Abstract: A Heideggerian Hermeneutical Analysis (HHA) approach was used for a study of returning registered nurse students (RRNS) from a nursing/health management context. In essence a descriptive interpretive study the intent has been to unveil the common meanings embedded in the lived experience of RRNS return to formal (advanced) studies. The phenomenon or issue of interest was pursued in the form of a question: What is meaningful and significant for participant RRNS in their everyday world on re-engaging in formal (advanced) nursing studies?Research from the RRNS viewpoint is scarce, so the focus of the study was to understand what RRNS themselves found to be the highlights of the experience. Participants included RRNS coming from a management background and, therefore, very much at the cutting edge of rapid and continuing change in health care provision. In addition to personal and professional reasons for returning to study, what the narratives disclosed was the compelling need experienced by the RRNS to increase understanding of changing requirements in the workplace. They looked for new possibilities to transform management of nursing/health services and for learning experiences favorable to that purpose. A key aspect of their concern related to the interactive nature of their lived experience as a RRNS with the entire context of their everyday world, that is, with the connections and relations between the study-work-homespace.Fourteen RRNS from an established university nursing programme participated in an expended non-structured interviews lasting 60 – 90 minutes. The interviews were held during 1993 in places selected by participants, some in the home but mostly in the work setting. With the consent of the participants interviews were audiotaped and then transcribed. The texts (transcriptions) were analysed hermeneutically using Heideggerian phenomenology, a particular tradition of philosophy whose concern is the meaning of Being. The concern is to make visible participants' experience of their 'world'. In this instance, it was the everyday 'world' of the participant RRNS and the lived meanings of what they experienced on return to formal (advanced) studies. Hence everyday lived experience is the focus of attention in Heiedeggerian phenomenology. In this research approach what is sought is understanding not explanation. It is a premise of phenemenology that, in general, an understanding of the meaning and significance of the lived experience can be required from the 'things' (the phenomena under study) themselves. Approaching a participant as an expert by virtue of directly experiencing the phenomenon, is basic to phenomenology. Hermeneutic analysis of the texts of the participant RRNS affirmed the authenticity of those assumptions.The study revealed several common or major themes, two relational themes and one constitutive pattern were identified through the process of textual interpretation. The constitutive pattern expressing the full complexity of the relations and connections between the themes, was found to be present in all fourteen texts; the nature of a constitutive pattern being 'that it's always there'. The constitutive pattern 'Nursing is Dwelling in Thoughtful Concern as Context Calls Forth', emerged as the major finding of the study. This pattern witnesses to the pragmatism that is inherent in nursing and commonly found in nurses' responses to the challenges presented by continuing and rapid change. For the participant RRNS nursing had become a way of engaging their energies in the workplace as appropriate to a given place, time and culture. The two relational themes accent particular aspects of the constitutive pattern. 'Nursing' is a whole pile of things'; and 'Curriculum: Reflective Openness' reveal the inherent meanings of the constitutive pattern. Firstly, that nursing is diverse in practice and has many dimensions; and,, secondly, that a curriculum befitting the diversity of nursing requires us to constantly challenge ad test the learning experiences we provide for RRNS.The fourteen participants traversed diverse pathways to acquire the understanding and skills required for altered health care structures. Adopting new relationships and 'leaping-ahead' (Heidegger, 1962), to be able to see the whole picture of what was being experienced in nursing/health care, reveals the RRNS becoming-as interpreters for both colleagues and clients. Leaping-ahead is reflective of thoughtful concern as the pattern of responding to presenting need. This way of living a life transforms work. The participant RRNS disclose that, dwelling in such a way in nursing/health work opens up a future of possibilities which brings all the presenting needs into focus. Sharing the story of their lifeworld as RRNS, the participants have exemplified the ' reflective openness' Senge(1990) advocates, as being a pre-requisite for 'learning organisations'. Contemporary oganisations require us to challenge our own thinking as well as being free to speak our minds ('participant openness'). Since, however much we value our daily life practices and understandings, they need to be 'always subject to test and improvement'. In effect, what the participants have bestowed on us is that, within the framework of a curriculum for RRNS and the content learning of a given course, we must generate a process of learning amenable to both individual and group requirements

