School of Health and Social Services

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Achieving harmony of mind : a grounded theory study of people living with HIV/AIDS in the Thai context : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing, Massey University, Palmerston North, New Zealand
(Massey University, 2010) Balthip, Quantar
The aims in this Straussian grounded theory inquiry were to gain better understanding of the meaning of spirituality and of the process of spiritual development in people living with HIV/AIDS in the Thai context. In Western contexts, spirituality has been described as the essence of human existence. However, in the Thai context, where Buddhist teachings underpin the understanding of life as body and mind, rather than as body, mind and spirit, the concept of spirituality is little understood by lay people. This gap in understanding called for an inductive approach to knowledge generation. HIV/AIDS is a life-altering and deeply stigmatized disease that results in significant distress and calls into question the meaning and purpose of life for many who are diagnosed with the disease. Nevertheless, some Thai people living with the disease successfully adjust their lives to their situation and are able to live with peace and harmony. These findings raise questions firstly as to the process by which those participants achieved peace and harmony despite the nature of the disease and the limited access to ARV drugs at the time of that study; and secondly as to whether or not the peace and harmony that they described could be linked to the Western concept of spirituality. Data were gathered from 33 participants from the South of Thailand, who had lived with HIV/AIDS for 5 years or more, were aged 18 years or older, and were willing and able to participate in this study. Purposive, snowball and theoretical sampling techniques were used to select participants. Data collection using in-depth interviews and participant observation methods was undertaken over a nine-month period in 2006. The process of data analysis was guided by Strauss and Corbin’s grounded theory and resulted in the development of a substantive theory. The substantive theory of Achieving Harmony of Mind comprises two categories: struggling to survive and living life. Each category has two subcategories: encountering distress (tukjai) and overcoming distress (longjai), and accomplishing harmony in oneself and discovering an ultimate meaning in life respectively. The metaphor of ‘an eclipse’ was used to describe the process of the development of mind of people living with HIV/AIDS and represents the extent to which the individual’s mind is overshadowed by the diagnosis of HIV/AIDS and its consequences. Diagnosis of this disease turns participants’ lives upside down. Yet selective disclosure of one’s HIV status, resulting in the receiving of support and connectedness with others, enables participants to find meaning and purpose in life that enables them to recover the will to live and to attempt to stabilise their lives by learning to live with HIV/AIDS. Most participants were able to adjust their mind to accept their new situation and find new self value enabling them to feel free from the shadow of HIV/AIDS and live life with HIV/AIDS as normal. Fewer participants found an ultimate meaning in life – consistent with Buddhist teachings about suffering and uncertainty, and the impermanence of life that links with an understanding of ‘nonself’ – that enabled them to obtain peace and harmony of mind (kwarmsa-ngobjai). It is this latter stage that represents spirituality in Buddhist terms. This form of spirituality differs significantly from that found in other religions because it does not involve an engagement with a divine and transcendent reality. The findings of this study enhance knowledge about spirituality in the Thai context, and provide a guide for health professionals and education curricula with the aim of achieving more holistic care for patients.
The actualized caring moment : a grounded theory of caring in nursing practice : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University
(Massey University, 1991) Euswas, Payom Wiriya
The purpose of this study was to provide a partial theoretical description of the phenomenon of caring in nursing practice. Three practice settings involving cancer patients were selected: hospital, hospice, and community with thirty patients and thirty-two nurses participating in the study. A research design combining a phenomenological perspective and grounded theory strategies was implemented. Data were collected by indepth interview, participant observation, and records. The data were analysed by the method of constant comparative analysis. A number of concepts were developed from the data and the theoretical framework of "The Actualized Caring Moment" was formulated to explain how the actual caring process occurs in nursing practice. This caring moment is the moment at which the nurse and the patient realise their intersubjective connectedness in transforming healing-growing as human beings in a specific-dynamic changing situation. The actualized caring moment is a gestalt configuration of three main caring components: The preconditions, The ongoing interaction, and The situated context. The Preconditions, which consist of the nurse, personally and professionally prepared to care, and the patient, a person with compromised health and wellbeing, are prerequisites for the occurrence of the caring process. The nurse has the qualities of benevolence, commitment, and clinical competency to be ready to care. The patient is a unique person in a vulnerable state and requires assistance from the nurse to meet personal health needs. The Ongoing Interaction, the actual caring process, is the continuity of the nurse-patient interaction moment-by-moment which brings together six caring elements: Being there, Being mindfully present, A relationship of trust, Participation in meeting needs, Empathetic communication, and Balancing knowledge-energy-time. The Situated Context is the situation and environment where the actual caring process is taking place, and this is comprised of circumstances of the nurse-patient meeting and care-facilitating working conditions The conceptual framework of "The Actualized Caring Moment" offers nurses an opportunity to understand their practice more fully in providing effective nursing service. Consequently, its implications are valuable for education, research, and the development of knowledge focused on the discipline of nursing.
