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 focus of this study is the management of unsafe nursing students within the tertiary education context. The moral dilemmas experienced by nurse educators, specifically linked to the issue of accountability for public safety, are explored. The theoretical framework for the thesis is informed by the two moral voices of justice and care identified by Gilligan and further developed using the work of Hekman and Lyotard. Case study methodology was used and data were collected from three schools of nursing and their respective educational organisations. Interviews were conducted with nurse educators and education administrators who had managed unsafe nursing students. Interviews were also conducted with representatives from the Nursing Council of New Zealand and the New Zealand Nurses Organisation to gain professional perspectives regarding public safety, nurse education and unsafe students. Transcripts were analysed using the strategies of categorical aggregation and direct interpretation. Issues identified in each of the three case studies were examined using philosophical and theoretical analyses. This thesis explores how students come to be identified as unsafe and the challenges this posed within three educational contexts. The justice and care moral voices of nurse educators and administrators and the ways in which these produced different ways of caring are made visible. Different competing and conflicting discourses of nursing and education are revealed, including the discourse of safety – one of the language games of nursing. The way in which participants positioned themselves and positioned others within these discourses are identified. Overall, education administrators considered accountability for public safety to be a specific professional, nursing responsibility and not a concern of education per se. This thesis provides an account of how nurse educators attempted to make the educational world safe for patients, students, and themselves. Participants experienced different tensions and moral dilemmas in the management of unsafe students, depending upon the moral language games they employed and the dominant discourse of the educational organisation. Nurse educators were expected to use the discourses of education to make their case and manage unsafe students. However, the discourses of nursing and education were found to be incommensurable and so the moral dilemmas experienced by nurse educators were detected as differends. This study bears witness to these differends.

Abstract: The New Zealand emergency department (ED) nurse is faced daily with the challenge of caring for patients of all ages with a wide variety of presenting complaints. Courses are available for ED specialty work such as trauma and paediatric assessment. However, this thesis argues, it is difficult to access updated and ongoing education in relation to caring for people with mental health problems who present to the emergency department. In addition to this education deficit, are the challenges of providing care in an overcrowded ED environment. The author goes on to say that such factors contribute to a perceived lack of confidence and sometimes ambivalence or frustration on the part of nursing staff in caring for this group. This may result in an inconsistent standard of care for the person with a mental health problem unless such issues are addressed. The aim of this research paper was to explore the education needs of ED nurses when caring for people with mental health problems. A literature review was undertaken to investigate the broad education strategies available to overcome these challenges. Diverse approaches were identified such as workshops, clinical guidelines, and mental health consultation-liaison roles. Research was also identified that examined ED nursing attitudes and their learning needs in relation to mental health. This paper concludes with a discussion of recommendations for the New Zealand setting with the intention of developing a more confident and competent nursing workforce, who are better prepared to care for the person with a mental health problem.

Abstract: Within New Zealand nursing education there appears to be a widespread acceptance of problem-based learning and an assumption that the strategies it uses are unproblematic. A review of the literature however, reveals that problem-based learning has drawbacks that may inhibit the achievement of desired graduate outcomes. It seems timely for nurse educators to exercise caution in uncritically accepting problem-based learning approaches and using them as the predominant approach to teaching and learning. To this end, a two-part critique of this teaching and learning method is presented. Part one critiques the methods of problem-based learning, discussing self-directed learning, the group process, self-assessment, and content knowledge. Part two explores the philosophical underpinnings of problem-based learning, and the so-called 'fit' within nursing.

Abstract: This research explored the relationship between entry criteria and academic performance in the first and second year bioscience papers at Otago Polytechnic School of Nursing. The School's inclusion of a bioscience requirement varies from the Nursing Council criteria for acceptance into undergraduate nursing programmes. Six hundred and nineteen academic records of 1994-2002 graduates were sampled. Chi-square and correlational analyses found a relationship between entry qualifications and students' academic performance in the two papers. The entry criteria had a stronger relationship with the students' performance in the first year bioscience paper than the second year paper. Performance in the first year was predicative of second year performance. Age was also found to be a useful predictor of grades. These findings support the School's Bioscience entry criteria and provide important information for admission committees.

Abstract: The purpose of this study was to evaluate how the New Zealand style of problem based learning was developing students' understanding and integration of knowledge. The 'pure' problem based learning process has been adapted to move students gradually from teacher direction to taking responsibility for their learning. Two cycles of an action research method were used, involving 4 lecturers and 17 students. Data was collected both quantitatively and qualitatively over a 16-week period. Findings indicated the importance of: explaining the purpose and process of problem based learning; communicating in detail the role of both students and lecturers; keeping communication lines open; addressing timetabling issues and valuing this method of learning for nursing practice. Implications for nursing education are addressed.

Abstract: Recruits Emergency Department (ED) nurses to participate in three semi-structured interviews. Conducts thematic analysis of interview transcripts to identify the effects on clinical skills, and what facilitated participants' learning.

Abstract: Current New Zealand health policy encourages collaborative health promotion in all sectors of health service delivery. The integrated approach to the acute management of coronary heart disease in a coronary care unit, combining medical therapy and lifestyle change, supports clinical health promotion. The aim of this study was to use the grounded theory approach to discover the main concerns of nurses' promoting health in an acute coronary care setting and to explain the processes that nurses used to integrate health promotional activities into their practice. Seventeen registered nurses from three coronary care units within a large metropolitan city in New Zealand were interviewed. Data were constantly compared and analysed using Glaser's emergent approach to grounded theory.The main concern for nurses promoting health within coronary care was ritualistic practice. In this study, ritualistic practice concerns the medically-based protocols, routines, language and technology that drives nursing practice in coronary care. This concern was resolved via the socio-cultural process of attitudinal shifting that occurs over time involving three stages. The three conceptual categories, environmental pressures, practice reality and responsive action are the main components of the theory of attitudinal shifting. In environmental pressures, nurses experience a tension between specialist medically-dominated nursing practice and the generalist nursing role of promoting health. In practice reality, nurses become aware that the individual needs of patients are not being met. This causes role conflict until the nurse observes colleagues who role model possibilities for practice, working with patients to promote health. Responsive action sees the nurse engaging in self-development, also focusing on the nurse-patient relationship, thereby enabling active patient involvement in individual health-promoting decisions. The author suggests that the findings from this research have implications for nursing practice and education. With the increasing specialisation in nursing practice, these findings may be of interest to nurses working in delegated medical roles where the reality of everyday practice precludes nurses from undertaking their essential nursing role. Health care facilities also need to ensure that there are opportunities for the personal and professional development of nursing staff. The place of health promotion within nursing undergraduate curricula needs to be examined, as many nurses found that they were ill prepared for undertaking health promotional activities.