Abstract: This dissertation had two main aims. The first was to explore the literature from which nurse leaders of alcohol and other drug services might develop their leadership skills so as to enhance nursing practice within an interdisciplinary alcohol and other drug team. The second was to further utilise these skills to develop a 'toolkit' which would assist in the successful management of the team but would also aid with workforce development. In addition, this dissertation was linked to the Nursing Council of New Zealand Competencies for the Registered Nurse Scope of Practice (2005) and Competencies for Advanced Nursing Practice (2001). This dissertation provides direction for the nurse leader wishing to develop their toolkit. Implications for the advancement of nursing are suggested.

Abstract: The process of describing her scope of practice led the author to become interested in just how she has advanced her practice and the journey that unfolded. The author was introduced to a number of models or frameworks and these frameworks have been critiqued within this dissertation.

Abstract: Explores and describes the experiences of RNs who have a disability or impairment, in their interactions with colleagues and managers in clinical practice. Discovers strategies used by them to ensure safe practice. Conducts 60-90-minute interviews with 10 RNs who identified as living with a disability or impairment.

Abstract: Evaluates nurses' experiences of working in decentralised work stations in NZ hospital wards, in order to explore the interesection between the physical environment and nursing care. Backgrounds the shift away from centralised nursing stations to satellite work stations within wards. Identifies the unintended challenges of the design for nurses. Conducts two focus groups of 7 nurses each about the benefits and disadvantages of such nursing stations.

Abstract: A qualitative framework was used to explore the nature and the quality of interactions between sole on-call primary health care rural nurses and secondary care doctors as a component of rural nursing practice and representative of the primary-secondary care interface. Crucial to patient centred care, the premise was that the quality of this interface would be variable due to multiple influences such as: the historical nurse/doctor relationship that has perpetuated medical dominance and nursing subordination; current policy direction encouraging greater inter-professional collaboration; and changing role boundaries threatening traditional professional positioning. A total of 11 nurses representing 10 separate rural areas participated in semi-structured interviews. Rural nurses typically interact with secondary care doctors for acute clinical presentations with two tiers of interaction identified. The first tier was presented as a default to secondary care doctors for assistance with managing primary care level clinical presentations in the absence of access to a general practitioner or an appropriate Standing Order enabling appropriate management. The second tier presented itself as situations where, in the professional judgement of the nurse, the client status indicated a need for secondary level expertise and/or referral to secondary care. The needs of the rural nurse in these interactions were identified as access to expertise in diagnosis, therapy and management, authorisation to act when intervention would exceed the nurse's scope of practice; the need to refer clients to secondary care; and the need for reassurance, encompassing emotional and professional issues. The quality of the interactions was found to be variable but predominantly positive. Professional outcomes of positive interactions included professional acknowledgement, support and continuing professional development. For the patient, the outcomes included appropriate, timely, safe intervention and patient centred care. The infrequent but less than ideal interactions between the participants and secondary care doctors led to professional outcomes of intraprofessional discord, a sense of invisibility for the nurse, increased professional risk and professional dissatisfaction; and for the client an increased potential for deleterious outcome and suffering. Instead of the proposition of variability arising from interprofessional discord and the current policy direction, the data suggested that variability arose from three interlinking factors; appropriate or inappropriate utilisation of secondary care doctors; familiarity among individuals with professional roles and issues of rurality; and acceptance by the primary care doctor of the sole on-call primary health care rural nurse role and the responsibility to assist with the provision of primary health care. Recommendations for improving interactions at the interface include national, regional and individual professional actions.

Abstract: This report presents selected aspects of an inquiry based on a conversation with Raeleen, a graduate of a post-graduate nursing programme. Raeleen talks about her experience of critical thinking during her post-graduate studies. The authors suggest that, through this conversation, it is possible to explore the nature of critical thinking and examine the important roles teachers can play in facilitating its development. Includes discussion questions prepared by Rebecca Hennephof that consider the relevance and impact of critical thinking on nursing practice.

Abstract: Literature and discussion on the role of caring theory in nursing has been in evidence for at least the past 30 years. Many nursing theorists have identified caring as the heart of nursing. Nursing is a profession involved and concerned with relationships. These relationships begin in the schools of nursing, and are continued into the clinical practice setting. Curriculum development is focused on ensuring nurses are prepared for the real world of practice. It is the author's belief, that nurses who receive their education in an environment where caring is modelled and evidenced throughout the curriculum, become nurses who continue to practice in a caring way. This dissertation will demonstrate that Swanson's (1991) five caring processes provide a framework to evidence caring practice within a nursing curriculum. The author believes this topic needs to be discussed as schools of nursing continue to review their curricula to prepare nurses for an ever changing and challenging health environment. This dissertation explores the question, 'If caring is at the heart of the profession of nursing, is it also at the heart of nursing education?' The author's objective is to inform the reader, and perhaps encourage educators to be courageous in the demonstration of caring practice, and in the development of caring curricula.

Abstract: The author notes that learning nurses require real clinical experiences in order to apply learnt theory to actual practice. Clinical learning environments have consistently been found to function variably and sub-optimally for both learners and teachers. In order to improve the quality of the clinical learning environment it is necessary to first evaluate how effectively a clinical learning environment is functioning. A number of different methodologies have been used to evaluate clinical learning environments, a recent and successful method being the use of questionnaires or clinical learning environment evaluation tools. The objective of the present study was to develop clinical learning environment evaluation tools for use in a New Zealand hospital health service. Four tools appropriate to evaluate the clinical learning environment from the different perspectives of any type of clinical learner, clinical teacher, clinical manager and programme co-ordinator or nurse lecturer were developed. Six newly graduated nurses, three senior nurses, and the researcher were involved in the development of the evaluation tools over a five month period. A participatory action research methodology was employed. The resultant tools had a unique local focus and were suitably similar to other internationally developed tools. After testing the clinical learning environment evaluation tools, it is hoped that the implementation of the tools will support all stakeholders to understand and consequently optimise the functionality of their clinical learning environment.