Nursing and Midwifery

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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.
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.
'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].
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.
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.
Cultural perceptions of illness in rural northeastern Thailand : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University
(Massey University, 1994) Nuntaboot, Khanitta; Khanitta Nuntaboot
In a transitional society like Northeastern Thailand, alternative and often competing therapeutic methods have been widely used by local people. Most illnesses are managed without recourse to the Government health care services. In Thailand there is a paucity of studies which explore and develop an understanding of how rural people regard illness in terms of causes and classification and how this knowledge influences what actions they take to deal with it. The impact of medical pluralism on illness management has rarely been studied in this country. The purpose of this study is to provide an understanding of the cultural meanings of illness for people in rural Northeast Thailand and their behaviour regarding health and illness care. An ethnographic approach, employing participant observation, interviews and ethnographic records, was selected as the research method, with fieldwork carried out in one rural village in Northeast Thailand where the researcher lived for 12 months. The findings suggest that what people do during an illness is guided by their healing knowledge which is experiential in nature. Mutual influences exist between people's beliefs about illness and their experiences of illness and healing methods. The experiential healing knowledge encompasses broad illness categories and beliefs in multiple causes of an illness. Multiple healing methods including both Western medicine and village curing methods are applied in any illness situation. Western medicine is believed to be effective to treat disease which is viewed as one part of illness, while village curing is believed to effectively treat other causes of illness as well as disease. Kin and neighbours actively participate in the articulation of illness situations, being involved in diagnosing the illness and identifying and prioritising multiple therapeutic management options. This description of people's perceptions of illness and its management, generated from the data, is crucial to increasing the knowledge base of members of nursing and other health professions. Such knowledge identifies critical aspects and possibilities for change in the practice of health professionals when working with rural people in Northeast Thailand. The study concludes with a discussion of strategies for practice and education which might be applied by nurses and other health professionals to improve the utilisation of available health care services.
Dancing around the families : a grounded theory of the role of neonatal nurses in child protection : a thesis presented in partial fulfillment of the requirements for the degree of Master of Philosophy in Nursing at Massey University (Albany), New Zealand
(Massey University, 2011) Saltmarsh, Tina Anne
The Ministry of Health objectives aim to protect the health and safety of children by reducing death rates, injury and disability from abuse. Family Violence is a significant health issue that impacts on children. Health professionals are key in the screening for Family Violence and assessment for child abuse. The philosophies of Family Centered Care and Developmental Care underpinning neonatal nursing practice are especially relevant for child protection. Nurses are in an ideal position to intervene before abuse perpetration. Increased awareness of child maltreatment and requirements for screening and reporting led to my research question, “What is happening for Neonatal Nurses in Child Protection?” Glaserian Grounded theory guided this study and the analysis of data. A total of ten semi-structured interviews was undertaken with nurses working in the participating neonatal units. Data were analysed and constructed into a substantive grounded theory, Dancing Around the Families and a Basic Social Psychological Process of Knowing at Risk Families. Dancing Around the Families explains nurses’ coping and acting upon child protection issues. It is about the creative conversations and work required to help support or enhance the infant’s safety. Difficulty with communication and transparency of information sharing between services, and differing perspectives creates this dance. Knowing at Risk Families captures how neonatal nurses construct child protection by acting on their personal and professional levels of knowledge. Nurses act on gut instincts, intuition or Red Flags to put supports in place for the protection of the infant. Child protection presents a state of conflict for nurses, where a sense of social justice prevails in their care, and their ideals and reality are often not congruent. Implications for practice require nurses to consider the way we look at families, as well as family capacities, capabilities and health literacy, and the importance of facilitating attachment.
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.
