Abstract: Participants for this study consisted of six Plunket Nurses from three Plunket operations areas within the North Island, varying in experiences from two to twenty three years, working with both urban and rural communities.

Abstract: Although it is accepted in rural nursing literature that the context shapes nursing practice there is limited opportunity to gain an understanding of how this occurs. This dissertation addresses this issue. Firstly, by employing a social geographical lens to define and examine the dynamic, evolving rural context and secondly, by considering the nursing concepts that arise from those contextual factors that relate directly to rural societal health needs. Defining 'rural' is essential when describing or debating rural nursing practice in context. However, there remains no universally accepted definition of 'rural'. Despite this and even though each location is individually specific, there are socio-cultural, occupational, ecological and health aspects that are common and bespeak rural society. These aspects have been developed into a Rural Framework Wheel as a visual reference to demonstrate the substantial influences which impact on nursing practice within the rural context. The framework encapsulates the distinctive dimensions that are hallmarks of rural nursing practice. Nurses can therefore use the framework to express concisely their individualised practice and competence by employing the two broad themes that have emerged from the literature; that of 'nursing per se' and 'partnership'. The Rural Framework Wheel is recommended as a paradigm to critique the practice of rural nurses from an educational, employment, research and political perspective. It is advocated that this framework be used by rural nurses to describe their practice and therefore to express the distinctiveness of the rural nursing identity.

Abstract: The purpose of this dissertation is to consider the potential role of nurse practitioners within the Family Planning Association using the “participatory, evidence-based, patient focused process for advanced practice nursing” framework. The existing model of care meets the needs of most Family Planning Association clients well in family planning and sexual and reproductive health care. Some population groups, for example, Maori, Pacific Island people and males are currently underserved particularly in areas of sexual and reproductive health. Consideration is given to how the Family Planning Association could incorporate nurse practitioner expertise to complement existing care and utilising innovative and cost effective ways of reaching some underserved population groups. The integration of the nurse practitioner role into the current staffing mix has the potential to enhance the current model of care, freeing medical officers to deal with more complex medical issues and providing a clinical career path for Family Planning Association nurses.

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.

Abstract: This research considers the issues raised by the transfer from New Zealand to India of a degree for registered nurses. In the context of globalisation and the continuing migration of nurses, many countries are actively facilitating the transfer of educational programmes from other countries into their own. This transfer brings with it particular challenges for educators establishing and implementing programmes in a new environment and culture. Based on the experience and reflections of one educator involved in such a transfer, this research considers pedagogical issues such as addressing cultural safety in course content and delivery, expectations of teaching and learning styles, as well as the ethical issues raised by transferring a programme to another country in order to facilitate nurses' migration from it.

Abstract: Based on qualitative research conducted in New Zealand and the Western Isles with rural primary care nurses and Family Health Nurses respectively, this thesis explores the ways that nurses construct flexible generalist professional identities that challenge traditional inter and intra-professional boundaries. Rhetoric of 'crisis' is often utilised to raise political awareness of the problematic, but in fact, rural general practitioner recruitment and retention has been documented for about a hundred years. For about the same length of time nurses have been providing primary health care services in rural and remote places, often working alone. In the New Zealand case, rural primary care nurses negotiate the boundaries between nursing and medicine, those within nursing itself, and also those between nursing a paramedic work. Nurses perform this boundary work by negotiating self-governing 'appropriate' and 'safe' professional identities. In the Western Isles case, the introduction of the newly developed role of Family Health Nurse serves to highlight the problematic nature of inserting an ostensibly generalist nursing role beyond the rural.

Abstract: A retrospective descriptive design was used to examine the records of all presentations to the emergency department of patients with COPD over a 3-month period to determine whether there is a subset group of people who present with hypercarbia. There were 114 presentations, amongst those there were 71 individuals, a number presenting more than once within the three months. 80% of the 71 individuals had a smoking history of which 53% were female. Of the 114 presentations, 76 had arterial blood gases taken during their emergency department presentation. Of these 76 presentations 30 had hypercarbia and 46 were non-hypercarbia. These 76 presentations involved 58 individuals, with some individuals presenting five times over the three-month period. Three groups emerged, some who were only hypercarbia (n= 18), some in the non-hypercarbia group (n=35) and 5 individuals who had presentations in both the hypercarbia and non-hypercarbia groups. Data showed that there was no definable subset group of hypercarbia patients within acute exacerbations of COPD presenting to the emergency department according to the variables. However the sample of presentations (with a blood gas) found within the study suffering hypercarbia was much higher (31.1%) than anticipated. Further analysis showed that the hypercarbia group had a significant lower forced expiratory volume in one second (FEV1) and a combination diagnosis of emphysema or asthma and congestive heart failure. An implication to the clinician is that identification of hypercarbia within COPD exacerbation is problematically difficult until the late signs are shown with the individual. By that time effective treatment patterns may have changed from the initial presenting problem. The author concludes that future areas of research within this field needs to lie within the community, and look at when these people start the exacerbation, what leads them to progression presentation to the emergency department, and whether these people are chronic sufferers of hypercarbia or presenting after a period of days exacerbation within their own home.