Abstract: This thesis presents a study of the every-day moral decision making of experienced nurses. Eight experienced registered nurses participated in the completed research that is based on data gathered through interviews, document audit and literature review. A grounded theory approach was used to analyse the extensive data gathered for the study. This methodology generated a theoretical description involving the antecedents, processes and consequences of nursing moral decision making.Nursing practice has moral content, if not an entirely moral purpose, and moral decision making is the central component of this practice, yet the ethical aspects of nursing practice remain a comparatively recent field of study. It is therefore essential to nurses and their patients that this process is adequately studied and theorised. To date, very few studies have been undertaken in this area in New Zealand. This study aims to at least partially redress this situation by offering insights through conceptualisation and theoretical description of nursing moral decision making.The findings of the study reveal that antecedents such as personal moral development, upbringing and social experiences, contribute to a 'nursing ethic' in the moral decision making of experienced nurses. Furthermore, the study shows that the context and individual and shared perceptions of moral events influence the degree of nursing involvement in ethical situations. Finally, the study maintains that an intrinsic and persistent nursing ethic guides ethical decision making in nursing. This ethic is an undeniable phenomenon of considerable significance to nursing practice and education

Abstract: We hypothesized that the use of an Action Plan might assist self management for patients with chronic obstructive pulmonary disease (COPD).A pilot process and randomized, controlled study were undertaken to evaluate an action plan that provided advice on management of usual care and exacerbations, together with a booklet on self management. Fifty six subjects with COPD recruited through general practitioners (GPs) completed the six month study, 27 in the control group and 29 in the intervention group. The control group received usual care from their GP and the intervention group received a booklet and Action Plan from their practice nurse plus a supply of prednisone and antibiotic from their GP.The two groups were demographically similar with a mean age of 68 yrs. The resources were well received by GPs, practice nurses and the intervention group subjects. After six months there were no differences in quality of life scores or pulmonary function. There were significant changes in self management behaviour in the intervention group compared to controls. In response to seterioting symptoms, 34 versus7% (p= 0.014) initiated prednisone treatment and 44 versus 7 % (p=0.002 initiated antibiotics.Subjects in the intervention group readily adopted self management skills but did not shpw any difference in quality of life or lung function parameters. A larger prospective controlled clinical trial of this approach is warranted

Abstract: The purpose of this study was to determine if there was commonality amongst teachers, in perceptions of the role of student self-assessment in the nursing programme. Four nurse educators, who were teaching and supervising students undertaking self-assessment in clinical practice, participated in a semi-structured interview. Three focus questions guided the interviews and addressed the individual teachers perception of self-assessment, what the teacher considered the benefits of self-assessment to be, and how the teacher used student's self-assessment's in their role as clinical supervisor. The taped interviews were transcribed, and coded and general themes identified. The findings revealed a high degree of consensus amongst the teachers in regard to the co-operative nature of self-assessment, and the teacher's role as a facilitator. The need for students to develop skills of analysis and reflection on their performance as well as the need to furnish students with clear guidelines on what to self-assess, were highlighted

Abstract: Up until the 1980s most of the historical writing about nursing and nurses in this country has been told from the points of view of past nursing leaders. The realities of day-to-day nursing in New Zealand general hospitals were relatively unknown.This thesis examines the experience of general hospital nursing between 1945 and 1960. The recollections of thirty-four nurses who nursed during this period have provided the key sources from which the major themes of this study have emerged. These themes, of dirty work, authoritarian control and discipline, and learning nursing are discussed within the context of an expanding hospital system and a shortage of nurses.The study demonstrates the vast differences between the recollections of nurses of the experience of nursing and the rather high-flown rhetoric of the nursing leadership.Changes to the amount of cleaning, the ;level of discipline and control, and ways in which learning nursing was organised were small and gradual and occurred in the late 1950s.Overall, though, nursing in general hospitals by 1960 ws almost unchanged from the 1930s.An ethos of selfless service, opposition to unionism, and Christian altruism was till dominant amongst the nursing leadership. Nurses in training still worked a six day week, were expected to stay on duty until the work was done, and were supervised closely in, on and off duty time

Abstract: The aim of this qualitative descriptive study was to explore the experience of new comprehensive nursing graduates as they adapted to working in the acute psychiatric setting. Interviews were conducted with four participants, focussing on their current work experiences and how the philosophical beliefs and values derived from their educational preparation fit with those they encountered within the practice setting. The data were analysed by noting common experiences, values and meanings and identifying the themes as they emerged. The themes were: transition to practice, conflict, contradiction, structural constraints, and the reality of the psychiatric setting. The results of the study confirm the concern that has been voiced by new graduates about the quality and quantity of current orientation programmes. Conflicting values and beliefs concerning the nature of mental health/psychiatric nursing has also become evident. It appears that the graduates' Comprehensive nursing preparation may have contributed to their feelings of unease as they attempted to fit their own values and beliefs about nursing with those of the acute psychiatric setting