Abstract: The author traces the development of rural nursing, which began as an assistant role for general practitioners, to the present role which incorporates advanced nursing practice. She reports the results of two surveys of nurses' roles and skills, from 1996 and 1999-2000. Specific rural competencies are identified, in managing isolation, professionalism in a small community, nurse/patient relationships in a small community, and independence.

Abstract: Explores the social construction of the evolving professional identity, of rural nurses between the 1990z and early 2000s, a period of time was associated with two
significant national directives impacting on the professional practice of rural nurses and their contribution to the delivery of health care, from the rural Otago region of NZ. Engages with the concepts of place and governmentality. Demonstrates that rural nursing is a place–based practice governed both from within and beyond location, an analytical diagrammatic matrix.

Abstract: The author tells a story to describe her advancing practice as a registered nurse practising in the rural context. Storytelling is a way to add to the growing knowledge of rural nursing practice in New Zealand. By sharing her rural nursing story through a storytelling framework, she suggests that other nurses may be in a position to utilise this framework and tell their own stories. She has adapted a formalised storytelling framework from McDrury and Alterio (2002). Concepts of the storytelling framework, including reflection, critical reflection and critiquing, can lead to new knowledge and understanding of nursing practice. Past experience is a component of this framework as are the concepts of surface and deep learning. In this way, nursing practice can be deconstructed then reconstructed for new knowledge to be obtained. The innermost thoughts and feelings of the nurse are an integral part of this whole process and need to be acknowledged. The author wanted to answer questions she asked of herself, namely, “how do I practise and how can I improve my practice for the benefit of my patients?” The rural context is expanded upon in her nursing story as this is where she practises as a registered nurse. Her various nursing roles, including advanced practice as a district nurse and rural nurse specialist, are described in depth as are the two areas where she has lived and worked as a rural nurse.

Abstract: In this chapter the author uses storytelling to explore the legal and ethical issues she experiences as a rural volunteer registered nurse. She describes the relationship between the nurse and community embodied in areas such as the public perception of nurses, and discusses aspects of her practice in the light of the particular legal and ethical context of rural areas.

Abstract: Despite the widespread acceptance of the value of supervision among practitioners and the large quantity of literature on the topic, there is very little empirical evidence in relation to its effect on clinical practice. It is not clear whether supervision actually produces a change in clinician behaviour, or whether it produces benefits in terms of client outcomes. This thesis evaluates the impact of clinical supervision on five co-ordinators in a rural home care setting. It looks at the impact clinical supervision has on their practice and professional growth. The nurses all belong to one organisation, Access Homehealth Ltd. The study builds on the findings of a clinical supervision pilot, which was trialed within the organisation in 2002. The pilot examined which model of supervision was most beneficial for Access Homehealth staff. Clinical Supervision is defined as a designated interaction between two or more practitioners within a supportive environment, that enhances reflective practice and professionalism, which in turn contributes to improved practice and client outcomes. The methodology of this research was qualitative evaluation. The themes which emerged related to personal support, managing stress and alleviating feelings of isolation, reflection, enhancing practice, improved communication skills and the concept of clinical supervision as a safety net. Participants also revealed that one-on-one supervision appeared more helpful than group supervision, and that phone supervision facilitated in-depth dialogue. These findings are important, as they demonstrate it is feasible to simultaneously offer a number of formats of clinical supervision within one organisation, allowing for the organisation to provide what works best for different workers. They also show that clinical supervision is a valuable and useful support tool for home care co-ordinators in order to facilitate empowerment, reflection and growth in practice. Further research is needed to provide evidence of the benefits of supervision on improving client outcomes.