Abstract: The focus of this research was to explore the migrant family's experience in palliative care. In writing this thesis, the author notes that it became evident that cultural safety was a connection that warranted further study in relation to end-of-life nursing care as was illustrated by the intergenerational case study of this migrant family in New Zealand. The use of the case study method of qualitative research enabled the voice of the migrant to be heard and the story of the migrant family's experience to be showcased. The uniqueness of this family's palliative care experience was around the religious and cultural needs and migration as a process of transition from a previous society to a new one. Palliative care was defined by the family approach with strong community support and empowered by culturally safe and appropriate nursing practice. End-of-life illness is a time when cultural perspectives are challenged for patients and their families and religious and cultural practices take on a new priority, regardless of how they have lived life previously. As a migrant nurse living and working in the New Zealand context, the author identifies as an important factor, the nurse-patient interaction as an encounter between two cultural perspectives, the patient's and the nurse as bearer of her own culture. Acknowledging this factor is an important step in developing a culturally safe approach to practice, an approach that proved to be a major ingredient in planning and caring for this patient and his family in end-of-life illness. This study and thesis explores the underpinnings of culturally safe palliative nursing care and identified 'reflexive bracketing' as a useful practice in the process.

Abstract: Therapeutic relationships are central to mental health nursing. The nurse's role in maintaining professional yet therapeutic boundaries within this relationship can be challenging. When therapeutic boundaries are breeched within the nurse adolescent relationship the adolescent's safety within this relationship is compromised. There is currently limited literature on how nurses are managing professional boundaries in relationships with adolescents in this setting. The adolescent's nature is to push boundaries; therefore the nurse needs to be acutely aware of this boundary pushing in everyday practice settings. For the safety of the adolescent and the nurse it is vital the nurse understands her role in managing the professional boundary. This thesis explores, through the use of narrative inquiry, four adolescent mental health nurses' experiences of assessing, understanding and maintaining therapeutic boundaries with adolescents in a mental health setting in New Zealand. The unique and specific implications for adolescent mental health nursing are discussed. Three key themes emerged from the analysis and findings: the importance of the nurse clarifying his/her role; the learning that occurs throughout the practice journey; and the role of the nurse in keeping the adolescent and the nurse safe. These findings highlight the importance of clinical supervision and open communication with senior nurses and mentors, which assist the nurse in monitoring practice. When nurses do not have sufficient knowledge of the fundamental principles of adolescent mental health nursing; such as knowledge and skills in both adolescent development and psychodynamic nursing, they are at risk of boundary crossings. Recommendations from this research include more emphasis on psychodynamic nursing principles in nursing education and nursing practice. There is a need for specialised education for nurses in child and adolescent mental health nursing. Nursing entry to practice programmes for new graduate nurses working in mental health, could assist in providing this. There is a call for further research into therapeutic relationships and professional boundaries in this complex nursing specialty.

Abstract: The aim of this research was to explore patients' educational experiences and the usefulness and benefits of this health education in the rehabilitation period, when undertaking a total joint replacement. An exploratory, qualitative descriptive study method was used to describing patients' experiences of health education. Five participants, convenience sampled, were interviewed eight to twelve weeks post surgery following unilateral total joint replacement in a tertiary hospital. Participants valued the education they received pre operatively, which included written material, video and individual interaction with varied health professionals. Although this was provided in a timely manner, evidence showed limited post operative reinforcement and follow up of given education and preparation for discharge. Three 'partnership' themes were identified from data, Communicative, Subservient and Knowledge. 'Communicative Partnership' conceptualised the participants' experiences of the nurse-patient relationship, whilst 'Subservient Partnership' captured the participants' experiences of 'being' patients. 'Knowledge Partnership' combined the participants' ideas about knowledge and their retention of this knowledge to assist with their rehabilitation post surgery. The needs and experiences of patients after total joint replacement reflect on transitional change – changes in roles, behaviour, abilities and relationships. Educational contents need to reflect a realistic recovery process to assist with this transitional period, delivered by health care professionals in a manner best suited for patients.