Abstract: This study presents information, obtained from health service managers, on the present use and possible future use of second level nurses within the region encompassing the Wanganui, Rangitikei, Manawatu, Tararua, Palmerston North City and Horowhenua districts. “ Second level nurses” are currently known as enrolled nurses and, in accordance with Section 53A of the 1983 Amendment to the Nurses Act, are required to work under the direction and supervision of registered nurses or medical practitioners. Enrolled nurses are usually allocated less responsibility for nursing assessment and judgement than registered nurses.Management perspectives, from seventy seven health workforce managers, were sought in relation to the future workforce need, the scope and boundaries of practice, and the alternatives for the future educational preparation of second level nurses. Seventy two percent of managers said that they thought enrolled nurses were essential to New Zealand's future nursing workforce. They predicted increased opportunities for enrolled nurses in care of the elderly and community care settings. Patterns in the current workforce utilization of enrolled nurses, however, did not support these views.In relation to the education of enrolled nurses, managers indicated that hospital-based training was the most preferred option. However, managers asserted that, in view of the current lack of employment opportunities no more enrolled nurses should be prepared at the present time.Although questions about education were focussed on the educational preparation of enrolled nurses, many of the respondent managers also expressed opinions about the educational preparation of comprehensive nurses. As a result, an evaluation of comprehensive nursing programmes is suggested.While the numbers of second level nurses being prepared and used is decreasing, there is a concomitant increase in the preparation and use of caregivers. This rapidly increasing group isfast becoming a “cheaper” second level workforce. The increase in the use of caregivers is seen to result from the pressure on healthcare employers to reduce spending within the current highly competitive, de-regulated economy. Managers asserted that enrolled nurses are not cost effective in comparison with either caregivers or registered nurses.The study concludes with thirteen recommendations which are made under the following four groups;1. Manawatu Polytechnic – provider of nursing education.2. Healthcare employers – users of nursing education.3. Enrolled nurses – participants in nursing education.4. Professional nursing bodies – guardians of nursing education

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: This study describes rural, nurse-led health services provided by the Takapau Health Centre (Central Hawkes Bay) and its outreach, Norsewood & District Health Centre. The study looks at its model of service delivery through to 2002. It examines the establishment, development, funding and management of the service, along with the nursing practice and the healthcare people received. The book is a snapshot of nursing initiative and survival through a decade of change in health policy and service funding and delivery. The information was subsequently used to move the health centre service into the new paradigm of primary health care launched in the New Zealand Health Strategy.

Abstract: This study provides insight into the experience of being an ICU nurse and relative of a critically ill patient. Analysis of data from interviews of four ICU nurses who had experienced having a family member admitted to ICU brought up several themes. These included: a nurses' nightmare, knowing and not knowing, feeling torn, and gaining deeper insight and new meaning. Recommendations for organisational support for ICU nurse/relatives, and education for staff are made, based on the findings.

Abstract: As has been the case internationally, deinstitutionalisation of dual diagnosis (intellectual disability and mental illness) services has also occurred in New Zealand. Inpatient services have been redefined to respond to the more acute focus that has arisen out of this deinstitutionalisation process and nurses are having to redefine their roles in response. This study was undertaken to explore and describe the culture of nursing practice in a dual diagnosis inpatient unit in one psychiatric hospital. A focused ethnographic approach was used to triangulate data gathered from fieldwork observations, review of documents and semi-structured interviews. Schein's (1985) levels of culture model, was used to identify and explore the artifacts, values and assumptions evident in this nursing practice. Analysis presents three key themes categorised as 'communication', 'assessment' and 'safety'. While these key themes are shown to be evident in the everyday practice of the nurses, how these relate to the notion of 'dual diagnosis nursing' is not clear. Therefore, the author describes the major finding of this study as revealing a nursing culture holding tight to traditional psychiatric and psychopaedic nursing practices and struggling to develop a distinctive culture in the absence of a defined dual diagnosis knowledge base. The author concludes that these findings suggest an urgent need to provide nurses with support in gaining contemporary knowledge regarding dual diagnosis nursing. Support for nurses in advancing these areas then impacts on support for the patients. It is suggested that additional research is undertaken to assess the learning needs of the nurses in order to develop clinical practice guidelines for this area. Further recommendations are made to address system issues which are contributing to the gap in knowledge.