Adding quality to the quilt : adolescent experiences of critical incident responses in secondary schools in Aotearoa New Zealand : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Social Work at Massey University (Palmerston North campus), New Zealand
(Massey University, 2008) Stewart, Kathryn Janet
Critical incidents impact on populations that experience them. Within secondary schools in Aotearoa New Zealand, there is an expectation that a response is made to schools that experience such incidents. There is much conflicting international research as to the efficacy of these responses. The adult experts are making decisions that they believe are in the best possible interests of the young people; they are putting together a quilt that they believe will nurture young people. The expertise and knowledge of a major stakeholder – the young people involved in the critical incident response – has been for the most part, omitted from research. This particular study set out to gather data about young people’s experiences of critical incident responses, so that the quilt being provided has input from this group and so is able to better meet their needs. The study had four major facets. It incorporated reflections on my intrinsic involvement in this field of practice and was, therefore, heuristic. Secondly, qualitative research was utilised to explore with young people their stories about what happened for them at the time of an incident. Thirdly, it incorporated principles of participatory research as an acknowledgement that young people are central stakeholders in secondary schools and that their voice was one that needed to be heard in order that the best responses may be offered. Lastly, it was utilisation focused. It was designed so that the findings were not just written up and filed away but disseminated to those who make decisions at the school level and policy level. At the analysis stage, two major methods were used. Firstly, inductive analysis was used to identify the themes that emerged from the interviews with the young people. Triangulation was then used to consolidate these themes using the input from Collaborative Groups and a systematic review of the knowledge that I have gained over the time that I have been involved with young people in the critical incident response area. This analysis of the contribution from the young people resulted in several areas being highlighted. Firstly, participants asked that those responding to critical incidents considered the use of language and the power of words, Secondly, they believed that schools needed to act proactively and to have a plan and, in association with this, that they develop a culture that better cared for the needs of young people. Thirdly, the young people involved requested that the ‘right’ people responded at the time of an incident: the qualities of the ‘right’ people and the ‘wrong’ people were also identified. Next, the young people were well able to identify the positives that could ensue out of negative situations, and lastly, they expressed their wish that there be a place for their involvement at the time of a critical incident response.
Advanced nursing practice and the nurse practitioner : New Zealand nursing's professional project in the late 20th century : a thesis presented in fulfillment of the requirements for the degree of Doctor of Philosophy in Nursing, Massey University, Palmerston North, New Zealand
(Massey University, 2005) Jacobs, Susan Haas
Beginning with the question, "what are the forces and voices influencing the meaning of the concept, and the development of advanced nursing practice in New Zealand in the 1990s”, this thesis uses an historical sociological approach to explore what New Zealand nursing is becoming and what it is ceasing to be. Through the examination of New Zealand nursing history from 1860 through the first years of the 21st century, seven historical understandings of the meaning of 'advanced' nursing practice emerged: nurses with higher education; nurses with more than one type of registration; community nurses; nurse educators and administrators; specialty nursing; a career hierarchy based on further education, experience and clinical focus; and the contemporary Nurse Practitioner. The thesis argues that each of the earlier historical connotations of advanced nursing practice is reflected in the Nurse Practitioner. The analysis of this broad scope of New Zealand nursing history, including a case study of the interpretation and implementation of contemporary advanced nursing practice, reveals essential themes of profession and professionalisation; politics and political sophistication. Drawing on theoretical perspectives from sociology, political science, and nursing, these concepts are further analysed, and developed into a representational framework. This conceptualisation depicts critical factors for nursing to achieve its preferred position in the context of time. Therefore, this study is also an exploration of New Zealand nursing's professional project A professional project is the process through which an occupational group gains control over the education and entry to practice of practitioners; secures legitimacy through the state and the public; achieves self-regulation over its practice; and secures, maintains and extends a market, or jurisdiction for itself. This thesis illustrates that while the course of action of a professional project is not always clear or deliberate for all the members of the profession, it nevertheless has a coherence that may be seen ex post facto. It is argued that what became the drive for the development of New Zealand's Nurse Practitioner and the expansion of nursing's jurisdiction at the turn of the 21st century, began long before the 1990s. The importance of history to understanding the past, the relevance of history to the shape of the present, and the significance of history's influence on the future are affirmed.
Are we failing them? : an analysis of the New Zealand criminal youth justice system : how can we further prevent youth offending and youth recidivism? : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Social Policy at Massey University, Auckland, New Zealand
(Massey University, 2015) Johnson, Charlotte
Youth crime is a prominent social issue in New Zealand that causes emotional and physical harm and loss to the numerous victims. This research provides an analysis of the current youth criminal justice system in New Zealand, beginning with a timeline of the history and evolvement of the youth justice system to illustrate how New Zealand has arrived at the present system. The drivers of youth crime and youth involvement in criminal offending were found to be initially born from a lack of engagement with education; neurological disorders; learning difficulties and mental illness; as well as the impact of young people’s childhood, which can include exposure to family violence; drug and alcohol abuse. Comparative policy evaluation was applied with comparative methodology and comparative cross national research to undertake an analysis of the youth justice system in New Zealand. International comparisons were used to discover plausible and practical improvements to the current youth justice system in New Zealand. The OECD countries used in the comparative analysis included Canada, Scotland, England & Wales, United States and Austria, who between them have significantly diverse and contrasting youth justice models ranging from welfare, care and protection centred models, to community-based rehabilitation models; preventative education and support to punitive models in their response to youth crime. ii It was found that several aspects of New Zealand’s current youth justice system function well when compared internationally. However, the comparative analysis also highlighted that New Zealand’s youth justice system presents a problematic gap in both the sheer lack of preventative methods in response to youth offending as well as community support during the rehabilitation stage. A number of policy recommendations are included within this report in response to the present shortcomings of the existing youth justice system in New Zealand. These policy recommendations provide practical solutions; adopting a preventative policy focus with plausible improvement suggestions to the existing youth justice system. The objectives are to ameliorate the youth justice system to better support youth offending and youth recidivism.
