Abstract: This research aims to clarify the knowing and wisdom that inform clinical nurse educators' responses through unpredictable situations. The author referred to philosophical literature on the notions of tacit knowledge, practical wisdom, smooth activity and the Unready-to-Hand experience. She created an explanatory framework and utilised this in a thought experiment by reflecting on personal experiences. To add clarity to these reflections, two layers of interviewing with nurse educators teaching in practice were carried out. The first layer was an interview with eight clinical nurse educators who in their role experienced Unready-to-Hand situations. The second layer consisted of four clinical nurse educators who volunteered to be involved in more in-depth interviews. An interpretive analysis of these clinical nurse educators stories illuminated the “Unready-to Hand as Adventure”, highlighting the uncertainty and energy associated with opening in the adventure, not knowing what will unfold, yet committed to remaining engaged and doing the best they can. Through the process of attuning to difference, accessing and deciphering knowing, nurse educators create meanings of situational complexities. By preserving the ideals of good practice and engaged caring, nurse educators salvage learning by creating opportunities for learning and teaching.

Abstract: This thesis concerns the Professional Development Programme at Lakeland Health. In New Zealand, such programmes were introduced as a mechanism to openly recognise the clinical expertise of nurses. Clinical Career Pathways were introduced to nursing in North America in the 1970's at a time of nursing shortage. Prior to their inception, nurses wishing to develop their careers had to move to administration, management or education. The programmes recognised and rewarded expertise in practice. A qualitative, descriptive approach (using focus groups) was used with Registered Nurses to gather their perceptions of what helps nurses enroll in the Professional Development Programme. The ideas and insights of nine Registered Nurses were clustered around three main categories: The People (fear; being struck; motivation; feedback; peer support; ways of learning); the Programme (relevance; flexibility; Bachelor's Degrees; implementation; supporting information; fairness); the Place (time; regular and accessible; support from nurse leaders; management). These perceptions are discussed in more detail in the context of nursing at Lakeland Health and of Clinical Career Pathways in New Zealand. The findings are helpful for the evaluation and future development of the Professional Development at Lakeland Health. The research contributes to our understanding of what helps nurses enroll in a Clinical Career Pathway, and emphasises the importance of the People, the Programme and the Place.

Abstract: This study explores the phenomenon of dilemma in paediatric practice. Using a hermeneutic phenomenological method informed by the writings of Heidegger [1889-1976] and Gadamer [1900-2002] this study provides an understanding of the meaning of 'being in dilemma' from the perspective of predominantly paediatric health care professionals but also families in New Zealand. Study participants include four families who had a child requiring health care and fifteen health care practitioners from the disciplines of medicine, nursing, physiotherapy, play specialist and occupational therapy who work with families and children requiring health care. Participants' narratives of their experiences of 'being in dilemma' were captured via audio taped interviewing. These stories uncover the everyday realities facing health professionals and families and provide an ontological understanding for the notion of dilemma. The findings of this study suggest that experience of dilemma for health professionals reveals a world that is uncertain and questionable where they are thrown into having to make uncomfortable choices and must live with the painful consequences of their actions. The consequences of being in such dilemma are having to find ways of living with the angst, or risk becoming too sensitive or desensitizing. For families the experience of dilemma reveals a similar phenomenon most evident in circumstances where they feel totalized by the impact of heath care encounters. This study has uncovered that the perspectives that health professionals and families bring to the experience of dilemma reveal different concerns and commitments and may be hidden from each other. This thesis proposes that health professionals and families need support in living with their own personal encounters of enduring experiences of dilemma.

Abstract: A paper presenting the findings of a small research project involving a group of self-selected senior nurses of Wellington Hospital to explore the nature of nursing practice in the care and management of hospitalised patients and to formalise the language that would acknowledge its significance in the current effort of hospitals to define patient care pathways. The nature of hospital nursing practice was described in themes of a generic process of nurse-patient care that articulates a distinct specialism of hospital nursing, whatever the hospital department in which nurses hold positions.

Abstract: This article reviews the recent evidence underpinning the New Zealand Ministry of Health's recommendation to offer free annual influenza vaccination to people aged six months to 64 years who have certain chronic medical conditions (eligible younger people). These results show there is relatively limited research providing evidence underpinning recommendations for influenza vaccination among people aged <65 years. These results show that there is a need to increase nurses' awareness of the rationale behind the New Zealand influenza vaccination policy, that this may in turn increase their willingness to recommend influenza vaccine to more eligible younger people.

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: It has been shown that intensive management of diabetes with type 2 diabetes is effective and has led to wider use of insulin. The conversion of patients from oral medication to insulin is usually managed in primary care. The study discussed here aimed to explore how patients with type 2 diabetes mellitus (T2DM) perceived insulin. The study was conducted in 2009 in an urban general practice in a large town in New Zealand with more than 300 patients with type 2 diabetes. A qualitative study was conducted with face-to-face interviews with 13 participants. The question focused on insulin initiation, lifestyle and routine. The transcribed responses were subject to thematic anaylsis. Interviews showed participants felt restricted by the prospect and eventuality of the routine and restrictions of being on insulin. Results show there needs to be a greater emphasis on the disease being progressive. This study provides the ground work for developing resources that will benefit patients with T2DM.