Abstract: This thesis concerns an investigation of the tripartite arrangements between the government, the nursing and the medical sectors in New Zealand over the period 1984 to 2001 with a particular focus on primary health care. The start point is the commencement of the health reforms instituted by the Fourth New Zealand Labour Government of 1984. The thesis falls within a framework of critical inquiry, specifically, the methodology of depth hermeneutics (Thompson, 1990), a development of critical theory. The effects of political and economic policies and the methodologies of neo-liberal market reform are examined together with the concept of collaboration as an ideological symbolic form, typical of enterprise culture. The limitations of economic models such as public choice theory, agency theory and managerialism are examined from the point of view of government strategies and their effects on the relationships between the nursing and medical professions. The influence of American health care policies and their partial introduction into primary health care in New Zealand is traversed in some detail, together with the experiences of health reform in several other countries. Post election 1999, the thesis considers the effect of change of political direction consequent upon the election of a Labour Coalition government and concludes that the removal of the neo-liberal ethic by Labour may terminate entrepreneurial opportunities in the nursing profession. The thesis considers the effects of a change to Third Way political direction on national health care policy and on the medical and nursing professions. The data is derived from various texts and transcripts of interviews with 12 health professionals and health commentators. The histories and current relationships between the nursing and medical professions are examined in relation to their claims to be scientific discourses and it is argued that the issue of lack of recognition as a scientific discourse is at the root of nursing's perceived inferiority to medicine. This is further expanded in a discussion at the end of the thesis where the structure of the two professions is compared and critiqued. A conclusion is drawn that a potential for action exists to remedy the deficient structure of nursing. The thesis argues that this is the major issue which maintains nursing in the primary sector in a perceived position of inferiority to medicine. The thesis also concludes that the role of government in this triangular relationship is one of manipulation to bring about necessary fundamental change in the delivery of health services at the lowest possible cost without materially strengthening the autonomy of the nursing or the medical professions.

Abstract: Accountability has been described by nurses as an elusive concept or myth. The author suggests that this elusive concept or myth can partly be attributed to accountability becoming visible usually following a critical incident. The overall goal of this project is to provide nurses working within mental health with the incentive to raise their awareness and explore what their roles and responsibilities are within the accountability process in a more positive scenario. This research paper reports on an exploration of the key components of accountability within the New Zealand mental health environment. It describes significant influences that affect accountability. This is achieved by the means of a literature review, sharing of the author's experience of being involved in a national inquiry, and the adaptation of a who what and how framework, in conjunction with a diagram displaying accountability levels and lines for mental health nurses. The author points out that the domains of accountability for nurses will continue to evolve and expand but what remains important is that consumers have access to good quality mental health care.

Abstract: The focus of this article is on the findings of a grounded theory study of sexual health nursing in New Zealand. Nurses' experiences of providing sexual health care are described and theoretical explanations generated. The emphasis in this article is on countering stigma which emerged as a recurrent problem for nurses in the study. A comparative analysis of the nurses' counter reactions with Gilmore and Somerville's (1994) model of stigmatised reactions towards people with sexually transmitted diseases was done. The model describes the processes of disidentification, depersonalisation, scapegoating, and discrimination, which characterise stigmatised reactions. Nurses' understandings of the impact of socioeconomic conditions and gender/power relations in society have an important role to play in how nurses manage care. The concept of destigmatisation, which seeks to counteract negative social attitudes, is discussed. The study showed that as a consequence of their work nurses in this study encountered professional stigma and marginalisation.

Abstract: This paper explores the nature of compassion and posits it as a moral virtue that requires the nurse to act in the presence of suffering. Compassion is defined in relation to suffering and reciprocity, and distinguished from sympathy and pity.

Abstract: This paper outlines the role that policy and nursing have in a demanding and changing health care environment. It shows the basic tenets of policy, and provides strategies to enable nurses to increase their involvement in policy-making.

Abstract: The research outlined in this paper used Heideggerian phenomenology to examine the phenomenon of expert public health nursing practice within a New Zealand community health setting. Narrative interviews were conducted with eight identified expert practitioners who are currently practising in this speciality area. Data analysis led to the identification and description of themes which were supported by paradigm cases and exemplars. Four key themes were identified which describe the finely tuned recognition and assessment skills demonstrated by these nurses; their ability to form, sustain and close relationships with clients over time; the skilful coaching undertaken with clients; and the way in which they coped with the dark side of their work with integrity and courage.