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Item Professional practice attributes within public health nursing : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University(Massey University, 2004) Hansen, ChiquitaModifiable organisational attributes that reflect a professional nursing practice environment are important determinants of both the experience of people who access health care services and the job satisfaction of nurses who work within health care organisations. Research relating to acute care settings, commonly known as the Magnet phenomenon has made an outstanding contribution to health sector knowledge by identifying features that attract and retain nurses, promote excellence in patient care, and achieve superior patient outcomes. These features have been studied by the Nursing Work Index Revised which measures attributes that reflect a professional nursing practice environment. More recently there has been an interest in the potential applicability of these attributes in the community setting. A recent study surveyed United States home health nurses and New Zealand district nurses to ascertain which of the Nursing Work Index Revised attributes were perceived by them as important to the support of their professional practice. In this study 92% of items previously tested in acute settings were considered important in community settings. This descriptive study extends the previous work by investigating how another group of primary health care nurses in New Zealand (public health nurses) perceive the importance of specific organisational attributes within their practice setting. The Nursing Work Index Revised was utilised and participants were asked to rate their agreement or disagreement with the importance and presence of 48 attributes on the Nursing Work Index Revised against a 4-point Likert scale. The findings of the study validate the use of the Nursing Work Index Revised as a tool in the community setting. The study's findings, implications for nursing practice, future research and the potential use of this tool to support the development of primary health care nursing in the New Zealand health sector is presented.Item Determined to make a difference : a study of public health nursing practice with vulnerable families : a thesis presented in partial fulfillment of the requirements for the degree of Master of Arts in Nursing at Massey University(Massey University, 2006) Garlick, AlisonPublic health nurses have traditionally worked with vulnerable families in ways that are relational, client driven and contextual, an approach that has been described as a health promoting model of care. There is evidence however, that political and ideological reforms occurring within the health arena over the last fifteen years have had a constraining effect upon this area of public health nursing practice. The aim of this study was to explore the perceptions of public health nurses working with vulnerable families within a New Zealand context. This was in order to provide a contemporary description of how public health nurses work with vulnerable families and factors that enhance or constrain this process. The researcher was interested in whether this aspect of public health nursing practice continues to align with a health promoting model of care. The research process utilised a qualitative approach. Semi-structured interviews were undertaken and a general inductive approach was utilised for analysis of the data. The participants consisted of ten public health nurses from a district health board within New Zealand. The findings identified that New Zealand public health nurses continue to align their practice with a health promoting model of care when working with vulnerable families, particularly if nurses are experienced, embedded within a community and determined to make a difference. It was evident however, that this process is significantly constrained by factors relating to the nature of the families themselves, the business model framing the delivery of public health nursing services and the challenges involved in dealing with the Child Youth and Family Service. This study also highlighted the vulnerability of the public health nurse which may occur as a result of working with vulnerable families and dealing with the constraints referred to above. These outcomes have implications for configuring effective services for vulnerable families and the place of public health nursing within the future primary healthcare nursing environment.Item Maximising, optimising, empowering : the work of the public health nurse in a college setting : a thesis presented in partial fulfilment of the requirements for the degree of Masters [sic] of Arts in Nursing at Massey University(Massey University, 1997) O'Sullivan, MargaretThis qualitative study focuses on the work of one Public Health Nurse delivering primary health care to potentially 950 students during her regular weekly visits to their suburban college. The interesting interface of health and education is captured by a single-case study design. In its ninety years of existence, public health nursing has seen very little research into practice, least of all practice in a secondary school or college. Data was collected from one primary participant in the form of two reflective monologues, six interviews taped at weekly intervals and five participant-observation sessions, and three taped interviews with senior school staff. The use of Yin's (1984) framework for data analysis generated support for the proposition that adolescent health was a great need in the nurse's area. Current literature shows that adolescence is one of the fastest growing areas of need in health today, particularly because of concern with New Zealand's high rate of youth suicide and poor mental health services for this age group. In keeping with the philosophy of primary health care, health promotion and self-responsibility, three key themes and associated subthemes were generated from the data. These were maximising ('working with' and 'working without'), optimising ('building' and 'breaking') and empowering ('using the critical moment' and 'sustaining the self'). These concepts encapsulate the substantial contribution that the Public Health Nurse participant made to adolescent health