Abstract: This thesis presents a grounded theory study following Glaser's methodological stance. It explores nursing of the 10-24 year old client through interviews with thirteen registered nurses. The participants worked in a variety of clinical settings including community, hospital and specific adolescent services. From the analysis of the data emerged the complexity of the nurses work with the chosen age group. The study identifies that the quality of the nurse/client encounter may enable the young person to feel accepted and to be empowered to make their own health choices.This thesis identifies how Having Attitude is seen by the nurse participants as critical in the care of the young person. Having Attitude is about the nurse balancing the dependence/independence needs of the young person with their family and peers, and about being acceptable to the client. This results from the work of the nurse which is characterised by the nurse being competent' and 'being supportive whilst taking into account all of the socio-political factors that effect the nurses working situation. The socio-political context impacts upon the young persons life in terms of the types of health issues they have, and the availability and affordability of appropriate health services. It also impacts on the environment in which the nurse works, in terms of the complexity of the concerns with which young people present, current health reforms and funding issues. The nurse needs to have a broad knowledge base and ability to work within a complex situation. Nurses believe they can make a difference to the young persons health experience when they are supportive, competent and have attitude

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: Hospice nurses in New Zealand provide supportive care to patients of settings. In doing so, the hospice nurse and team are likely to have an ideal of a “good death” that guides their practice.A 'good death“ is one where symptons are well controlled without over medicalisation, where there is an acceptance of death by the patient and loved ones and where appropriatepreparation and completion of unfinished business has occurred. The death itself is peaceful and the loved ones are present. However, patients or their families do not always accept the treatment or care that the nurses offer to facilitate the best quality of life and a ”good death“ for the patient. This may leave the nurses involved feeling distressed and confused, as they are confronted with the conflict between the patients' path and the nurses' ideals.This study employs critical incident technique to explore how nurses respond and feel when the patients decline the treatment or care the nurse feels will improve their quality of life and eventually lead to a ”good death“. The findings illustrate a broad range of treatment or care that is declined by either patients or their families in the first instance. This study uncovers a number of action responses nurses use in these situations, which demonstrate acceptance of patient choice but also need to help the patient experience a ”good death". In addition it demonstrates that nurses experience a gamut of emotional responses to such situations, some of which are painful for the nurse and have the potential to cause stress. Recommendations are made which may assist nurses limit the distress they experience when patients of their families decline the treatment or care, and empower nurses with further strategies to use in such situations

Abstract: This thesis provides an interpretive critique of the way in which knowledge is viewed, transmitted and crystallized in the practice worlds experienced by four registered nurses working in acute care hospital settings. The theoretical assumptions of critical social theory underpin both the methodological approach (case study) and the analysis of data. In-depth unstructured interview, a critically reflexive dialogue between the investigator and participant focussed on the practice world experiences of the nurse, was the principle research method. A brief analysis of documentation was also undertaken.It is argued that previous studies related to nursing practice, and to the social worlds of nursing, have been limited by their failure to take account of the socio-political context in which nursing takes place. There has been a tendency to treat the transmission of knowledge in nursing and nursing practice process of information exchange. No account of socially generated constraints on personal and professional agency, or of systematic distortions in communication within the practice setting are therefore given.The analysis of data in this study demonstrates the way in which constraints on personal and professional agency were experienced by each of the four participants. In particular, practice expressing the participant's professional nursing knowledge and values ws often denied in the face of shared understandings reflective of the institutional ideology. These shared understandings included a belief in the legitimacy of medical domination over other social factors and the support of doctor, rather than nurse or patient, centered practices.This study demonstrates that the way that nurses and other social actors come to “know” and interpret their social worlds is dependent on the socio-political contest in which that knowledge in produced. It also shows how this knowledge may be treated ad though it were 'an object'. This tendency to treat existing social relationships and practices as 'natural' hence unchallengeable masks possibilities for transformative action within the practice of nursing.It is argued that a particular form of knowledge is required if nurses are to overcome the types of constraint experienced by these four nurses. This knowledge, emancipatory knowledge, is that developed in the process of shared, socially critical self-reflection rather than solitary, self-critical reflection