'Being there' when one's spouse is hospitalised in a non-local tertiary centre : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Palmerston North, New Zealand
(Massey University, 2006) Mercer, Christine Joy
Illness that requires hospitalisation is a potential cause of anxiety for the entire family. Furthermore, increases in technology and specialisation of hospital services have resulted in increasing numbers of patients being transferred to centralised tertiary hospitals. There is limited international and national literature that explores the phenomenon of having one's spouse hospitalised in non-local tertiary centres. Therefore, this study was conducted with the aim of exploring the experiences of those whose spouses were hospitalised in non-local tertiary settings. Understanding of the experiences of 14 people affected by such hospitalisations was underpinned by a Heideggerian phenomenological perspective. Three major themes emerged from this study. Those who have their spouse hospitalised in non-local tertiary settings spend time waiting; a time best described as being-in-suspense. Despite being-in-suspense the research participants adjusted to their understanding of the situation; a period of time interpreted as fitting being out-of-town into being-in-the-world. The final theme that emerged from this study is that there were times when the research participants perceived that they were alone, unable to support or be supported by their spouses: being with and without others. Overall the findings of this research indicate that those whose spouses were hospitalised in a non-local tertiary centre lived day by day, with little or no social support, awaiting outcomes over which they had limited control. The worst potential outcome for these individuals would be that of the spouse's death in the non-local centre. When the outcomes of the non-local hospitalisation could be predicted, the events of living day by day were manageable. It also emerged from conducting this study that in living day by day, the supporting spouse dealt with the circumstances by being focussed on the temporality of the present and a vision of a positive future. However, their spouses were not always able to conceive the future in such a positive way. Nurses and other health professionals must remain cognisant of the fact that while they are familiar with the everydayness of non-local hospitalisations, [abstract incomplete].
Belonging and whakapapa : the closed stranger adoption of Māori children into Pākehā families : a thesis presented in partial fulfilment of the requirements for the degree of Master of Social Work, School of Health and Social Sciences, Massey University, Aotearoa New Zealand
(Massey University, 2011) Haenga Collins, Maria
Between 1955 and 1985, approximately forty-five thousand closed stranger adoptions took place in Aotearoa New Zealand, with adoption directly affecting twenty-five per cent of the total population. A significant proportion of closed stranger adoptions involved children who could claim Māori ancestry through at least one of their birth parents. The majority of these Māori children were placed within Pākehā families. This research explored the narratives of six self-identified Māori adults who were adopted into Pākehā families by way of closed stranger adoption. The study utilised a Māori-centred research approach, and a thematic narrative analysis of the participants’ accounts was undertaken. The study found that adoption is not a one off event, but is an on-going life experience. The multiple and complex ways the participants narrated their cross-cultural adoption experience reflected the diverse and contradictory narratives Māori adopted into Pākehā families navigate. The narratives clustered around the idea of ‘walking between worlds’, with two major themes of ‘belonging’ and ‘whakapapa’ emerging from the analysis process. Participants told stories on a continuum between ‘belonging’ and ‘not belonging’ within their birth and adoptive families, and in Māori and non-Māori worlds. Specific to Māori in Aotearoa New Zealand is ‘belonging’ through whakapapa. Whakapapa is essential to a Māori identity and to whānau inclusion. This study found that without knowledge of whakapapa, Māori become socially and culturally invisible within te ao Māori. In the telling of these narratives, participants have sought to repair the rupture in their lives when the dominant familial narrative of growing up in a birth family with a shared cultural heritage was not possible. For Māori adopted into Pākehā families, their identities as Māori and as adopted people are inseparable.
Bewhoherenow : philosophy of existing sense : a thesis presented in partial fulfilment of the requirements for the degree of Ph. D. in Social Policy and Social Work at Massey University
(Massey University, 1995) Goodwillie, Craig
body is[born and sustained through] sacrifice. i see mind seek immortalityandomnipotence through sacrifice. i see mind over body - mind rooting divide in subtraction of orgasmic from being[beingintheworld] to body to part[orgasm] to non i see mind rage [Laing] - where there was once here - rapeing here. seeyouhere [appealing]. argument [syllogism]. i, bodimentofbeing [eg Laing] iam bewhoherenow lookdown. iambody in Pain. The mutual repulsion of profane and sacred [Gould on sacred Hindu law]. profanity [of body] is polluted in embodying [pollution in her] and the sacrifice [decay and death - of zeroing body] - purifies sacred. Based on Gould's summary of the underlying assumptions of Hindu sacred law in chapter four "Priests and Conrapriests" (1967) In Gould, Harold A. (1987) The Hindu Caste System: The Sacralization of a Social Order. Chanakya: Delhi. p. 111. Reprinted from Contributions to Indian Sociology. New Series, No. 1, pp 28-57. pain embodimentofbeing [eg Kierkegaard guilts] therefore pain splacematterenergytime [Zeno on splacematterenergytime] splacematterenergytime therefore physics [physics - enlightenment testing ground for cause and effect. Einstein is the light speed observer - observing as fast as impossible with all else in train[slaved]. Newton masters gravity. Chaos is unpredictable slave. Second law of thermodynamics is mastery of slavery. Determinism - master[cause] and slave[effect] - exposed.] physics therefore chemistry [cell bodies], biology [organic bodies], psychology [human body], sociology [human bodies] physics therefore economy [shop - supply of body mastered and demand of body slaved], therefore law [keep shop] and policy [shop front] physics therefore mathematics [dominating human language. the right angle [triangle, hypotenuse, point of view] from Pythagorus and the zeroing of infinity from Indian grammar as void shape [the view of] mind.] physics of mathematics therefore philosophy of mathematics [the form of Plato called first cause by Aristotle and named one by Parmenides and Ptolemy