Browsing by Author "Neville, Stephen John"

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    Delirium in the older adult : a critical gerontological approach : a thesis presented in fulfilment of requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Palmerston North, New Zealand
    (Massey University. School of Health Sciences, 2005) Neville, Stephen John
    The purpose of this thesis has been to explore the discursive production of delirium in people over the age of 65 years. The philosophical approaches underpinning the study were derived from the field of critical gerontology, postmodernism and the utilisation of a Foucauldian understanding of discourse and power/knowledge. Data sources included published documents on delirium, interviews with people over the age of 65 years who had been delirious (as well as their clinical notes), family members, registered nurses and a doctor.Textual analysis revealed the presence of two contesting and contradictory discourses that impacted on being an older person who had delirium. These were identified as the discourse of delirium as a syndrome and a personal discourse of delirium. The discourse of delirium as a syndrome is underpinned by the biomedicalisation of the ageing process. This process utilises scientific methods as the foundation from which to understand, research and provide a health service to older people with delirium. Any personal perspectives on delirium are rendered unimportant and relegated to marginalised positions. Nursing through its vicarious relationship to medicine is interpellated into deploying the discourse of delirium as a syndrome and has largely ignored the personal dimensions associated with this phenomenon. Consequently, the older delirious 'body' is known and inscribed as unruly, problematic, physically unwell, cognitively impaired and at risk.Conversely, a personal discourse of delirium privileges the individual narratives of people who have been delirious and provides a different perspective of delirium. The deployment of a personal discourse of delirium offers another position that views this group of older people as bringing to the health care setting a rich tapestry of life experiences that are more than a cluster of signs and symptoms. It is these varied life experiences that need to be included as a legitimate source of knowledge about delirium. This thesis demonstrates how nursing needs to espouse a critical gerontological position when working with older people who have delirium. Critical gerontology provides nurses with the theoretical tools to challenge the status quo and uncover the multiple, varied, contradictory and complex representations of delirium in older people.
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    Well-being in the older male : an investigation of mental, social and physical well-being indicators in Wanganui men : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University
    (Massey University, 1998) Neville, Stephen John
    New Zealand's older population is gradually increasing. This will mean the number of people with problems related to psychological and general well-being will also rise. When compared to women, men do not live as long, are more likely to die from intentional injury and use primary health services less. There is a paucity of research on older men, particularly within a New Zealand context. Because nurses work closely with people in primary, secondary and tertiary care settings they are well placed to undertake research and utilise research findings from studies relating to the older adult to promote health and well-being. The intention of the present study was to gain a greater understanding of those factors which impact on well-being in older men. Based on Wan, Odell and Lewis's (1982) model of general well-being, mental, social and physical well-being indicators were investigated to examine their relationships to overall psychological well-being and physical health. The data for the present study were collected from a non-probability sample of 217 older males (over 65 years) residing in the Wanganui area. Multiple regression analyses revealed that of the mental, social and physical well-being indicators only satisfaction with social supports and number of visits to the doctor in the previous 12 months were significantly related to psychological well-being, and number of medications and illness/disabilities were significantly related to physical health as measured by self ratings of health. Findings are discussed in relation to the literature. It is clear that nurses, and other health professionals, need to be aware of the relationship between objective health status and subjective well-being, and the distinction between the quality and quantity of support in order to provide effective care to older men. Finally the general limitations and future research implications are discussed.