Expressions of cultural safety in public health nursing practice.

Cultural safety is an essential concept within New Zealand nursing that is formally linked to registration and competency-based practice certification. Despite its centrality to New Zealand nursing philosophies and the stated expectation of cultural safety as a practice element, there is limited evidence of its application in the literature. This research presents insight into public health nurse's (PHN) experiences, demonstrating the integration of cultural safety principles into practice. These findings emerged following secondary analysis of data from a collaborative, educative research project where PHNs explored the use of family assessment tools. In particular, the 15-minute interview tool was introduced and used by the PHNs when working with families. Critical analysis of transcribed data from PHN interviews, utilising a cultural safety lens, illuminated practical ways in which cultural safety concepts infused PHN practice with families. The themes that emerged reflected the interweaving of the principles of cultural safety with the application of the five components of the 15-minute interview. This highlights elements of PHN work with individuals and families not previously acknowledged. Examples of culturally safe nursing practice resonated throughout the PHN conversations as they grappled with the increasing complexity of working with a diverse range of families.

The nurse practitioner role: Solution or servant in improving primary health care service delivery.

In New Zealand, as in many other countries, the demand for health services is escalating as chronic disease, population ageing and health disparities increase. It has been argued that a more comprehensive primary health care approach is needed combining biomedical approaches with a social determinants and social justice based approach. The contemporary development of the nurse practitioner (NP) role in New Zealand (NZ) offers the possibility of taking up a more critical approach to strengthen and extend primary health care services (PHC). Nurse practitioners could simply be utilised to shore up the nature and style of existing primary care (PC) service configurations or, more usefully, they could lead a revolution in traditional approaches towards genuine primary health care delivery.

What exposure do student nurses have to Primary Health Care and community nursing during the New Zealand undergraduate Bachelor of Nursing programme?

A research project to examine the theoretical and practical exposure student nurses have to Primary Health Care (PHC) and community nursing in their undergraduate programme was undertaken in New Zealand (NZ). Providing quality clinical placements for health care students is acknowledged as a major challenge for tertiary institutions. In order to reflect the current shift in health care delivery from hospital to community settings, one such challenge is to ensure students receive appropriate theoretical programme content and clinical experience in PHC and community settings. The project consisted of a review of relevant international literature, and a questionnaire sent to all NZ tertiary institutions providing a Bachelor of Nursing (BN). Findings included a variable understanding of the concept of PHC, a lack of appropriate PHC placements across the country, competition for student placements in PHC, and professional organisation requirements for student supervision impacting on placement availability. Innovations identified to increase PHC placements comprised the establishment of Dedicated Education Units (DEUs), curriculum revision, and final year PHC placements offered only to students targeting PHC settings on registration. Study recommendations involve establishing a regional rather than a local approach to managing clinical placements, increasing professional governance support and reviewing clinical placement funding.

Nurses' views of family nursing in community contexts: an exploratory study.

In their day to day practice nurses interact with 'family' as a whole in a variety of community locations. Public health, Practice, District, Well child health and Rural nurses participated in a qualitative study in which four focus groups were used to explore the ways in which each nurse integrated 'family' into their practice. Thematic analysis of the data revealed four related themes: the labyrinth of family nursing, relational webs, personal and professional knowing, and contextual determinants. It was found that 'family' was integrated into participants' community practice in a "narrative, dialogical, relational and contextual" manner (Doane Hartrick, 2002, p. 623). Each family/nurse interaction had its own story exemplifying the contextual complexity and uncertainty, while at the same time showing the deep satisfaction inherent in working with families. Paramount in this practice was dialogue and building relationships, not only with families, but also with colleagues, health and other professionals. While it is apparent a family/family health nursing role has yet to be established, the possibilities of such a role have been recognised in this study. Yet considerable work still remains to be done before this nursing role is seen as an imperative in improving family health and wellbeing.

Meningococcal B: tell me everything you know and everything you don't know. New Zealanders' decision-making regarding an immunisation programme.

AIMS: To describe parents' decision-making process and investigate what factors influenced decisions regarding children's participation in the MeNZB immunisation programme. METHOD: 10 parents who consented to their children receiving the vaccine, 10 parents who did not consent to immunise their child, and 1 parent who chose to immunise only 1 of their 2 children all participated in a semi-structured interview. A qualitative descriptive thematic analysis was thereafter undertaken. RESULTS: Both groups of parents were influenced by similar factors and followed similar decision-making processes. Four non-linear phases were identified; a gut reaction, a trigger, reconnaissance, and risk analysis. Most parents expressed a degree of uncertainty about their decision. CONCLUSION: Parents had a largely unfulfilled desire for reliable, valid, and balanced information about the MeNZB vaccine. Health authorities balance of risk at a population level may not coincide with that of individual parents. This study suggests other factors are likely to influence decisions. Parents' generally negative view of official information provided in the MeNZB immunisation programme suggest that communication strategies may require rethinking for future programmes.

Women maintaining physical activity at midlife: contextual complexities.

Health benefits associated with being active are well recognised and yet for many, particularly women at midlife, how this activity is maintained is both complex and poorly understood. This paper describes a qualitative feminist study in which 10 midlife women participated in two semi-structured interviews to explore factors influencing their ability to maintain physical activity over time. A thematic analysis uncovered participants' beliefs and behaviours regarding their experience of, and strategies used to maintain, regular activity. Four core themes emerged; 'exercise is part of me, part of my life', 'the importance of being fit and healthy', 'exercise interweaves and changes with life situations', and 'constraints and conflicts'. Encompassed within these four was a desire for life long good health and physical fitness. Maintaining regular physical activity was intrinsically connected to family, relationships and work. Findings from this study indicate how important it is for nurses to consider contextual realities when encouraging and supporting midlife women to maintain physical activity.