Abstract: This paper has been developed from part of the writer's doctoral thesis on forces influencing the development of innovative roles in primary health care nursing. The focus of this paper is leadership strategies designed to reduce the issue of poor professional identity and support.

Abstract: Because nurses work in a wide range of settings they are well-placed to provide support for smokefree environments. The aim of this research was: to assess the knowledge of cessation, attitudes towards smoking, the provision of smoking cessation advice and treatment, and attitudes to and management of smokefree workplaces in a sample of nurses with practising certificates in New Zealand; and to describe the prevalence of smoking in nurses using the 2006 New Zealand census. One thousand questionnaires were posted to a random sample of 1000 nurses (500 community-based nurses, and 500 hospital-based) from the New Zealand Nursing Council register of nurses with current practising certificates. Statistics New Zealand provided results from the New Zealand Census of Population and Dwellings, 2006, for nurses by gender, practice area and cigarette smoking status. Responses were received from 371 (37%) of the nurses. They were enthusiastic about and committed to including smoking cessation in their practice, and to learning more about helping clients who smoke. Nine out of ten felt that it was part of their responsibility to advise clients to stop smoking. Nearly nine out of ten said they would be happy to spend an extra five minutes with each patient who smoked if they could effectively intervene. Over half had not received training for effective evidence-based smoking cessation interventions but three quarters were interested in learning more about how to help people stop smoking. The respondents' knowledge of the health effects of smoking was high, but there were gaps in knowledge of effective smoking treatments and a wide misunderstanding that nicotine causes cancer and heart disease. These gaps may limit nurses' ability to intervene effectively. Nurses supported their smokefree work policies although a fifth did not report support with enforcing these. Results from the 2006 census showed that smoking prevalence among nurses has declined from 18% in 1996 to 14% in 2006. Smoking rates in mental health nurses (29%) remain higher than the New Zealand general population (21%, census data).

Abstract: The aim of this study was to explore the practice of flexible learning for postgraduate nurses. Flexible learning is a contemporary approach to learning that utilises the benefits of technology. Flexible learning can be understood as a continuum, from fully on-line or web-based courses, to those that are on-campus and supported by technology. Internationally, the rise of flexible learning has been influenced by increased demand for higher education and competition among providers within the context of reduced education funding. The study population, New Zealand postgraduate nurses, are accessing higher education in increasing numbers to advance their practice and to position themselves for new roles and opportunities. These are often experienced nurses yet inexperienced in higher university education, who combine study, work and other commitments. The study employed a qualitative case study design because it enabled multiple perspectives to be gained. Data included documentation, participant observation, survey, students' assessed work and interviews with key stakeholders: student, teacher and the organisation. Thematic analysis was conducted on reviewed documentation, participant observation and interviews. The study identifies the elements that contribute to flexible learning and the interconnectedness between the elements within the dynamic context of a university to illustrate that effective flexible learning can be provided by using a student centred approach to ensure the learning needs of postgraduate nurses are met. The author concludes that flexible learning improved access, choice, and provided an emphasis on the student as central to learning. In response to these findings the weighting of recommendations are toward the organisation as, the author suggests, it is at this level where greater change can be made to improve support for flexible learning provision.

Abstract: This thesis explores the customary kaupapa of Matauranga Maori or Maori knowledge, which the author identifies as the appropriate technique to determine how health care should be maintained by and for Maori. The research highlights the need to meld these kaupapa with that of a contemporary Maori viewpoint, to focus more on a deeper enhancement of these kaupapa, and develop an understanding of the social, cultural, educational, political and economic contexts these concepts have on Maori as a people. This research identified six Maori registered women nurses, who shared their experiences regarding Matauranga Maori and its importance to their nursing practice. Over a period of one year, in-depth conversations unfolded and produced data on what Matauranga Maori involves and how the six participants in the study believe it influences their nursing practices. All were currently practicing nurses within various health settings such as psychiatric and comprehensive nursing. From the inception of this study, the focus was to introduce Matauranga Maori as the epistemological framework of choice. The author notes that the findings of this research indicate that a collection of key kaupapa, namely whakapapa, whanaungatanga, te reo Maori, wairuatanga, tuurangawaewae, manaakitanga and rangatiratanga are crucial to the health and wellbeing of Maori as a people. These kaupapa enable Maori to determine and strengthen their worldview, which in turn reflects the concept of being Maori thereby contributing to the health and status of their whanau, hapu and iwi. She goes on to say that the findings support the view that there is a substantial collection of kaupapa, which are inherent in Matauranga Maori as being able to provide a framework for theoretical research. These kaupapa will provide a framework for nursing practice and educational curricula that will develop and maintain nursing standards to meet the needs of Maori.

Abstract: The aim of this research was to gain a more complete understanding of cigarette smoking and cessation during pregnancy by examining the men's role in supporting smoking cessation of their pregnant partners. A search of online databases was made for studies published in the last 10 years, in English, that included three phenomena; pregnancy, male partners, and cigarette smoking. Data were identified and organised according to theoretical, descriptive, and intervention methods of research. A growing body of literature indicates an interaction between pregnancy, male partners, and smoking behaviors. Explicating relationships between these phenomena is necessary for understanding and encouraging behaviours that promote maternal, child, and family health. The researchers conclude that current research highlights a need to further investigate the potential relationships, interactions, and health consequences of smoking behaviours of men and women during pregnancy.

Abstract: Clinical practice is an essential and integral component of nursing education. The decision-making process involved in student selection of clinical placements is influenced by a range of factors which are internal or external to students. As there was little research that explored these factors and the influence they have on student decisions, the author sought to investigate this further. A mixed-method approach was used, using a questionnaire and focus group interview, to give breadth and depth to the research. This study found that students are particularly influenced by previous positive experiences, or an interest in a particular area of practice. Their personality will also influence their placement decisions. Nurse preceptors and clinical lecturers also provide a key support role to students in the clinical environment.

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.

Abstract: The primary purpose of this study was to explore and identify the meaning and importance of service for health professionals. Those who participated in this study are all registered nurses who each have between 10 and 40 years of clinical nursing and nurse lecturing experience. The participants each wrote two stories, one about the meaning of service and the other about the importance of service. Definitions of service generally suggest organised labour involving an act of help or assistance. Our intent was to understand what constituted service for each of us in the healthcare – and specifically the nursing practice/education – context. A secondary purpose of this qualitative research was guided by participatory and critical theory paradigms. Seven participants and the initiating researcher formed a co-operative inquiry group to undertake the research using a collaborative process. Within this method the leader and the group became co-participants and co-researchers. Nurses and women are identified as marginalised people and by honouring the principles of co-operative inquiry we were empowered through this process. While the initial data was analysed thematically by the lead researcher, the original 19 sub-themes were refined by participants into five themes. The findings of the participants are consistent with overseas studies on emotional labour and sentimental work. The five themes that emerged as the meaning of service are helping, giving, elements of service, acts of doing, and pride in work. This study affirmed that service has much importance to those involved and deepened our understanding of the blend of meanings service expresses.