Abstract: The authors introduce the Kaupapa nursing service at Te Puna Hauora, Tauranga Hospital. It implements an indigenous health model, the Whanaungatanga Model of Care, to guide nursing practice. This paper describes the concept of care it applies to serving its Maori population and the role of the Kaiawhina Social Worker. The authors highlights the interface between primary and secondary care after patients are discharged. The authors address the shortfall of Maori practitioners in the nursing service and the aims of a year-long pre-entry Kaupapa Health Professional Programme.

Abstract: By describing and gaining insight into one rural nurse's experience working with dying people in a highly, remote rural area, this project seeks to advance nursing practice. Key findings indicate that, through community partnership and teamwork, nurses can act to assist rural people by: increasing public awareness of health resources; exposing barriers to access; and identifying different health service needs. The author makes a case that some rural nurses may feel insufficiently prepared for rural nursing. To understand death and dying, key ideas from Kuebler-Ross's (1969) framework for dying are examined: denial, fear of dying, spirituality, hope, depression and how to die well. Nurses require a blend of end-of-life and rural nursing postgraduate education and skills, to manage well. Key findings imply that dying people can be helped by: improving function and independence to promote autonomy; encouraging faith, hope, and love within the person's personal concept of spirituality; listening to dying people, to oneself, to one's own reactions, and knowing oneself. Parse's theory (1981) indicates nurses can help rural dying people by the following key factors: encouraging the person to live life to the full while dying; accepting humans cannot be separated from their perspectives, circumstances or environments; focusing on quality of life from the person's perspective: encouraging the person to live life fully while dying; and offering new possibilities. The author goes on to say that Parse's human-universe-health process aids nurses to live their beliefs indicating Parse's theory could guide and advance nursing practice.

Abstract: When the New Zealand Nursing Council introduced the nurse practitioner as a new level of nurse in 2001, the opportunity arose for the introduction of primary health care nurse practitioners into the rural practice arena in this country. This dissertation explores the influences on the development of rural nursing in the last decade in New Zealand including the role of the Centre for Rural Health in advancing rural nursing education, as well as the impact the shortage of health professionals in rural New Zealand has had on the development of the rural primary health care nurse practitioner concept. For pioneering primary health care nurse practitioner roles to be successfully implemented in rural communities in New Zealand, several challenges need to be faced; the creation of roles and employment opportunities, community acceptance of the role, medical and nursing acceptance of the role and the establishment of independent nurse prescribing within the constraints imposed by current legislation. The dissertation explores the current literature in an attempt to offer solutions to the identified challenges. With the creation of primary health care nurse practitioner roles and the establishment and acceptance of these roles in rural communities, a new mode of health service delivery in rural New Zealand will begin.

Abstract: This paper documents a practice development initiative with the aim of formulating a rationale for the professional practice development of a relatively recently conceived nursing initiative; that of a Palliative Care Liaison Nurse (PCLN) role. The project involved conducting an inquiry through a search of the literature with the aim of discovering ways to articulate, then develop, the role to meet the needs of elderly people living in Residential Aged Care Facilities (RACFs), their family and the whanau. The paper initially explores the concept of liaison roles globally, to consider how this role might be located as an interagency position between palliative care and aged care within the context of Aotearoa/New Zealand. The paper then reveals the perceived skills and personal attributes required by a person in the PCLN role that the author, drawing from personal and professional experience of having been appointed to this position, considers are necessary to effectively manage the diverse dimensions of this role. Bridging the gap is a key role discussed which centres on the capacity to organise and present an effective education programme while supporting, encouraging and role modeling for staff providing the day to day nursing care. This role involves practice wisdom and advocating for change and tolerance within everyday practice. An example of this dimension is discussed in depth, because the researcher considers that through staff working together, they can effectively bridge the knowledge-practice gap which exists between specialist palliative and gerontological nursing care.