mythologise shape as truth.] mathematics therefore logic [proofing the dominance of mathematics as dominant perspective. Leibniz puts one[everything] and zero[nothing] in Aristotle's syllogism and Boole starts crunching medium of english.] language therefore body [language is metaphor - the naming of] therefore is am i [who] was seen before [then] and therefore pain is becoming in between being inbetweenbeing - etheranderos - heavenandearth and [therefore] creation becomes kill[determined] [sacrifice]. sense [evidence]. inaffinity i body being in words [sound] in paper [light] in hand [body] and water [blood] and inaffinity [analogy] i syllogism. i syllogism to immortality [aim of mind] and syllogism immortality to death [target]. i deal summarily with logic [Aristotle, Leibniz, Boole, Russell and others] language [Panini, Itkonen, Laing, Burke and others] law [Williams, Waddams and others] mathematics [Sarton, Kline, Weyl and others] physics [Zeno, Pythagorus, Newton, Einstein] chemistry [Van Helmont, Brock, Hoagland] biology [Malthus, Darwin, Carson] sociology [Milgram] psychology [Skinner] economy [Smith, Marx, Stigler, Mumford] policy [Machiavelli, Orwell] and mythology [Upanishads, Plato, da Vinci, Galileo, Kant]. i quote directly or quote quote from recognised source. i use subheadings. i sound wordsounds [eg bodyandsoul] i emotion for sound [errors abound]. conclusion [assumptions]. beingintheworld is[the way of the world]. body is mind is being. mind is grasping[knots] itself. mind is lost[without body]. presumption [prediction]. beingwhole [therefore] letgoofyourself [advice given] and shebehere. [500 words]
Breaking another silence : the long-term impacts of child sexual abuse on committed lesbian couples : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Social Work at Massey University, Auckland, New Zealand
(Massey University, 2005) Hanna, Sue
This qualitative research enquiry sought to develop an understanding from forty-four women, comprising twenty-two couples in committed lesbian partnerships, of how they managed the long-term impacts of child sexual abuse, both on themselves and on their relationships. This is an area that is under- theorised in the literature. A number of key findings emerged from the analysis. The sexual abuse that women had experienced had impacted their adult lives in various ways. Of these the personal aspect featured most highly, with feelings of self-blame, shame and low self esteem commonly reported. Those women who reported physically invasive sexual abuse also reported a wider variety of effects, and in proportionately greater numbers, than women whose abusive experience had not encompassed that particular dimension. Just as the survivors were impacted in a variety of ways by their abuse, so too were their partners, although the effects upon the partner varied over time and in intensity depending on the length of the relationship and the degree of resolution experienced by the survivor. Despite challenges the over all view of couple relationships was positive, and couples were able to articulate coping strategies they felt would be useful to others in similar circumstances. Partners were able to identify with many of the relationship issues outlined by heterosexual male partners of female survivors, although lesbian partners had more a positive view of counselling. The emotional support and commitment of a caring partner was clearly valued although in these partnerships both women wanted their relationship to be based on more than the reparative needs of one member. Finally, being lesbian was no barrier to seeking counselling assistance. A large proportion of the participants had used counselling as a way of working through their experiences of child sexual abuse and had found this to be valuable. These findings have implications for social work practice with child and adult female survivors. They emphasise the long term impacts of sexual abuse, the important contributions made by partners and counsellors in supporting women sexually abused as children and the levels of inter-sibling sexual abuse perpetrated by brothers. The research findings also contain information from the women themselves on what facilitated their ability to cope with the effects of child sexual abuse from the varying perspectives of survivor, partner and couple. This will be essential information for counsellors and social workers wishing to employ strengths and evidence-based approaches in their work with this client group and others, particularly heterosexual women and heterosexual couples.
Breaking the silence : restorative justice and child sexual abuse : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Social Policy at Massey University, Albany, New Zealand
(Massey University, 2001) Jülich, Shirley Jean
This research investigated the relationship between justice and child sexual abuse from the perspective of adult survivors. Utilising participant observation, unstructured interviews and focus groups within a feminist framework, 21 adult survivors of child sexual abuse (18 women and 3 men) were consulted to identify issues that were problematic for them. In addition, 2 jurors, 1 judge and 2 counsellors were interviewed. The findings indicated that child sexual abuse has been shrouded by a conspiracy of silence, caused partly by deeply entrenched structures within society. These forces combined with the complexity of recovery, including the possible impacts of Stockholm Syndrome, and the perceived inability of the criminal justice system to meet their needs, have appeared to silence many survivors of child sexual abuse. A review of the economic consequences and an analysis of the subsequent costs of child sexual abuse have indicated the need to implement programmes that would lessen the burden for victims, offenders, their families and the broader society. Survivors cautiously suggested that restorative justice might be sufficiently flexible to encourage victims of child sexual abuse to criminally report, thereby breaking the silence. A cost benefit analysis of a restorative justice programme indicated that significant savings could be made and highlighted that the prevention of child sexual abuse should be a priority. The findings of this research would have implications for policy makers and all those who provide services to victims and offenders of child sexual abuse. Stockholm Syndrome has highlighted the complexity of the recovery process for victims of child sexual abuse. This syndrome combined with the concerns of adult survivors of child sexual abuse would have implications for practitioners within the traditional criminal justice system and the restorative justice movement. Finally, the costs of child sexual abuse in New Zealand would have implications for justice agencies, health agencies, social welfare organisations and the Accident Compensation Corporation of New Zealand.