The elderly primigravida : contest and complexity : a Foucauldian analysis of maternal age in relation to pregnancy and birth : 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, 2001) Payne, Deborah
This study identifies and analyses the discourses deployed by women recalling their experiences of pregnancy and birth at the age of 35 or over, and by maternity service practitioners describing their practice in relation to women pregnant or giving birth for the first time aged 35 and over. The philosophical approach underpinning the study was derived from the works of Michel Foucault, particularly his concept of discourse and its inextricable relationship with power and subjectivity. The data for the study included texts of published medical, midwifery and women's health literature and relevant government policies. The primary source of data was the transcripts from 32 interviews with women, midwives, general practitioners and obstetricians. The analysis reveals the diversity, contest and complexity that exists amongst women and the practitioners in their ways of thinking about prenatal genetic diagnosis, birth, and maternal age in relation to pregnancy and birth. Textual analysis identified two contesting discourses regarding pregnancy and birth: the scientific medical discourse and the natural birth discourse. The scientific medical discourse demarcates the age of 35 as the time when pregnancy and birth become problematic for such women and assigns to them the label of "elderly" primigravida/primipara to signify their different status. Thus defined, "elderly primigravida/primipara" are recommended to be under the care of an obstetrician and to give birth in an obstetric hospital. The natural birth discourse opposes the construction of maternal age as an independent risk factor. Instead speakers reproducing this discourse argue that other factors are the cause of complications experienced by "elderly" primigravida/primipara, in particular the beliefs and fears perpetuated regarding these women and the interventions that occur as a consequence. Each discourse offers competing subject positions for the first time pregnant woman aged 35 or over. She is positioned in the scientific medical discourse as potentially pathological and incapable of giving birth without intervention. In contrast, the natural birth discourse positions her as not different from younger women and capable of giving birth naturally. Maternal age has the potential to further complicate pregnancy in that women aged 35 and over are compelled to consider the possibility of being mothers of a child with chromosomal abnormalities, particularly Down syndrome. Analysis of the texts showed that the participants brought numerous discursive identities into being in relation to prenatal genetic diagnosis. While most of the women and practitioners identified themselves as subjects of the medical genetic discourse, the discursive identities brought into play by the women were quite different to those deployed by the practitioners. Although the choice to undergo prenatal genetic diagnosis is a binary yes/no, the women revealed fragmentary and complex subjectivities. The study found that women assessed their capabilities to mother a disabled child drawing on multiple and contradictory discursive meanings of risk, motherhood and disability. In comparison, the practitioners positioned themselves as enforcers of informed choice, information experts and as vulnerable to discipline. I suggest that the legal discourse's subject position of vulnerable practitioner may complicate the practitioners' positioning and interests in informing women. Women's right to informed choice may compete in priority with the practitioners' desire to avoid being disciplined for the wrongful birth of a child. A further finding of the study is the strategies deployed by women, midwives and general practitioners to resist power techniques such as surveillance. Women's tactic of elusion avoids the normalising gaze of prenatal genetic diagnosis. Similarly, a strategy of opposition is used by midwives and some general practitioners to create an opportunity for "older" primigravida/primipara to keep open the possibility of giving birth without intervention.
An ethnography of caring and control in an acute psychiatric unit : a dissertation presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing Studies at Massey University
(Massey University, 1992) Boddy, Julienne Mary
The setting for this study was a 19 bed general hospital psychiatric ward serving a heterogeneous population. The objective of the study was to generate thick description of the cultural knowledge patients and nurses used to organise their behaviour and interpret their experience in an acute psychiatric unit. Further aims were to describe the nature of the service provided, and more specifically to identify relationships between caring and controlling in this social context, and the outcomes for patients of caring and controlling interventions by nurses. Over a 10 month period primary data were obtained through participant observation and ethnographic interviews, with analysis of documentation providing secondary data. Thirty patients and 20 nursing staff acted as informants. They were selected on the basis that they had experienced the event being studied, and that they were both willing and able to share the experience. A cyclic research process was adopted, in which initial data analysis followed early data collection resulting in more focussed questions for subsequent data collection. Content analysis was undertaken to inductively derive patterns or themes from the data. Validity of data was achieved through triangulation of multiple data sources. Interpretations of the findings were verified and clarified in collegial dialogue with other psychiatric nurses, and with academic colleagues. The central thesis which emerged from the data is that the nature of caring and controlling acts by nurses is shaped by the social organisation of care, and by the dominant belief system of that setting. A view of mental illness as a life long event for the majority of inpatients, coupled with beliefs about the "outside world" as tough, contributed to nurses' feelings of powerlessness to change situations for, or with patients, and so diminished expectations for change. Caring as a moral obligation was often interpreted by nurses as a moral obligation to provide a safe haven, with nurturance and acceptance of patients viewed as chronically psychiatrically disabled. Additionally, features of the organisational context including nurses' lack of autonomy in their practice, the absence of both appropriate environmental controls and a clearly articulated rule structure, and the competing demands on nurses arising from the provision of the after hours crisis service from the ward, contributed to an organisational context which was not supportive of sustained therapeutic interaction between nurses and patients. There was a culture of chronicity in the ward. Implications of these findings for psychiatric nursing education and practice, and for service development are discussed.