Abstract: Primary health care is a dynamic and ever-changing area of practice which has undergone many changes in the last ten years. Traditionally, primary health care was not a routine choice for new graduate nurses as they were encouraged to work in a hospital setting before seeking a position in the community. Bachelor of Nursing programmes emphasise primary health care practice and increasingly nurses and their employers are moving away from the traditional belief of 'doing your time in the hospital' before contemplating the move to primary health care. Currently in New Zealand increasing numbers of graduates from Bachelor of Nursing programmes want to begin their working life as registered nurses in this area. A constructivist approach was taken to explore the experience of five nurses who entered primary health care practice as new graduates. Participants were interviewed using a semi-structured format. They constructed their experience as role transition and identified a number of significant factors which had impacted on their practice. These factors included both the personal and practice challenges they experienced and the strategies they used to address them. Further research findings were a transition time of one year, the importance of both formal and informal support, planned orientation and opportunities for reflection. A number of mediating factors including new graduate programmes, peer support and mentorship were also discussed. Key implications for practice, education, employers and future research regarding transition to primary health care for new graduates are discussed. This research emphasised the importance of appropriate resources and support for new graduates from Bachelor of Nursing programmes. These factors are suggested as integral to the development of new graduates' practice in primary health care and reduction of the challenges inherent in this transition.

Abstract: Psychiatric consultation liaison (PCL) nursing is an evolving specialist area of mental health nursing in the USA, UK, Australia and New Zealand. The aim of this dissertation is to explore models of PCL nursing practice in order to develop and discuss a PCL nursing model applicable to the New Zealand context. The role of the PCL nurse was of particular interest to the author as a new practitioner in this specialist area. While there have been PCL nurses in practice for over 50 years, the literature does not offer much clarity about models of PCL nursing. From a review of the literature, four themes were recurrent in the work of PCL nurses. These themes represent four functions which are vital to the role of the PCL nurse: partnership, expertise of the PCL nurse, therapeutic relationship and organisational consultation. The needs of the patient are the core of this model and the primary objective is to improve the quality of care of patients in the general hospital with co-existing physical and psychological problems. It is imperative that PCL nurses evaluate their practice and embark on research to investigate clinical outcomes, cost effectiveness and the impact of PCL nurse practice on patients and staff. This PCL nursing model provides a beginning for this process. It also clarifies and articulates the role of the PCL nurse which enables the service to be promoted to colleagues. This PCL nursing model represents a critique of the author's understanding of the role of the PCL nurse. As expertise develops, the model will continue to be tested and refined.

Abstract: Rural nursing in the remote context of South Westland is shaped by factors common to rural nursing practice world-wide including geographical and professional isolation, living and working in a small community, providing health care to rural people and the broad, generalist and advanced scope of nursing practice. Tourism is a major industry in the townships in the proximity of the two accessible glaciers in South Westland. The practice of the nurses in these areas is significantly affected by tourists seeking health care and by providing a health service for the large number of migrant seasonal workers who service the tourist industry. Tourists seek health care from the nurses across the full spectrum of health problems and their expectations of the health care required may exceed the service that can be provided. The nurses are challenged to advance their practice to find the personal and professional resources to provide a safe service. This includes the challenge of cultural safety and personal safety. The tourist industry brings significant numbers of young people as seasonal/temporary workers to the glacier areas. This imposes a youth culture onto the existing rural culture. Nursing practice has expanded to include the specialist practice of youth health care that includes the problems of alcohol and drug misuse, sexual and reproductive health, and youth mental health. This work is drawn from the experience of the nurses working in the glacier communities. The impact of the tourism industry on their rural nursing practice includes the increasing volume of work that challenges the viability of the service, the advanced scope of practice required to meet the health needs of tourists and the seasonal tourist industry workers, and challenges to personal and professional safety.

Abstract: The last twenty years, particularly the early 1990s, ushered in major mental health sector reforms inclusive of deinstitutionalisation policies and subsequent development of community services. Concurrent changes to student nurses' education left registered nurses as the workforce mainstay on inpatient units. However, the author suggests, an emerging global shortage of nurses and implementation of the Employment Contracts Act (1991) negatively impacted on recruitment and retention of registered nurses. Inpatient nurses either left nursing or moved to community positions for better money and increased job status. The author suggests that, as a consequence, the 'critical mass' of experienced and skilled nurses who traditionally provided nursing leadership disappeared resulting in compromised standards of care for patients. As the manager of an inpatient unit, the author proposed the establishment of advanced nursing practice roles as one initiative to provide nursing leadership in order to attract and retain nurses. This study explored five inpatient nurses' perceptions of advanced practice and whether these roles could assist to provide leadership and improve standards of care. The research was a qualitative exploratory descriptive study using a focus group interview as the data collection method. A thematic analysis of the group discussion transcription revealed three key themes: 1) the 'makeup' of advanced nursing practice, 2) moving forwards: establishing roles, 3) moving sideways: barriers to role development. The themes are critically discussed in relation to selected literature. The thesis includes recommendations that could be used by nurses responsible for planning and implementing advanced practice roles on inpatient units.