopting new relationships and 'leaping-ahead' (Heidegger, 1962), to be able to see the whole picture of what was being experienced in nursing/health care, reveals the RRNS becoming-as interpreters for both colleagues and clients. Leaping-ahead is reflective of thoughtful concern as the pattern of responding to presenting need. This way of living a life transforms work. The participant RRNS disclose that, dwelling in such a way in nursing/health work opens up a future of possibilities which brings all the presenting needs into focus. Sharing the story of their lifeworld as RRNS, the participants have exemplified the ' reflective openness' Senge(1990) advocates, as being a pre-requisite for 'learning organisations'. Contemporary oganisations require us to challenge our own thinking as well as being free to speak our minds ('participant openness'). Since, however much we value our daily life practices and understandings, they need to be 'always subject to test and improvement'. In effect, what the participants have bestowed on us is that, within the framework of a curriculum for RRNS and the content learning of a given course, we must generate a process of learning amenable to both individual and group requirements

Abstract: This study presents information, obtained from health service managers, on the present use and possible future use of second level nurses within the region encompassing the Wanganui, Rangitikei, Manawatu, Tararua, Palmerston North City and Horowhenua districts. “ Second level nurses” are currently known as enrolled nurses and, in accordance with Section 53A of the 1983 Amendment to the Nurses Act, are required to work under the direction and supervision of registered nurses or medical practitioners. Enrolled nurses are usually allocated less responsibility for nursing assessment and judgement than registered nurses.Management perspectives, from seventy seven health workforce managers, were sought in relation to the future workforce need, the scope and boundaries of practice, and the alternatives for the future educational preparation of second level nurses. Seventy two percent of managers said that they thought enrolled nurses were essential to New Zealand's future nursing workforce. They predicted increased opportunities for enrolled nurses in care of the elderly and community care settings. Patterns in the current workforce utilization of enrolled nurses, however, did not support these views.In relation to the education of enrolled nurses, managers indicated that hospital-based training was the most preferred option. However, managers asserted that, in view of the current lack of employment opportunities no more enrolled nurses should be prepared at the present time.Although questions about education were focussed on the educational preparation of enrolled nurses, many of the respondent managers also expressed opinions about the educational preparation of comprehensive nurses. As a result, an evaluation of comprehensive nursing programmes is suggested.While the numbers of second level nurses being prepared and used is decreasing, there is a concomitant increase in the preparation and use of caregivers. This rapidly increasing group isfast becoming a “cheaper” second level workforce. The increase in the use of caregivers is seen to result from the pressure on healthcare employers to reduce spending within the current highly competitive, de-regulated economy. Managers asserted that enrolled nurses are not cost effective in comparison with either caregivers or registered nurses.The study concludes with thirteen recommendations which are made under the following four groups;1. Manawatu Polytechnic – provider of nursing education.2. Healthcare employers – users of nursing education.3. Enrolled nurses – participants in nursing education.4. Professional nursing bodies – guardians of nursing education

Abstract: As has been the case internationally, deinstitutionalisation of dual diagnosis (intellectual disability and mental illness) services has also occurred in New Zealand. Inpatient services have been redefined to respond to the more acute focus that has arisen out of this deinstitutionalisation process and nurses are having to redefine their roles in response. This study was undertaken to explore and describe the culture of nursing practice in a dual diagnosis inpatient unit in one psychiatric hospital. A focused ethnographic approach was used to triangulate data gathered from fieldwork observations, review of documents and semi-structured interviews. Schein's (1985) levels of culture model, was used to identify and explore the artifacts, values and assumptions evident in this nursing practice. Analysis presents three key themes categorised as 'communication', 'assessment' and 'safety'. While these key themes are shown to be evident in the everyday practice of the nurses, how these relate to the notion of 'dual diagnosis nursing' is not clear. Therefore, the author describes the major finding of this study as revealing a nursing culture holding tight to traditional psychiatric and psychopaedic nursing practices and struggling to develop a distinctive culture in the absence of a defined dual diagnosis knowledge base. The author concludes that these findings suggest an urgent need to provide nurses with support in gaining contemporary knowledge regarding dual diagnosis nursing. Support for nurses in advancing these areas then impacts on support for the patients. It is suggested that additional research is undertaken to assess the learning needs of the nurses in order to develop clinical practice guidelines for this area. Further recommendations are made to address system issues which are contributing to the gap in knowledge.

Abstract: This research explores the issues and experiences of mental health nurses who experience or have experienced mental illness. This project was prompted by the author's concern for colleagues and friends in this situation. The research topic was approached using a mix of critical ethnography and action research principles. Five mental health nurses who all work for the same district health board were interviewed about their experiences of being mental health professionals with mental illness and the issues that arose from this. The themes that emerged from this research are: the reactions of nurse colleagues, the effects on participants' own mental health treatment, employer responses, professional experiences and issues and strategies for coping. Discussion and recommendations focus on the need for improvements to the responses that mental health nurses with experience of mental illness encounter in their workplace. Recommendations from this research encompass suggestions for both individual and organisational education, action and change.

Abstract: In 1999 primary health care in New Zealand was in the process of change from the current personal health care model, which focuses on general practitioner based care, to a population and community based health care programme. Carryer, Dignam, Horsburgh, Hughes and Martin (1999) submitted a report to the National Health Commission entitled “Locating Nursing in Primary Health Care”. This report envisaged that nurses in primary health care would be part of interdisciplinary teams, act autonomously and undertake community consultation and education. The submission suggested that nurses, currently working in primary health care, were alraedy prepared and able to move across into the new form of primary health care, without further education or training.

Abstract: This thesis reviews the role of primary health care nurses, who have an opportunity to play a unique role in teaching, touching and empowering families with newly discharged pre-term babies. Birth of a baby earlier than 37 weeks gestation ushers in a period of uncertainty and stress for parents. Uncertainties may centre on whether their infant will survive and what ongoing growth and developmental issues their infant will face.