The everyday always-thereness of living with rheumatoid arthritis : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Albany, New Zealand
(Massey University, 2001) Roy, Dianne
This study explores the phenomenon of 'living with rheumatoid arthritis'. Utilising a hermeneutic phenomenological methodology informed by the writings of Martin Heidegger and Hans-Georg Gadamer, the study provides an understanding of the meaning the phenomenon has for the participants and illustrates the impact it has had on their lives. The participants in the study were twenty-five people who have varying experiences of the phenomenon. Eleven participants were people who have the disease, six were partners of people who have rheumatoid arthritis, and eight were adult-aged children whose mother or father has the disease. Drawing primarily on the stories shared by the participants, the study uncovers the everyday realities of living with rheumatoid arthritis and it reveals the taken-for-granted nature of the experience. The interpretation offered in the thesis raises new understandings of the complex phenomenon of 'living with rheumatoid arthritis'. The findings of this thesis show that rheumatoid arthritis is always there in the lives of those who experience the phenomenon, whether as partners, adult children, or the person with the disease. In its always-thereness rheumatoid arthritis becomes part of the background familiarity of their lives. Those who live with rheumatoid arthritis take the experience with them into all other worlds. It permeates, to varying degrees, all aspects of their lives. In the presence of rheumatoid arthritis different things matter and things matter differently. Living with rheumatoid arthritis means finding a new way of being-in-the-world. It means developing and maintaining strategies for being-in-the-world with rheumatoid arthritis. As the strategies are developed, these people come to live in the world in an everyday way that in itself becomes taken-for-granted. They, as I suggest, come to live resolutely with the disease. However, living resolutely with rheumatoid arthritis is always tenuous and at the beck and call of the disease and a myriad of other influences. Resoluteness in the everydayness of living with rheumatoid arthritis can be lost at any time, in any way. Living with rheumatoid arthritis becomes a cycle of always working towards and maintaining the everydayness of resolute coping, while knowing it may be lost at any moment, which will necessitate coming again to pick up the strategies that bring one back to a taken-for-granted everydayness.
Exploring the health care experiences of rural Thai people living with acquired valvular heart disease : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Wellington, New Zealand
(Massey University, 2010) Buatee, Supatra
Valvular heart disease (VHD) is a preventable disease but it is one of the major causes of chronic illness in developing countries. As this disease is curable by surgery, access to appropriate and effective health care is necessary to prevent people from developing this disease and to treat people with VHD. The voices of people living with this condition will provide direction for health professionals in the development of better health care services for those living with VHD. This qualitative narrative study aimed to explore the experiences of individuals living with VHD. Thirty individuals diagnosed with VHD participated in this study drawn from a population of individuals attending a Thailand provincial hospital. They participated in (open and honest conversation) which was supported by a Thai cultural stance to build the trust necessary for the conversations. Conversations aimed at eliciting information about personal health care experiences were undertaken and lasted from 30 to 90 minutes, all were audio-taped and transcribed verbatim. Multistage narrative analysis methodology was used to identify emerging themes and three major themes emerged: autonomy and life with VHD, the effort of learning for life with VHD, and the maximisation of resources for the management of life with VHD. All of these themes indicated difficulty of access of acceptable and affordable care and difficulty in involvement in health care and illness management. These findings suggest that health care structures, resource distribution and the way professionals interact and communicate are important factors in the health care experiences of individuals living with VHD. Health care services that are based on the principles of equity and balance of power between institutions and clients may support the development of appropriate health care services for all individuals. Culturally-based narrative research is recommended to increase the possibility of expanding ways of knowing with the inclusion of a range of points of views for understanding health care provision. This knowledge is necessary for the development of client-centred and community-based health care services to improve health care outcomes for the rural population in Thailand.