Breastfeeding practices in New Zealand during the first year postpartum
(Massey University, 2014) Jia, Ruimin
There is a lack of research observing breastfeeding (BF) practices in detail globally and in New Zealand (NZ). This longitudinal study examined BF patterns and the association between BF duration and frequency per day in NZ infants from the birth to 12 months old. A total of 61 self-selected women in the Manawatu region were recruited during the last stage of pregnancy. The average age was 32.1±0.6 years. BF practices were obtained by 24-hour recall noting all of the infant‘s activities through a telephone interview. The interviews were conducted at approximately 2 weeks after birth and then at 2 weekly intervals during the first three months, and then once per month until the infants first birthday. Results show that the majority of infants during the first four weeks postpartum were fully BF (81% at two weeks & 82% at four weeks), 8% infants were mixed-fed and 10% had stopped BF by four weeks. At 16 weeks, 61% infants were fully BF, and 9% infants had been introduced to complementary foods (CF). At 24 weeks, most infants (93%) were no longer fully BF and 24% were receiving no breastmilk. At 48 weeks, 48% infants had stopped BF. Regarding BF patterns, throughout the first 48 weeks postpartum there was a wide variation of BF frequency/day, the longest interval between BF and the length of BF sessions. For example, at two weeks fully BF infants were fed from 5-21 times/day (interquartile range (IQR): 8-10 times/day); at 48 weeks BF infants receiving CF had from 1-22 breastfeeds/day (IQR: 3-8.3 times/day). For the longest interval between BF, at two weeks for fully BF infants the longest interval ranged from 3-10 hours (IQR:4.3-5.5 hours), and at 48 weeks for BF infants receiving CF the longest interval ranged from 3-24 hours (IQR:6.4-12.5 hours). The length of BF session, at two weeks ranged from 2-205 minutes/feed (IQR: 12-30 minutes) for fully BF infants, and at 48 weeks ranged from 4-85 minutes/feed (IQR: 5-15 minutes) for BF infants receiving CF. At the majority of observations there was a significantly lower BF frequency/day and longer longest interval between breastfeeds for mixed-fed infants compared to infants who were fully BF (p<0.05). For instance, at four weeks, median BF frequency/day for mixed-fed infants was five times/day, and for fully breastfed infants ten times/day; at 16 weeks the median BF frequency, for mixed-fed infants was 6.5 times/day, and for fully breastfed infants 9.5 times. At four weeks, the median of the longest interval between breastfeeds for mixed-fed infants was 8.5 hours, and for fully breastfed infants five hours; at 16 weeks, for mixed-fed infants the median was 11.8 hours, and for fully breastfed infants 6.2 hours. There was generally no significant difference in the length of BF sessions between these two groups (p>0.05). There was a significantly positive, but weak correlation between BF duration and BF frequency/day at two weeks (p<0.01; r=0.352) and four weeks (p<0.01; r=0.404), and between BF duration and BF frequency/day of fully BF infants at four weeks (p<0.05; r=0.289). There was no significant correlation between duration of BF/fully BF and maternal and infant characteristics, with the exception of parity (there was a positive association between parity of two or more and BF duration, p<0.05). Case studies were made of four participants who were still breastfeeding their babies at 48 weeks and whose frequency of feeding in the first four weeks after birth was outside of the often recommended 8-12 times/day. Results show that their BF practices varied widely between women during 48 weeks. BF frequency and the total length of BF sessions decreased over time. For two infants who had higher BF frequency in the first four weeks, BF frequency remained relatively high through the end of the first year. For another two infants who had lower BF frequency in the first four weeks, BF frequency remained relatively low through the end of the first year. For all cases, the total length of BF sessions per day did not generally fluctuate with the changes of BF frequency. In conclusion, this longitudinal study supplies a detailed picture of BF practices by 24-hour recall. Results show that almost half infants had stopped BF by 48 weeks. There is a wide variation of BF practices associated with successful BF. Therefore, individuals‘ particularity should be considered when making suggestions to the mother. Overall, this thesis may contribute to the literature on BF practices in NZ.