Abstract: The author suggests that the thesis as a production of disciplined work presented in a creative style is congruent with performance and presentation best practice in community arts. As a practising nurse artist the author describes creating spaces of alternate ordering within the mental health field environment. “I also inhabit the marginal space of the artist working in hospital environments. This Other Place neither condones nor denies the existence of the mental health field environment as it is revealed. Yet, it seeks to find an alternative to the power and subjectivity of the [social] control of people with an experience of mental illness that inhabit this place both voluntarily and involuntarily. I have used a variety of texts to explore the experience and concept of Otherness. The poems are intended to take you, as a reader where you could not perhaps emotionally and physically go, or might have never envisaged going. They also allow me as the author to more fully describe the Otherness of place that is neither the consumer story nor the nurse's notation, but somewhere alternately ordered to these two spaces. Drawing on the heuristic research approaches of Moustakas and literary psychogeography , particularly the work of Guy Debord, this thesis creates the space to explore the possibilities of resistance and change and the emergence of the identity of the nurse artist within the mental health field environment”.

Abstract: This research paper reports on an exploration of the key elements nurses need to be aware of to effectively nurse adolescents in an adult inpatient unit. It describes the developmental needs and significant influences that affect this age-group, that when incorporated into nursing care, nurses can gain a therapeutic relationship with the adolescent. By means of a literature review, sharing the author's experience in nursing adolescents, and through vignettes of practice, an illustration of some common situations that may occur during the adolescent's inpatient stay are described. These situations are explored and a perspective is offered on how nurses may be effective in their nursing of an adolescent patient from the point of admission through to discharge. More research is needed on adolescent mental health nursing, however the author anticipates that nurses will be able to use this report as a helpful resource in their current practice.

Abstract: Respiratory nursing has, as a core clinical concern, the alleviation of distress and suffering associated with respiratory disease. This research describes the ways in which experienced New Zealand respiratory nurses understand, assess, manage and support patients suffering from chronic breathlessness. It reviews the professional context in which these nurses practice, and examines the experiences and beliefs that have lead them to, and maintain them in, this area of practice. This study has been stimulated by the realisation that the skills, understandings and practice wisdom exhibited by experienced Respiratory Nurses is poorly described in the published research literature. This qualitative, grounded theory research is based upon data gathered from in-depth interviews with six experienced New Zealand respiratory nurses. A constructivist research position is adopted. Analysis of these interviews revealed distinct phases of developing respiratory nurse practice including preparing and entering respiratory nursing practice, comprehension of the phenomena of chronic breathlessness and the effect upon the patient and the seeking of possibilities which may alleviate and modify the debilitating effects of chronic breathlessness. Consistent values and beliefs are identified, which are captured in the concepts of professional caring and the movement towards developing expertise in practice. The unifying concept of journeying is employed to draw together these conceptual elements and develop a substantive model describing the work of experienced respiratory nurses with patients with chronic breathlessness. Implications for practice and the health system, and suggestions for further research, are discussed.

Abstract: When a child lives with a life-threatening illness there is a range of emotions that affect the child, family and people close to the child. This study utilises a narrative approach to explore what the child puts emphasis on in what is important to them as they live with serious illness. The study incorporates the nurse as narrator with the 'narratives' of the children integrated into her reflections to gain a broader understanding. The focus is on listening intently to the spoken needs of children, their story and the meaning they make of their situation when they live with their illness. 'Children' in this study are between the ages of six years to 15 years. The aim of this research is to provide a clear understanding of the lived experience, which may illuminate the needs of the child and what is required throughout the time of illness; therefore informing health professionals of a culture of care that may support these needs. A broader understanding and deeper insight into the complexity of children living with life-threatening illnesses provides a basis for the development of sensitive, humanistic quality nursing care for both the child and his/her family, this then enhances the potential for best practice for children living with a life-threatening illness.