Abstract: The research on which this thesis is based involves both a private narrative and a public narrative, with the story of cultural safety, and the history, theory and the future direction gathered into one qualitative work. The work is divided into three sections. The first is entitled, Ko Wai Matou? The Private Narrative. This section seeks to explore the historical, social, educational, physical, emotional, political and moral influences and ephiphanies which brought about the personality which introduced cultural safety ideas into nursing and midwifery. Early nursing practice is investigated and examples from practice are used to illustrate learning and consolidation of the ideas which led to Cultural Safety Theory. The second section is entitled He Huarahi Hou: A New Pathway. This section explains the progress of the theory and its relationship to education pedagogy and to nursing practice. Comparison between the work of Madeline Leininger and the Transcultural Theory of Nursing and the New Zealand concept of cultural safety is undertaken. The role and application of the Treaty of Waitangi to the theory of cultural safety is explored in this section. The third section, entitled He Whakawhanuitanga: The Public Narrative, looks at the introduction of cultural safety into the nursing education system and its implementation. The public and media reaction to the inclusion of cultural safety in the national examination for nursing registration and the subsequent parliamentary response are noted. The interviews with nursing and midwifery leadership, Maori and pakeha key players in the process and consumer views of the ideas are documented and pertinent excerpts have been included. The work concludes with a discussion on the likely future of cultural safety as a theory and in practice and outlines several issues which represent a challenge to the viability of the concept in nursing and midwifery education. The author notes that the story of cultural safety is a personal story, but also a very public one. It is set in neo-colonial New Zealand, but has implications for indigenous people throughout the world. It is about human samenesses and human differences, but is also a story about all interactions between nurses and patients because all are power laden. Finally, she points out that, although it is about nursing, it is also relevant to all encounters, all exchanges between health care workers and patients.

Abstract: This literature review discusses the history of the inclusion of culture into nursing studies. There is a small sample of overseas literature for critique with a focus on the inclusion of cultural safety in New Zealand. The concept of cultural safety was first introduced into New Zealand in the late 1980s. It was adopted by the New Zealand Nursing Council for nurses and midwives in 1992 and became part of the basic curriculum for nursing and midwifery education.

Abstract: This article outlines some of the health experiences and concerns of people with physical and/or mental disabilities. These experiences and concerns are explored within the context of the practice of cultural safety. In 1996, the Nursing Council of New Zealand adopted its definition of cultural safety and defines 'culture', in the context of 'cultural safety', as involving all people who are not part of the culture of nursing. Each person with a disability is unique, and they may also be part of a larger disability culture, which has its own shared experiences, values, beliefs and lifestyles. People with disabilities are also a minority within the population. Therefore, any power they might have within their own culture is minimal, compared to the advantages enjoyed by the rest of the population.

Abstract: Forensic mental health nursing roles have developed along different lines in the United States and the United Kingdom. The authors suggest that New Zealand nurses consider the evolution of such roles here.

Abstract: Clinical practice is an essential and integral component of nursing education. The decision-making process involved in student selection of clinical placements is influenced by a range of factors which are internal or external to students. As there was little research that explored these factors and the influence they have on student decisions, the author sought to investigate this further. A mixed-method approach was used, using a questionnaire and focus group interview, to give breadth and depth to the research. This study found that students are particularly influenced by previous positive experiences, or an interest in a particular area of practice. Their personality will also influence their placement decisions. Nurse preceptors and clinical lecturers also provide a key support role to students in the clinical environment.

Abstract: The purpose of this thesis has been to explore the discursive production of delirium in people over the age of 65 years. The philosophical approaches underpinning the study were derived from the field of critical gerontology, postmodernism and the utilisation of a Foucauldian understanding of discourse and power/knowledge. Data sources included published documents on delirium, interviews with people over the age of 65 years who had been delirious (as well as their clinical notes), family members, registered nurses and a doctor. Textual analysis revealed the presence of two contesting and contradictory discourses that impacted on being an older person who had delirium. These were identified as the discourse of delirium as a syndrome and a personal discourse of delirium. The discourse of delirium as a syndrome is underpinned by the biomedicalisation of the ageing process. This process utilises scientific methods as the foundation from which to understand, research and provide a health service to older people with delirium. Any personal perspectives on delirium are rendered unimportant and relegated to marginalised positions. Nursing through its vicarious relationship to medicine is interpellated into deploying the discourse of delirium as a syndrome and has largely ignored the personal dimensions associated with this phenomenon. Consequently, the older delirious 'body' is known and inscribed as unruly, problematic, physically unwell, cognitively impaired and at risk. Conversely, a personal discourse of delirium privileges the individual narratives of people who have been delirious and provides a different perspective of delirium. The deployment of a personal discourse of delirium offers another position that views this group of older people as bringing to the health care setting a rich tapestry of life experiences that are more than a cluster of signs and symptoms. It is these varied life experiences that need to be included as a legitimate source of knowledge about delirium. This thesis demonstrates how nursing needs to espouse a critical gerontological position when working with older people who have delirium. Critical gerontology provides nurses with the theoretical tools to challenge the status quo and uncover the multiple, varied, contradictory and complex representations of delirium in older people.

Abstract: The author examines influences on contemporary dementia specific nursing practice. She addresses the current situation and future developments in this area.

Abstract: Critical Comparative Nursing Assessment (CCNA) is a theory about how the competence of completing Bachelor of Nursing students in New Zealand is determined. Semi-structured, audio-taped interviews and field notes were used to collect data from twenty-seven nurses with experience in undertaking competency assessment. A Glaserian grounded theory approach was used to guide the data collection and analysis. This utilised the processes of constant comparative analysis, theoretical sampling and saturation to generate a middle range substantive grounded theory. This is presented as a model consisting of four emergent categories that explain how nurses formulate professional judgements about competence. These are a) gathering, which describes the processes used to collect evidence of practice to inform decisions; b) weighing up, which explains how evidence is analysed using the processes of benchmarking and comparative analysis; c) judging brings into focus the tensions inherent in making professional judgements about competence and how nurses formulated these, and d) moderating, which describes the processes nurses use to validate decisions and ensure that professional responsibilities and public safety are upheld. The basic social psychological process of comparing integrates these categories to explain how nurses resolve the tensions associated with making decisions about competence. This research presents a new way of viewing and understanding how nurses assess competence. It identifies where the challengers and tensions related to the assessment of competence lie and suggests strategies that if implemented, the author suggests could further enhance the validity and reliability of assessment outcomes.