BSMC : is there room for me? : an exploration of nursing leadership in primary health care : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University, Auckland, New Zealand
(Massey University, 2012) Calverley, Rachael
The unpredictability of health in a dynamic climate can result in a multiplicity of challenges. Indeed unpredictability has been referred to as the essence of creativity. Strong leadership in healthcare and importantly nursing is crucial to seeking solutions to organizational change especially when decision making will impact on the population’s health. By influencing policy objectives through leadership, nurses have the opportunity to develop strategies that make a difference to future complex problems. With the implementation of the Governments Better Sooner More Convenient (BSMC) policy agenda and principles underway from 2008 onwards, to reframe primary health care services, a series of key principles emerged including: a more personalized primary health care system with services moved closer to home; reduction in demand on hospitals and a package of services centred on integrated family health centres, with nurses taking a key role in shifting services from the secondary to primary care needs of patient support. From seventy health collective submissions positioning themselves to address these principles, nine were selected to move through to the next stage of development. The applications from all of the successful organizations referred to the need for improved multi-professional working and/or the importance of the nursing workforce to the BSMC agenda. Importantly, it would appear that a high quality nursing leadership function within the BSMC health collectives developing BSMC service configurations would be required to meet their goals. The purpose of this study was to explore with nurse leaders how they were able to contribute to these evolving primary health care collectives and changes that influenced the development of new or reviewed services, in addition to gaining insight into their challenges and opportunities as nurse leaders. The literature suggests a move away from the post heroic model of leadership and refers more frequently to coalitions of experts or leaders as a collective intelligence. These emerging characteristics represent a distributed leadership model that is leadership shared across varying people, professions and roles. It is this distributed model of leadership that provided a conceptual framework and a clear point of reference for this study. A qualitative approach derived from an interpretive perspective was the methodology chosen for this research. Eight out of nine potential nurse leaders involved in each of the regional health collectives participated in telephone interviews and communicated with the researcher via email networks. Theme identification was the essential task for the analysis process. Four key themes were identified with subthemes: politicization (power to influence), infrastructure (teams and education/training), coalitions of leaders (communication and relationships) and resilience (battling and visibility). The findings suggest on-going challenges to nurses leading in primary health care which include fragmentation among nurses, variable investment in regional nursing infrastructure, interdisciplinary relationship issues and limited training to develop future nurse leaders. Addressing these results requires clinical, strategic and professional nursing leaders to work within fora that are unified, cohesive and collectively agreed on their purpose.
Caesarean section in the absence of clinical indications : discourses constituting choice in childbirth : thesis submitted to Massey University of Palmerston North in fulfilment of the requirements for the degree of Doctor of Philosophy in Midwifery, Massey University, Palmerston North
(Massey University, 2007) Douche, Jeanie Raeburn
This poststructuralist qualitative study explored the discourses constructing women’s choice for a caesarean section in the absence of clinical indications, in the talk and texts of women, midwives, an obstetrician, professional journals and the media publications. The study affirms inscriptions surrounding choice in childbirth are shaped discursively through a multiplicity of discourses underpinned by social and institutional practices. With advances in technology, childbearing women have a greater variety of options from which to choose. Controversial, is the option of a caesarean section, regardless of clinical need. The issue is depicted in both professional and popular discourse as contentious, complex and contradictory. Its momentum into the 21st century, as a new object of obstetric discourse, has been played out on a number of platforms. In this thesis I draw from the theoretical ideas of French philosopher Michel Foucault, to examine this complex debate. I argue there is a volatile moment in the history of childbirth in which an explosion of discourses have sculptured choice for a caesarean, in the absence of clinical indications, out of a repartee of autonomy, convenience, desire, fear and risk. In this precarious moment, new meanings joust with the old on a shifting terrain awash with rhetoric that co-opts, competes, and contradicts to bring about a caché of mutable ‘truths’. Whether caesarean, as an optional extra, can be explained in terms of a libertarian imperative, an embodiment of lifestyle, the satiation of desire, the attenuation of fear or the avoidance of risk, the democratisation of this choice has exposed a pathologising paradox, whereupon the normal emerges as the abnormal, and the abnormal emerges as the normal. The deconstruction of choice through a poststructuralist lens has enabled insight into how contradiction and contest befall the ‘order of things ’ and in so doing, provides new openings for contemplating the discursive positioning of women through the competing discourses of childbirth.
Carbon dioxide insufflation during colonoscopy : a randomised controlled trial : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Philosophy (Nursing) at Massey University
(Massey University, 2009) Cleland, Anne
Aim To determine that carbon dioxide (CO2), instead of air, insufflated during colonoscopy reduces pain experienced by patients post colonoscopy. Method A randomised, double blinded, controlled trial with 205 consecutive consented patients referred for elective colonoscopy was undertaken at MidCentral Health Gastroenterology Department between July 2008 and January 2009. Patients were randomised to colonic insufflation with either air or CO2. A comparison of reported pain was undertaken using a 0 -10 point numeric rating scale at several time periods; intra procedure, 10, 30, and 60 minutes post procedure. Results The results were analysed using the SPSS programme. CO2 insufflation was used in 108 patients and air in 97 patients. Pain scores 10 minutes after were 0.43 ± 1.20 for CO2 and 1.61 ± 2.40 for air (P < .0001). 30 minutes after the procedure 90% of patients in the CO2 group reported no pain, compared to 61% of the air group. CO2 significantly reduced the amount of discomfort post colonoscopy at 10, 30 and 60 minutes. Conclusion Those receiving CO2 during colonoscopy experienced less post colonoscopy pain than those who received air insufflation. Carbon dioxide should be considered as the insufflating gas during colonoscopy.