The Fijian Diploma of Nursing curriculum : an indigenous case study of a curriculum change : 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, 2011) Vudiniabola, Alisi Talatoka; Vudiniabola, Alisi Talatoka
This thesis explores an educational change process in Fiji and used a case study methodology to examine the introduction of the 2004 Diploma of Nursing programme in the Fiji School of Nursing. The three-year competency based curriculum was developed and funded by the Australian government through the Fiji Health Sector Improvement Project (FHSIP) with limited participation of the local teachers at the Fiji School of Nursing. Many problems beset the programme, beginning with its rushed implementation at the end of an academic year and the incompleteness of the curriculum document. Teachers questioned the quality and nature of the competency based curriculum, and the absence of many supportive networks and resources to facilitate curriculum change. The majority of the staff did not understand the competency-based nature of the curriculum and its requirements. Using the vanua indigenous research framework and Fullan’s educational change theory to guide and inform the case study, qualitative methods of data collection and analysis were employed, including documentary analysis, participant observations and interviews. Talanoa, a culturally appropriate method of data collection for Pasifika people was used in both individual and group interviews. The research found indigenous nurses continue to be colonised and made to reproduce western ideologies and nursing values, perpetuated by the use of external educational aid and expertise. The execution of the curriculum project and the decision-making flowed from the Ministry of Health down to the Fiji School of Nursing, without consultation with the school’s staff, reflecting the former colonial administration where such a top-down approach was acceptable. Neo-colonialism is therefore regarded as the dominant paradigm where indigenous nursing leaders emulated the dominant behaviour of their former colonisers on their fellow indigenous subordinates. Moreover, it is argued here that foreign-influenced curricula continued to produce nurses who are not adequately prepared to care for the indigenous Fijians, and contributed to the attrition of Fijian nurses to countries whose values underpin the curriculum.
Food choices and feeding patterns for women and infants in rural northern Thailand : an ethnographic study : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University
(Massey University, 1992) Ratanawadee Boonyaprapa
The question for this study arose from the situation that malnutrition remains one of the major health problems among Thai children, particularly the under-fives. The purpose of it was to develop better understanding as to what sustains beliefs and practices associated with infant nutrition. An ethnographic approach was chosen as the research method. One rural village in northern Thailand was selected as the site of fieldwork for a period of 10 months. Data were collected through participant observation, interview, and ethnographic records. Key informants were 18 pregnant women and mothers of the under-twos. General informants were elderly kinswomen, fathers of the under-twos, volunteer health workers and community health workers. From the data it can be argued that what each woman does with regard to her own nutrition during pregnancy and following childbirth and the feeding pattern that she adopts for her infant are the outcomes of interplay between a complex network of cultural, social, personal and situational factors. These act and interact as pushes and pulls in a woman's decision making, frequently conflicting. Four main sources of pushes and pulls are: traditional beliefs; personal factors including attitudes, feelings, needs and experiences; sociocultural situations and changes; and government health services. If nursing interventions aimed at promoting a well nourished woman and a well nourished child are to be effective, nurses must be aware of these multiple influences. The conceptual account generated from the findings of this study has potential value for nursing practice, education and research. It identifies the aspects amenable to change by nurses and other health workers in their work to counter malnutrition situation, and so to improve the health of mothers and children.
From experiencing social disgust to passing as normal : self-care processes among Thai people suffering from AIDS : a thesis presented in fulfillment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Palmerston North, New Zealand
(Massey University, 2008) Siriwatanamethanon, Jirapa
AIDS is a chronic disease that seriously affects health, emotions, social relations and household economy. People living with HIV/AIDS experience great suffering, stigmatisation and discrimination from other people around them because they know that it is incurable, contagious, evokes social disgust and is a complex disease requiring life-long self-care. This researcher explored ways people with HIV/AIDS take care of their health and manage their lives in the context of stigma and discrimination. A grounded theory study was conducted with 30 participants with HIV/AIDS, in Mahasarakham Province, Thailand. Participants were recruited from an HIV/AIDS day care clinic and by snowball sampling. Data were gathered through in-depth interviews, participant observations and field notes made during home visits. Interviews were tape recorded, then transcribed verbatim. “From experiencing social disgust to passing as normal” was generated inductively from the data as the basic social psychological process of Thai people living with HIV/AIDS. From experiencing social disgust to passing as normal comprised four categories: being HIV/AIDS, making choices, keeping well and feeling empowered. The category “being HIV/AIDS”- discovering the meaning of having HIV/AIDS, comprises four concepts: being diagnosed with HIV/AIDS, being stigmatised, suffering, and learning about HIV/AIDS. The category “making choices”- to live a normal life, involves three concepts: avoiding unhappy situations, getting remarried and seeking support. The category “keeping well”- maintaining emotional and physical health, includes eight concepts: religious practices, keeping a cheerful mind, self-treatment, taking care of the body, keeping the environment clean to prevent getting germs, healthy behaviours, getting healthcare services, and attention to, and concern about, medication. The last category “feeling empowered”- personal and social acceptance of illness, includes eight concepts: being encouraged, acknowledging the disease, social acceptance, tamjai, feeling proud of self, feeling good about life, feeling lucky and having hope. In the context of northeastern Thailand, successful management of HIV/AIDS was underpinned by participants making a transition from “experiencing social disgust” to “passing as normal” within their communities. The desire to live a normal life despite having HIV/AIDS motivated participants to undertake effective self-care in order to remain symptom free (thus avoiding visible signs of the disease), and to selectively disclose their illness to avoid the ongoing risk of stigma and discrimination. The findings of this study are useful in that they will provide Thai health professionals with a clearer conceptualisation of self-care among the Thai population. An inductively derived theory of self-care among Thai with HIV/AIDS can be applied and integrated by health professionals into the self-care models for people living with HIV/AIDS including models used in nursing education, research and practice.
