School of Health and Social Services
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Browsing School of Health and Social Services by Subject "Attitudes"
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- ItemA qualitative exploration of environmental and relational factors affecting service user involvement from the perspective of community mental health nurses : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University, Palmerston North Campus, New Zealand(Massey University, 2012) Brown, Vicky KerynMental health policy and clinical guidelines require service user involvement principles within clinical practice and service provision, yet few national studies exist to examine Mental Health Nurse’s (MHNs) viewpoints about its implementation. This qualitative research project asks the question ‘What are the environmental and relational factors which affect service user involvement in community mental health team settings from the perspectives of community MHNs?’ The research aims were: (1) Explore how the practice environment supports service user involvement; (2) Explore how they include, or not, service users in the provision of care; and, (3) To discuss how the group of community MHNs recognise and describe service user involvement. Central ethics approval was gained and eight community MHNs in two District Health Board’s (DHBs) with over 5 years experience were interviewed. Participant’s discussion was audio taped, transcribed and then analysed utilising a thematic analysis approach. From this analysis, two predominant themes arose. Theme one highlights the ‘relationship dynamics of practice’ through exploration of concepts of historical changes; conflicting relationships, influential attitudes and powerlessness. Theme two explores ‘strength based approaches’ from the participants perspectives and includes recovery; inclusive practices; challenging stigma and beliefs towards service user involvement. Mutual agreement about the benefits of service user involvement was identified. However, changes to funding, hierarchical mental health organisations, nurses’ education, stigmatising attitudes and lack of nursing identity have impacted on the implementation and support of service user involvement. Recommendations for further research and suggestions for nursing practice are offered through building nursing capacity, capability, quality and strengthening the profession.
- ItemA study of medical, nursing, and institutional not-for-resuscitation (NFR) discourses : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Sociology, Social Policy and Social Work at Massey University, Palmerston North, New Zealand(Massey University, 2002) Bickley Asher, Joy LynleyThis study investigates the way that medical, nursing and institutional discourses construct knowledge in the specific context of Not-for-resuscitation (NFR) in a New Zealand general hospital where NFR guidelines are available in the wards and from the regional ethics committee. The thesis argues that there are ranges of techniques that staff use to construct NFR knowledge, enacted through various forms of speech and silence, which result in orderly and disorderly experiences for patients nearing death. The study was conducted through a critical analysis of the talk of health professionals and the Chairperson of the Regional Ethics Committee. Critical discourse analysis, a methodology that is primarily concerned with a critical analysis of the use of language and the reproduction of dominant ideologies or belief systems in discourse, was employed. The researcher examined the transcribed, audiotaped talk of eleven professional staff members of a large metropolitan general hospital, and the Regional Ethics Committee Chairperson. The results of the analysis indicate that medical discourses do not dominate the construction of NFR knowledge within the institution. Nor do the institutional or ethics committee discourses, written as NFR policy documents, dominate by instilling order into NFR practices with patients. Rather, a range of discourse practices within the disciplines of nursing, medicine, management and policy advice work to determine what happens to patients in the context of NFR and, unexpectedly, cardiopulmonary resuscitation. NFR discourses designed by the institution to influence and standardise practice at the bedside are resisted by professional discourses through the techniques of keeping quiet and keeping secrets, forcing others to keep quiet, delays in speaking up, through to speaking up against opposition. These techniques of speech and silence constitute a divergence between institutional discourses and professional discourses, and divergence within nursing and medical discourses. Both medical and nursing discourses underplay the degree of influence their professional power had over NFR events. This research is potentially significant at two levels; firstly because of what it reveals about the way in which health professionals and policy advisors construct NFR knowledge and secondly, because of the relationship between NFR practices in the health sector and societal ideas about control of death at the beginning of the twenty-first century. These findings will have particular relevance for the shaping of future health care policies. The outcomes of this study also point to the need for further research, both into NFR and into cardio-pulmonary resuscitation events particularly with regard to the implications of the policies for patients and their families.
- ItemA study of the career pathways of Canadian young adults during the decade after secondary school graduation : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy, Social Work and Social Policy at Massey University, Palmerston North, New Zealand(Massey University, 2011) Campbell, Catherine GraceThis study examined the career pathways taken by 47 young adults in Canada after they graduated from secondary school. Based on a grounded theory analysis, this thesis explored the way young adults made career decisions and how their resources (individual, family, social and environmental) and the messages that they heard from significant others influenced their career pathways. The majority of the young people in this study either did not know what they wanted to do when they graduated from secondary school or subsequently changed their minds. Most engaged in a process of identity exploration through experimentation with tertiary programmes and different types of work as they tried to ascertain what constituted satisfying work. As participants experimented with different career pathways, they obtained a better sense of who they were and what types of work they found satisfying. Findings indicated that participants engaged in a process of finding a career-related place, an activity that superficially involved selecting a career pathway but more substantively meant a search for identity and life purpose. Finding a career-related place was achieved through the interchangeable use of five strategies: navigating, exploring, drifting, settling, and committing. These strategies emerged as a host of internal and external factors impinged on a young person’s simultaneous search for a career and the identity that could potentially come with it. This contingent nature of finding a career-related place stood in sharp contrast to the discourse of what is referred to in this thesis as the “career myth”. This discourse related to the belief that young people should follow a linear, predictable route from secondary school to tertiary training, and then on to a permanent, full-time job. Based on these findings, an argument is made that developmental and chaos-oriented approaches to career development should be moved into the foreground when professionals assist young people in the immediate years after secondary school graduation. Accordingly, the trait and factor ethos, which continues to dominate the career counselling field, should be deemphasised. Six career design principles are identified that provide guidelines for how young people can engage in the process of finding a career-related place in a way that is proactive while at the same time accepting that career pathways and the identities that follow may be uncertain.