Career break or broken career? : mothers' experiences of returning to paid work : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy at School of Sociology, Social Policy and Social Work, Massey University, Palmerston North, New Zealand
(Massey University, 2007) Ang, Ee Kheng
Servicemen returning from two World Wars were granted assistance in finding work, retraining and other benefits in recognition of the sacrifices they had made. Yet mothers' returning to work after time out bearing and raising children are reliant on a booming economy to obtain even limited entry to the labour market, and the work obtained is very often inferior to the jobs held by women before becoming mothers. Currently due to lower fertility rates and the ageing populations of the world's richer nations, a shortage of working-age people is predicted to continue into at least the middle of the twenty-first century. To overcome this shortfall, the Organisation for Economic Cooperation and Development (OECD) advises its member states to assist mothers to return to paid work sooner. Most OECD nations are complying, with varying degrees of success. Some policy frameworks make this goal more easily attainable than others. Mothers in liberal welfare states often return to paid work later than they might otherwise prefer. Many returners are overqualified for the work they are doing. While there appears to be relatively few barriers to re-entry, the choice of re-entry occupations are limited and returners are predominantly offered low status jobs with no career opportunities at the back of the job queue and gender queue. Mothers who interrupt their careers by taking a career break for childbearing and rearing generally face downward occupational mobility and loss of lifetime incomes. This thesis assesses the experiences of mothers who return to employment in one liberal nation, New Zealand. It applies Esping-Andersen's three models of welfare states and Reskin and Roos' gender queues model to the situation of returners. The study investigates the precise nature of the obstacles and processes encountered by a number of mothers attempting to resume a career. It argues that social policies matter: returners in countries where state intervention is more widespread and where there is universal, extensive and generous social provision and support for working mothers are economically better off. The research methods include in-depth interviews and a focus group with mothers, a mail questionnaire and interviews with employers, and a study of recent and current New Zealand and overseas government policies to assist working parents. The findings of this thesis are that regardless of skill levels, New Zealand returners are consigned to low status occupations where they are not fully integrated into the 'normal' full-time workforce with career opportunities. These mothers generally suffer more than one episode of returning to the back of the queue. They also earn less (weekly and annually) than mothers who do not take career breaks. The study identifies social policy frameworks and employers' policies and practices as factors contributing to the processes whereby returners are relegated to the back of the queue. Although New Zealand has recently brought in policies to assist mothers to return to paid work these initiatives have not addressed the processes that currently confine returners in low status, part-time employment. Policies similar to those created to specifically target the needs of ex-servicemen would go a long toward assisting mothers to access higher status and better-paid jobs at the head of the queue. The thesis concludes with policy recommendations to facilitate mothers' integration into such jobs.
Christian social workers and their sense of effectiveness in social work practice : a thesis submitted in partial fulfilment of the requirements for the degree of Master of Social Work, School of Health and Social Services, Massey University, Albany Campus
(Massey University, 2010) Hare, Jennifer Lois
While social work roots are undoubtedly firmly in religious soil, over recent years the emphasis has widened to include a more inclusive definition of spirituality that seeks to mirror the diverse society we now live in. How social work responds to this increasingly complex environment is a matter of concern for social work educators, practitioners and academics, who all share the same aim of developing the most effective ways to deliver services to the client. The evidence-based practice movement is an evolving response, seeking to offer quality research based solutions to be implemented in practice. Missing in the equation to date is the ability to capture the spiritual aspects of practice both for practitioner (in terms of ‘use of self’) and client ( in relation to spiritual assets that assist them). To this end this qualitative study conducted semi-structured interviews with eight Christian practitioners as examples of spiritually motivated social workers. The research sought to explore how a Christian perspective contributed to a sense of effectiveness in social work practice. The findings produced discoveries that concurred with the literature and revealed insights from the participants about the ways in which they sought to practice that were consistent with their most valued beliefs. Using the findings and the literature, practical applications are suggested as a way forward for the inclusion of spiritual aspects in evaluating effective social work practice.
Civil society in the Chi River, Northeast Thailand : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Social Policy and Social Work at Massey University, Auckland, New Zealand
(Massey University, 2005) Choopug Suttisa
The thesis 'Civil Society in the Chi River, Northeast Thailand', aims to answer the questions of what civil society means in the Northeast Thai village context, which factors make civil society proactive and how civil society is activated. Participatory action research (PAR) was carried out in two communities in the Chi River Basin to answer the inquiries. The research discusses the contexts of the Northeast Region and the two communities in the Chi River Basin. The people in this area are of the Thai-Laos ethnic group and hold particular beliefs in an amalgam of Buddhism and animism which creates cultural rituals that are different from other regions. The society is based on kinship ties. The economic situation has transformed from an agrarian society to a commercial agriculture society. Through the research process the new term of 'grounded civil society' was created. It means 'the sphere of an autonomous group of local people who actively participate in collective action to deal with their struggles and promote their common interests by mobilizing cultural and social capitals in consort with other people to productively solve their problems. Grounded civil society may include traditional forms of mutual assistance, and formal or informal social associations. It seeks to have a significant influence on public policy at any level'. The research found that grounded civil society was activated by both outside and inside factors. The outside factors included the negative effect of government development projects and the intervention of the participatory action research, which stimulated local people to engage in civil society. The inside factors activating civil society were the poor economic conditions of the villagers and the social capital existing in the communities. The social capital was built up around kinship ties and cultural capital, which generated the social values and norms of the local people. The research concluded with an analysis of the causal links between social capital and civil society claiming that social capital facilitated the creation of civil society. Further research possibilities are suggested.
