Browsing by Author "Horrell, Barbara Mary"
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- ItemExploring informal caregivers' health needs from a capability perspective : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Manawatū, New Zealand(Massey University, 2015) Horrell, Barbara MaryDespite more than forty years of informal caregiving research, the health needs of informal caregivers continue to generate considerable scrutiny. Most commonly, caregiving is portrayed as burdensome and a health risk, although positive and ambivalent experiences have been reported. This study uses the Capability Approach (CA; e.g. Nussbaum, 2000; Sen, 1980) as a theoretical framework to add another perspective to the existing literature regarding informal care provision for older people. Participatory principles informed the research, insofar as the participants were accorded flexibility, control, and helped to co-analyse some of the data. Undertaken in New Zealand, the research comprised two studies. In Study One, 60 caregivers anonymously participated in an online research forum, in an evolving joint discussion of their health needs. Template analysis (King, 2012) of the forum postings, based on Nussbaum’s (2007) capabilities list, highlighted the relational nature of caregiving and the importance of emotions to the caregiving role. Emotional attachment influenced the caregivers’ freedom to choose how they lived their lives, and emotions in general were implicated in the complexities and tensions associated with the caregiving process. An important finding was the self-abnegation of the caregivers who neglected self-care in order to provide care for another. These results led to a second, prospective study that explored in more depth the role of emotions in the everyday lives of caregivers. Six informal caregivers participated in Study Two which involved up to six successive interviews with each participant. Four of the participants kept a solicited diary, which informed the subsequent interviews. Narratives from the second study provided more nuanced data that affirmed the first study’s findings, and contributed to the overall finding that an ethic of care underpins the provision of informal care for older people. The participants valued having the capability to care, evidenced by their emotional attachment, attentiveness and commitment to providing competent care. The participants approach to self-care and their own wellbeing was inseparable from the wellbeing of the person being cared-for. These findings have important implications for social policy aimed at improving the experience of providing informal care for older people.
- ItemTalking about end-of-life care for older people in a rural New Zealand community : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Palmerston North, New Zealand(Massey University, 2009) Horrell, Barbara MaryRural experiences are under-represented in the end-of-life care literature. In addition, population projections indicate that the numbers of older rural people are increasing. In an attempt to better understand their needs, this study considers how older people experience end-of-life (EOL) care in a rural New Zealand setting. Having responded to local media and community notices, seven participants, who in the last eighteen months had cared for someone over the age of 65 with a terminal illness, spoke about their experience of rural EOL care. Their stories were then transcribed and analysed, using narrative analysis. Participants spoke about similar issues, but from different, sometimes conflicting, perspectives. Positioning themselves primarily as carers, rather than as rural people, the participants’ stories nevertheless reflected their social location for caring, as they talked about exhaustion and needing 24 hour support; limited access to specialist palliative care services; and the difficulties of caring for people with complex needs. At the same time they spoke of the joys and rewards of caring. The ambivalence and conflict evident in the stories indicates the participants’ location in a particular place and time in the history of dying. Caught between two paradigms of care, these participants vacillate between the desire for the empathic, compassionate care of yesteryear and the best that modern medical technology can offer. Discussing when to continue and when to stop medical intervention produced the most conflicting perspectives. However, all agreed that having time to form therapeutic relationships is a key component of EOL care. Overall, the stories demonstrate that the multiple and complex experiences of older rural people render stereotypical assumptions about rural life and dying at home problematic. However, as this study demonstrates, simply talking with people provides access to and understanding of their lived realities. Incorporating this kind of approach in future rural EOL care planning will move us closer to achieving contemporary goals of positive ageing and dying well.