Abstract: A report on the analysis of data from an in-depth survey designed by Sue Dawson, previously Rural Health Researcher in the Centre for Rural Health, and follow-up interviews. The study purpose was to construct a definition of ?successful design and delivery of rural health services? as a step towards a measurement tool. Participants were grouped as general practitioners (GPs), nurses and community representatives. A format for a participatory approach to evaluation of rural health services is derived from the criteria of success identified, with its relevance for the implementation of the new Government primary health care strategy explicit. This format provided the basis for a subsequent evaluation case study undertaken in a small rural forestry township by the Centre for Rural Health.

Abstract: Compares the delivery models used by primary health-care nurses in Auckland for follow-up services aimed at Pacific children discharged from hospital with preventable illnesses, with similar services and programmes in Tonga and Samoa. Also compares NZ and Pacific Island programmes to promote immunisation and breastfeeding. Part of the Margaret May Blackwell Scholarship Reports series.

Abstract: This paper is a culmination of the author's inquiry, reflection and critical thinking on the transitional phase that practice nursing is currently undergoing as part of the New Zealand Primary Health Strategy. The paper utilises both reflection-in-action and reflection-on-action as well as reflection-before-action, as a process. The author's starting point for this inquiry was attending the New Zealand Nurses Organisation Primary Health Conference in Wellington and reading a report from the Expert Advisory Group on Primary Health Care Nursing. Knowing that practice nurses are the majority of nurses working in primary health, she was concerned that changes to primary health were being driven with little reference or participation by them. The paper explores how practice nursing evolved in New Zealand and the developments that have occurred in the 30 plus years since its inception. It describes the role and current work of practice nursing in general practice, and highlights the constraints that have held back development and continue to do so. The 2002 New Zealand Primary Health Strategy is shown to provide an opportunity for development and enhancement, if some of the constraints are removed. As part of looking to the future the possibilities for practice nurses to lead the way in primary health development are explored.

Abstract: The aim of the study was to explore how practice nurses perceive engagement in Peer Learning and Review Groups impacts personally and professionally on their clinical practice. An anonymous self-administered postal questionnaire was completed by 55 practice nurses who attend Peer Learning and Review Groups in the South Island. A mixed method design was utilised to obtain both qualitative and quantitative data. Practice nurses considered group attendance was important for professional development with the majority perceiving that their attendance had a positive effect on their clinical practice. The nurses perceived clear linkages between the significant learning that occurred in the groups and changes in delivery of patient care. Additional benefits included improved collegial relationships, professional awareness and personal growth. The author concludes that, together, these findings underline the importance of Peer Learning and Review Groups as an effective tool for ongoing personal and professional development within nursing.

Abstract: This dissertation focuses on the concepts of island, island-ness, and isolation. It aims to further advance the national and international literature relating to the health beliefs of island people as linked to the provision of primary health care services within New Zealand. New Zealand is an island nation made up of two main islands and numerous outlying islands, relatively isolated from the rest of the world by water. This geography means going anywhere from New Zealand involves traveling either “over” or “on” the sea. All people of New Zealand since the first inhabitants, whether residents or visitors, have arrived to New Zealand either by sea or more recently by plane. The population of New Zealand is 25% rural, with most of these rural dwellers residing in the South Island, and several of the smaller off shore Islands. This builds a sense of culture of the people, or tangata whanua (the people of the land), for whom there are degrees of island-ness, and the characteristics of this can be seen amongst the people of New Zealand. A further challenge which is discussed comes in the form of the “island penalty” which encompasses high transport costs, long distances to travel to main centres, lack of specialists and trained health workers, effects of migration and tourism, and communication difficulties. The more isolated people are, the tougher the challenges become. Most rural island populations are served by lay care workers, volunteers, and rural and remote nurses. Nurses are often the main health care providers to small island populations, and they demonstrate advanced nursing practice which is acknowledged internationally as meeting Nurse Practitioner competencies. As a group these nurses possess knowledge of the extrinsic and intrinsic factors involved in the health needs and health determinants of these island communities. Researching these advanced nursing roles adds to the body of knowledge around isolated and island communities. The author suggests that studying the concepts of islands, islandness, and isolation in relation to health beliefs will bring more understanding of services for the advanced rural nurse to consider in developing appropriate, accessible, affordable and adaptable Primary Health Care which is fair and equitable.

Abstract: When the New Zealand Nursing Council introduced the nurse practitioner as a new level of nurse in 2001, the opportunity arose for the introduction of primary health care nurse practitioners into the rural practice arena in this country. This dissertation explores the influences on the development of rural nursing in the last decade in New Zealand including the role of the Centre for Rural Health in advancing rural nursing education, as well as the impact the shortage of health professionals in rural New Zealand has had on the development of the rural primary health care nurse practitioner concept. For pioneering primary health care nurse practitioner roles to be successfully implemented in rural communities in New Zealand, several challenges need to be faced; the creation of roles and employment opportunities, community acceptance of the role, medical and nursing acceptance of the role and the establishment of independent nurse prescribing within the constraints imposed by current legislation. The dissertation explores the current literature in an attempt to offer solutions to the identified challenges. With the creation of primary health care nurse practitioner roles and the establishment and acceptance of these roles in rural communities, a new mode of health service delivery in rural New Zealand will begin.