Community participation in health development in Thailand : a thesis presented in fulfillment of the requirement for the degree of Doctor of Philosophy in Nursing at Massey University
(Massey University, 1997) Tassniyom, Nit
This thesis is a chronicle of research into the implementation of community participation in health development in Thailand. Community participation is recognised as the key concept of primary health care. Participation in this study has been conceptualised as power. Therefore, to participate is to achieve power, and participation is a process of empowerment. The research participants were health workers employed at the subdistrict health centre, and village health volunteers. These participant groups were chosen because the researcher perceived that they were groups with relatively little power in the Thai health service. The research involved the participants in a two stage process. The first stage was an examination of the concept of participation in relation to the community's experience with development projects. During this stage it became apparent to the researcher that the original concept of community participation was poorly understood by both participant groups. The second stage involved the use of participatory research to achieve community empowerment by supporting the participants in an analysis-action-reflection process. Dialogue, with equal respect between the researcher and participants, was the key method to encourage analysis of their existing situation in order to raise their awareness, the most important step of empowerment. Simultaneously, action research was also utilised to solve a selected health problem, dengue fever control. A comparison between the results of the implementation of action research processes and that of the participatory research processes utilised in this study revealed that participatory research better ensured community participation in health development. The findings provide an understanding of the theoretical concept of community participation in health development, and its enaction by the use of an empowerment process. The utilisation of a new primary health care approach, whereby the community is empowered to be self reliant and solve its own health problems, would depend on the acceptance and application of the empowerment approach by health workers. The empowerment approach would need to be pivotal in the work of all health personnel, including the implementation of policies and routine practice. Specifically, the empowerment approach has much to offer community health nursing and its adoption would support the World Health Organisation's recommendation that a problem-solving, process-oriented and community-based curriculum is necessary to adequately prepare these practitioners. The adoption of this approach would require expansion of the present curriculum to include not only public health science and nursing science concepts, but also those related to community development. The new curriculum would uniquely equip nurses to work in communities and this in turn would provide specialised knowledge for community health nursing, allowing it to be differentiated from other nursing specialties.
Complexity and context : staff support systems in mental health after critical incidents and traumatic events : a thesis presented in partial fulfilment of the requirement for the degree of Doctor of Philosophy in Social Work, School of Sociology, Social Policy and Social Work, Massey University, Wellington, New Zealand
(Massey University, 2005) Adamson, Carole
This thesis presents an ecological exploration of the experiences of mental health workers faced with critical incidents and traumatic events in the course of their work. A qualitative study, it takes the experiences of twenty workers from a range of disciplines and environments, and examines their preparation for exposure to extreme stress, their passage through the incidents that they chose to relate, and the organisational response to the events. The central research question explores the knowledge bases currently utilised within trauma and critical incident response, and the degree to which these provide adequate explanatory, practice and evaluation models for responses to workplace incidents. It is examined through the narratives of the mental health workers, who self-define and explore the nature of their preparation for, and experience of, critical incidents and traumatic events in their workplace. The question is contextualised through a review of the knowledge bases of trauma and extreme stress, and of the mental health environment in which the workers practice. A case study of the workplace support known as debriefing illustrates the tensions between current knowledge bases in the area. Informed by this, the key issues of what did or did not work for the participants are explored. The thesis argues that the paradigm shift signalled by the latest developments within conceptualisations of trauma is not yet complete, and that the ensuing tensions have created debate and confusion in the creation of adequate responses to workplace incidents. Whilst conceptualisations that attempt to address issues of complexity and context are evolving, it is argued that an ecological framework has the potential to both explain and respond to incidents that occur within the mental health environment. The findings of the research raise issues of complexity in the design and implementation of appropriate support systems, and lend a perspective to the critique of debriefing that has been missing from existing debates. Key principles for the development of safe and sound support systems, and their evaluation, are developed.
Contested inheritance : the emergence of social science research in New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Social Policy at Massey University
(Massey University, 2004) Lunt, Neil T.
The substantive task of the thesis is to explore a dimension of social change - the emergence of social science research within New Zealand by 1984. The thesis begins by asking questions about the status of any account - as description, understanding, or explanation. In the first instance, these questions are discussed within positivist and anti-positivist traditions. Following on from these, the work examines a series of post-positivist approaches that focus on method, general theory, and methatheorising. Many accounts of social science development emphasise the role of a rational social science idea, others stress contextual considerations. In finding these wanting, the thesis argues for the incorporation of culture, structure and agency, and discusses attempts at resolving these within the work of Anthony Giddens and Andrew Abbott. The final part of the theoretical discussion explores the potential of Critical Realism for causal analysis. Within this tradition, Margaret Archer's work is particularly useful with its commitment to robust notions of agency, culture and structure, and emphasising their interplay through time. With some modest revision to attune her position to the demands of practice, the thesis suggests 'Retroductive Narrative Realism' that incorporates ontological insights and the two practical moves of analysis and narrative. The thesis argues that these moves must be explicit, using the analytic to create hypothesis that are then tested via narratives that link emerging structural and cultural forms. The thesis uses this approach for the substantive task of writing a theoretically informed account of social science research. It works within the spheres of State, University and broader social spaces, centring interests and the role of conditioned interaction. The account is presented within four phases: the inheritance - research by the State for the purposes of the State; in search of independent means - research by the State of broader social forms; alternative benefactors - research of social issues by broader social and University interests; on the brink of bankruptcy - a questioning of the State and social forms by social and University interests. Over these four periods it is possible to trace the emergence of social research, then social science, and then specific disciplines.

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