in a college. In 'working with' the student, the college staff, the nurse's colleagues, as well as the community, the nurse made a difference by 'maximising' or making the most of the moments she spent with the students in making decisions about their health. Issues, including sexuality, drug and alcohol abuse, are further articulated in the optimising and empowering themes which look at the need for young people to hope by empowering themselves to cope with the future. The nurse was seen by the staff at the college as a vital part of the community. It was this connection that was most valued for the balanced perspective that the Public Health Nurse brought to the college in her weekly visits.Item Challenging the boundaries : an initiative to extend public health nursing practice : an action research study : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Arts in Nursing at Massey University(Massey University, 2000) Hinder, GracePublic health nurses working in the Child and Youth Team, Child and Family Services, Auckland Healthcare, view their practice in relation to children and their families, with the primary focus being on the child. Public health nurses could well provide other appropriate assistance and intervention for families and this is the focus of this research project. The purpose for this Action Research project is to provide a process where public health nurses can examine their existing practice and ask: What knowledge and skills would an advanced public health nurse practitioner require to work autonomously and effectively in a 'family centred' clinic within a primary school environment? A convenience sample of competency level III and IV public health nurses in the Child and Youth Team, Child and Family Services, Auckland Healthcare were invited to take part in a collaborative / participatory working group. Using a process of collective inquiry and reflection the working group developed a 'portfolio' from which to define an advanced public health nurse practitioner. The recommendations made by the working group provide a vision of practice. The challenge to public health nurses now is to make this practice a reality.Item Expert public health nursing practice : a complex tapestry : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University(Massey University, 1997) Gallaher, LeoniePatricia Benner's seminal work, From Novice to Expert (1984), can be considered the starting point for ongoing nursing research that has sought to describe and understand expert nursing practice. A review of the nursing literature revealed a gap in the research based knowledge relating to expert nursing practice from a New Zealand and community health nursing perspective. This study used Heideggerian phenomenology, as this methodology has been interpreted and utilised by Benner, to examine the phenomenon of expert public health nursing practice within a particular New Zealand community health setting. Narrative interviews were conducted with eight identified expert practitioners who are currently practising in this specialty area. Data analysis led to the identification and description of themes which are presented as the research findings, supported by paradigm cases and exemplars. Four key themes were identified. These seemed to capture the essence of the phenomenon of expert public health nursing practice as this was revealed in the practice of the research participants. The themes describe the finely tuned recognition and assessment skills demonstrated by these nurses; their ability to form, sustain and close relationships with clients over time; the skilful coaching undertaken with clients; and the way in which they coped with the dark side of their work with integrity and courage. It was recognised that neither the themes nor the various threads described within each theme exist in isolation from each other. Each theme is closely interrelated, and integrated into the complex tapestry of expert public health nursing practice that emerged in this study. Although this research supports and elaborates upon many of the findings from published studies that have explored both expert and public health nursing practice, differences were apparent. This suggests that nurses should be cautious about using models or concepts developed in contexts that are often vastly different to the New Zealand nursing scene, without carefully evaluating their relevance.Item A Māori model of primary health care nursing : a thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Massey University, Palmerston North, New Zealand(Massey University, 2002) Holdaway, Maureen AnnWhile the philosophy and policy of primary care nursing are consistent with Māori development objectives, the practice can fall short of this ideal. This thesis identifies and examines the shortfall in terms of Māori women's expectations and identifies ways in which traditional nursing practice among Māori communities may be enhanced. The research highlights the need for nursing to broaden our concepts of health, community, and public health nursing, to focus more on issues of capacity building, community needs, and a broader understanding of the social, political, cultural, and economic contexts of the communities we work with. This research used a critical ethnographic method underpinned by a Māori-centered approach to explore health as experienced by Māori women. The primary data collection involved, a period of intensive fieldwork within the community, use of in-depth interviews, attendance at hui, and a review of literature and policy documentation. The findings of this research articulate a model of health that is a dynamic process based on the restoration of, and maintenance of cultural integrity, and is based on the principle of self-determination. Primary health care is a process of enabling Māori to increase control over the determinants of health and strengthen their identity as Māori thereby improving their health and position is society. The findings support a substantive Māori model of Primary Health Care Nursing that provides a framework for theoretical research, which will lead to further conceptual refinement. The model also provides a framework for education curricula and nursing practice that will enhance nursing's ability to meet the needs of Māori.