Abstract: Pain management practices within emergency departments require a more patient focused approach due to extended waiting times for analgesia. This dissertation questions current methods of providing timely and appropriate delivery of analgesia. Nurses represent the biggest resource in emergency departments therefore are in a position to be able to access patients in a timely fashion. A review of the literature pertaining to nurse initiated analgesia protocols has been evaluated and information relating to efficiency and safety utilised to discuss the processes for planning and implementation of a similar protocol. The author finds that the literature provides no evidence that nurse initiated analgesic practices prior to medical assessment compromises patient safety or delays diagnosis. A discussion of the benefits to patients, nurses and the institution has been included to highlight the appropriateness of extending nursing roles.

Abstract: On call emergency health services are becoming routinely provided by some rural nurses, predominantly within the South Island. Rural nurses have been advancing their practice to accommodate the limited availability of general practitioners in rural communities. Although this is becoming routine practice, the author has been providing a service such as this for the past 12 years. This dissertation describes this practice in relationship to the present social-political context, advancing nurse competencies and her experience of rural nursing in a rural town within the South Island. Particular significance for the rural nurse is the required independent practice and overall responsibility when remote from traditional medical oversight. Providing on call emergency care with the possibility of a broad spectrum of emergency situations while maintaining competence for the unpredictable frequency (or lack of frequency) of the rural emergency is the focus of this dissertation. The professional and personal risks are high for rural nurses when placed in situations they are not prepared for or unable to remain competent to manage. Implications resulting from the critique of the health service literature on this subject are identified. Firstly, rural nurses need to be insightful of their own emergency on call expertise and limitations. Secondly, rural nurses require ongoing education and thirdly that appropriate education is available and accessible to rural nurses. Lastly, rural nurses require maintenance of competency so these emergency skills are not lost. This dissertation and the resulting recommendations embrace Nursing Council of New Zealand Nurse Practitioner Competencies. The resulting outcomes fulfilling the rural nurse's need for maintenance of competency for emergency on call care, the community's need for safe appropriate emergency care and national legislation requirements.

Abstract: The development and role of the clinical nurse specialist in New Zealand is the focus of this dissertation. It is an area that has not clearly been documented previously and the author hoped that by articulating this role to nurses, educators, and administrators that the role of the clinical nurse specialist will be more clearly defined and perhaps recognised for the contribution it provides to health care in New Zealand. At present, it is difficult to justify the clinical nurse specialist position in New Zealand, when individuals have been left to define and develop their own positions. This has led to widely differing practice modes and role confusion, and therefore a varying degree of success in achieving improved nursing practice. Without title protection and some form of accreditation process to ensure standard of practice throughout the country it is not possible for post-holders to move from position to position throughout the country. The role and definition of the clinical nurse specialist must be clarified in order to reduce confusion. Restriction of the title to those who meet the defining characteristics will strengthen the role, improve collaboration with other members of the team as well as making it easier for the public to understand the role.

Abstract: Hope is considered an elusive, vague, over-used, and ambiguous concept in nursing practice which lacks clarity, but hope is essential to the quality of life in the terminally ill. Therefore, hope is an important concept to research further. A gap in nursing research has been identified in the area of hope in terminal illness. The aims of this research were to clarify the concept of hope as perceived by patients with a terminal illness; to develop hope as an evidence-based nursing concept; and to contribute new knowledge and insights about hope to the relatively new field of palliative care. Utilising Rodgers' (2000b) evolutionary concept analysis methodology and thematic content analysis, 17 pieces of research-based literature on hope as perceived by adult patients with any terminal illness pathology (from the disciplines of nursing and medicine) have been reviewed and analysed. Hope's attributes, antecedents, consequences, social-cultural variations, temporal variations, surrogate terms, and related concepts have been considered. An exemplary case of the concept in action is presented along with the evolution of the concept hope in terminal illness. Ten essential attributes of the concept were identified in this research: positive expectation, personal qualities, spirituality, goals, comfort, help / caring, interpersonal relationships, control, legacy, and life review. The evolution of hope in terminal illness has evolved from patients hoping for a prosperous healthy future to an enrichment of being is more important than having or doing. Patients' hopes and goals are scaled down and refocused in order to live in the present and enjoy the time they have left with loved ones. Hope in the terminal phase of one's illness is orientated in the past and the present, hope in the here and hope in the now. The author concludes that by completing all the steps to Rodgers' (2000b) evolutionary view of concept analysis, a working definition and clarification of the concept in its current use has been achieved, providing a solid conceptual foundation for further study. Recommendations are made for hope-enhansing strategies, that may help to maximise the quality of life of terminally ill patients in the future.

Abstract: This thesis uses an autoethnographic method to describe the author's personal journey and the influences on teaching the Treaty of Waitangi in the School of Nursing at Otago Polytechnic, from 1985 to 2005. The author starts this exploration as a beginning teaching practitioner in 1985, and continues on with her attendance at the original workshop for trainers by Project Waitangi in 1990. She discusses the influences of her studies towards a Bachelor of Arts at Otago University, through the development of School Charters which influenced her children's schooling and through the process of teaching and facilitating the workshops for Treaty education, until her position in the School of Nursing changed in 2005. She discusses through reflection, the personal influences, the socialisation process of teaching the history of Aotearoa New Zealand to students, the influences of nursing education on Treaty education, the influences of Irihapeti Ramsden's relationship to her journey and also her lecturers at university. She also traces her journey of beginning teaching practice. The author identifies this work as providing a starting place for potential research into the experiences and reflections of nurse educators over this period of time, and across other educational institutes and disciplines. The experiences of students from this teaching would also add to the profession's and the country's knowledge about the relationship of the Treaty of Waitangi to both education and health.

Abstract: Homosexuality has been practiced since ancient times, but through the centuries this expression of sexual identity has moved from being acceptable to unacceptable and finally regarded in a contemporary era as a mental health problem that needed to be, and it was thought could be, cured. This paper focuses on the barriers that lesbian women perceive when wanting to access health care. Most of the research about lesbian women has been conducted in the United States with some in the United Kingdom, Canada and New Zealand. Through reviewing the available literature and grouping common themes, the author identifies three main barriers to health care that exist for lesbian women. Firstly, ignorance or insensitivity of the health care professional about the specific health care needs of this client group; secondly, homophobia or heterosexism that may be present in the health care environment; and thirdly the risk of disclosing one's sexual orientation. These barriers are discussed using the concepts of cultural safety and nursing partnership. The author concludes that the negative health care experiences that lesbian women encounter leave them feeling vulnerable and fearful. This fear and stigmatisation has resulted in lesbian women becoming an 'invisible' community. It is the assumption of heterosexuality that immediately places the lesbian woman at a disadvantage and this potentially may produce missed opportunities to provide individualised care to the lesbian client. The purpose of this work is to encourage discussion within nursing to challenge attitudes and the approach to women who identify as lesbian. The author hopes that this paper will contribute to the increasing body of knowledge in regard to this client group.

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.