Browsing by Author "Wilkinson, Jillian Ann"

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    A mantle of protection? : a critical analysis of the personal safety of district nurses : a thesis presented in partial fulfilment for the degree of Master of Arts in Nursing at Massey University
    (Massey University, 2001) Wilkinson, Jillian Ann
    This qualitative inquiry, informed by Critical Social Theory, explored the personal safety experiences of district nurses in a New Zealand city. While interest in workplace safety in New Zealand has been gaining momentum, there has been no formal research to date regarding the personal safety of district nurses. Studies by Beale, Fletcher, Leather and Cox (1998), Koch and Hudson (2000), and White (1999) have begun to address district nurses' experience and management of violence in the community but do not address the power issues implicit in the existence of the problem. The Critical Social Theory perspective that underpins this study aimed not only to initiate discussion about occupational safety for nurses working in the community, but paid critical attention to the power systems that are perpetuated by ensuring district nurses remain vulnerable and relatively powerless. It also explored the tolerance that nurses demonstrate for an unsafe working environment. District nurse participants recalled incidents in which they felt their personal safety was compromised. Data was collected from six district nurses using interviews based on the incident(s), in order to explore the ways in which personal safety of district nurses was compromised. Data was also collected from a focus group discussion with the participants. Analysis of the data suggests that nurses have modest expectations for their own safety and even these were circumscribed by institutional practices. The complex power relationships that shape the experience of nursing in a community impinged on the ability of the nurses in this study to confidently and safely fulfil their role. Recommendations emerging from the research are that issues of building security, access to client information, provision of cellphones and regular safety in-service require urgent attention. Attention must also be given to the development of institutional policy that prioritises nurse safety, and has in place post-incident plans and support structures.
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    The New Zealand nurse practitioner polemic : a discourse analysis : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing, Massey University, Wellington, New Zealand
    (Massey University, 2007) Wilkinson, Jillian Ann
    The purpose of this research has been to trace the development of the nurse practitioner role in New Zealand. Established in 2001, this advanced nursing practice role was birthed amid controversy as historical forces at play both inside and outside nursing struggled for power to control the future of the profession. Using a discourse analytical approach informed by the work of Michel Foucault, the study foregrounds the discourses that have constructed the nurse practitioner role within the New Zealand social and political context. Discourses, as explained by Foucault, are bodies of knowledge construed to be ‘truth’ and connected to power by reason of this assumption, serving to fix norms and making it virtually impossible to think outside them. Discourses of nursing and of medicine have established systems of disciplinary practices that produce nurses and physicians within defined role boundaries, not because of legislation, but because discourse has constructed certain rules. The nurse practitioner role transcends those boundaries and offers the possibility of a new and potentially more liberating identity for nurses and nursing. A plural approach of both textuality and discursivity was used to guide the analysis of texts chosen from published literature and from nine interviews conducted with individuals who have been influential in the unfolding of the nurse practitioner role. Both professionally and industrially and in academic and regulatory terms dating back to the Nurses Registration Act, 1901, the political discourses and disciplinary practices serving to position nurses in the health care sector and to represent nursing are examined. The play of these forces has created an interstice from which the nurse practitioner role in New Zealand could emerge. In combination with a new state regime of primary health care, the notion of an autonomous nursing profession in both practice and regulation has challenged medicine’s traditional right to surveillance of nursing practice. Through a kind of regulated freedom, the availability of assessment, diagnostic and prescribing practices within a nursing discourse signals a radical shift in how nursing can be represented. The nurse practitioner polemic has revolutionised the nursing subject, and may in turn lead to a qualitatively different health service.