He iwi ke koutou, he iwi ke matou, engari i tenei wa, tatou, tatou e = You are different, we are different, but we are able to work together : Family Partnership as a model for cultural responsiveness in a Well Child context : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University, Albany, New Zealand
(Massey University, 2013) Tipa, Zoe Kristen
In 2006 the Royal New Zealand Plunket Society embraced a model of communication and practice titled Family Partnership. The Family Partnership model and training is designed to develop the communication skills of professionals working with families in order to acknowledge and enhance the capabilities of parents. It is acknowledged that the degree to which a service is culturally safe is defined by the individual receiving the service. Nurse leaders, educators and peers are consistently required to make judgements as to the extent to which the nurse being observed is culturally safe, without obtaining client feedback. This research examined whether the Family Partnership model could be considered a model for cultural responsiveness with the dual benefit of providing a platform to more accurately assess the cultural competence of Plunket nurse practice. An evaluation design and methodology was used to determine the relationship between Family Partnership training for Plunket nurses in relation to Māori health outcomes. There were two phases in the data collection process. In phase one an online survey was completed by a group of Plunket nurses who had completed Family Partnership training along with a group that had not completed Family Partnership training. Phase two included ten observations and interviews with Plunket nurses and Plunket clients who identified as Māori. A combination of evaluation tables to determine merit and thematic analysis were used for the analysis of the mixed methods data. The results were presented in three sections relating to Plunket nurse practice, client experience and the impact on Plunket as an organisation. All Plunket nurses who participated in the research believed that Family Partnership had a positive impact on their clinical practice. The extent to which their practice had changed was difficult to determine, however the need for ongoing updates in Family Partnership was strongly indicated. Māori Plunket clients were generally satisfied with the Plunket service and their responses aligned with the concepts outlined in Family Partnership communication theory. The relationship between the findings and the principles of the Treaty of Waitangi were highlighted. This research has indicated that cultural responsiveness can be defined as the way in which a service identifies and attempts to meet the needs of the individual. It has discussed the complexity around what constitutes a health outcome for Māori clients and ultimately how cultural competence may be better assessed in practice.
The health status of Māori nursing students : a cross-sectional survey : a thesis in partial fulfilment of the requirements for the degree of Masters of Philosophy in Nursing at Massey University, Albany, New Zealand
(Massey University, 2009) Panapa, Shahana
In New Zealand Maori are less likely to engage in tertiary level education and less likely to complete a tertiary level qualification than non Maori. These issues of recruitment and retention are reflected in other areas for Maori such as health, where Maori have worse levels of health Maori are more likely to have lower socioeconomic status. The initial findings of recent research indicate that Maori nursing students find it a struggle to remain on the Bachelor of Health Science in nursing degree programme. This study is designed to explore further what might be occurring for Maori nursing students by obtaining a snapshot of their health. Aim: To describe the health status of Maori nursing students. Participants: 75 nursing students undertaking nursing degree programmes in New Zealand, who identified as Maori. Method: A cross-sectional survey was undertaken with Maori nursing students completing nursing degrees from thirteen of sixteen tertiary institutions in New Zealand. Instrument: A questionnaire comprising demographic data, SF-36, and two cultural questions was used for students to self assess their health status. Participants were also invited to write relevant comments on the survey. Findings: Descriptive statistical data revealed participants with a stronger cultural identity as Maori were more likely to have their cultural needs met whilst studying compared to participants with a weaker Maori cultural identity. Participants in a relationship had more income than those who were not in a relationship. Participants’ overall health was worse than one year prior and their physical health was better than their mental health. More specifically, for physical health, general health, tiredness and lack of vitality were most affected, while roles and relationships were most affected for mental health. Implications: Institutions providing cultural support and kaupapa Maori programmes may assist in improving the recruitment and retention of Maori in nursing programmes. These results revealed a snapshot picture of the health 3 status of Maori nursing students and identified issues around their health status which is consistent with the literature.

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