School of Health and Social Services

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The nursed passage : a theoretical framework for the nurse-patient partnership : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University
(Massey University, 1988) Christensen, Judith C.
This study focused on nursing in action. The research goal was to identify nursing-relevant dimensions within a person's experience of being a hospital patient undergoing elective surgery. In order to discover and conceptualise the underlying processes which are present as patients are nursed through this experience, an open question was posed - What is happening here? A qualitative research method was the most appropriate means of discovering an answer to this question. The particular method chosen was the grounded theory approach developed by Glaser and Strauss. Data were collected in five surgical wards of a large city hospital over a period of five months. The research participants were twenty-one patients and the nurses involved in their care. Primary sources of data were interviews and the nursing records. These were augmented by field notes and accounts of observed incidents relating to the care of each patient. Using the inductive strategies of the grounded theory method, numerous descriptive concepts were generated during data analysis. These were ordered within an integrating social process derived from anthropology. By this means a grounded theory in the form of a theoretical framework - the Nursed Passage - was developed. Within this passage the patient is the passagee and nursing is translated into action through the agency of the nurse. The Nursed Passage is a patterned partnership with three key elements. Firstly, the temporal element, characterised by ongoing movement and constant change, is conveyed in the sequence of phases or stages. Secondly, the participative element is portrayed as a patterned relationship in which both nurse and patient are actively involved in progressing the patient through the passage. Finally, the contextual element recognises complex factors within the nursing environment which have an impact on the shape of the relationship between patient and nurse. This theoretical framework, generated from the reality of nursing as it occurs in one setting, assigns a specific shape to the encounter between nurse and patient. It identifies the contribution nursing alone can make to optimise each patient's hospital experience. In this way it both complements and facilitates the work of medical and other colleagues with whom nurses work. Thus, it serves to revalue nursing in terms that can maximally utilise the registered nurse's knowledge and skill for the benefit of all concerned, but particularly the patient and the nurse. Consequently, it has potential value for nursing practice, education and research.
The restructuring of the Department of Social Welfare and implications for social work practice, 1986-1988 : a dissertation presented in partial fulfillment for the requirements of a Doctorate in Philosophy at Massey University
(Massey University, 1990) Barretta-Herman, Angeline
This exploratory study analysed changes in the practice of social work in the Department of Social Welfare which occurred as a consequence of the Department's restructuring in 1986. This restructuring introduced major changes in management, service delivery, and the provision of culturally appropriate social services. It was proposed that changes in the practice of social work were related to wider economic, political and social debates regarding the viability and effectiveness of New Zealand's social services. These debates were interpreted as indicating a significant shift from policies derived from a welfare state model of provision to a welfare society model of social service delivery. A multi-leveled analytical framework was used to examine issues of policy, organization and professional practice. Three qualitative techniques were used to generate the data reported in the dissertation: documents published during the period 1969 - 1988; a structured interview schedule completed with both managers and social workers; and, finally, participant observation in two District Offices of the Department. Findings from this exploratory study provided general support for the shift in policy from a state funded, centrally directed model of service provision, to a pluralistic model that altered the role of the state and was intended to increase the involvement of community - based voluntary services. Within this shift, it was shown that during the 1986 - 1988 period, the Department's role became increasingly concerned with funding, monitoring and evaluating services. Biculturalism and the needs of Maori were shown to be critical factors in these shifts. The practice of social work within the Department of Social Welfare also became more limited and more specialised and its professional identity was altered by the changed organizational emphasis and the requirements of the Department. Several avenues for further research were delineated. Prospects for the future practice of social work sketched in the context of ongoing change within the Department were identified.
From rocking the cradle to rocking the system : women, community work and social change in Aotearoa : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy, Department of Social Policy and Social Work, Massey University
(Massey University, 1991) Craig, Wendy
This dissertation explores women's involvement in community work in Aotearoa. It is argued that women's significant contributions to community work have been hidden, devalued or ignored in mainstream writing and teaching. This study documents women's experiences and their perceptions of these experiences; such stories which are very seldom told. It also focusses on an explanation of social change from the perspective of women community workers. These women view community work as a site of struggle for change, through the processes of empowerment, self-determination and working collectively. Sixteen women, eight Maori and eight pakeha, participated in this study. These women have been identified as change agents and throughout their stories they constantly link their daily experiences to national, global and structural issues. All of the women have made a commitment to working towards change. This commitment has not always been been without cost to themselves and to their families. Although the changes that the women have achieved can, at times, be seen as reformist in nature, it is argued that as women's community work challenges the practices of the state, it contributes to social change processes. The approach taken is informed by my socialist feminist perspective. Issues pertaining to gender, race and, to some extent, class are considered in this thesis.. The study concludes that future theorising about community work in Aotearoa, must, of necessity show, more effectively how gender, race and class are interrelated. The differences between the Maori and pakeha women's stories indicate that gender cannot be examined in isolation from race. The existence of gender, as a category, is shaped also by other relations such as race and class. In articulating their struggles for change, the women reveal that there is much to be learned about the politics of caring. The women recognise that they have been trained to be the caregivers in society. For these women, however, caring plays an important role in the social change process. Their approach is based on an empowering model rather than a dependency one. Yet, whilst the women celebrate their own capacities related to caring, they are also concerned that men stand back from, and even devalue, this essential role which enables society to function. Thus community work is frequently conceptualised as women's work, and the women have to struggle to be recognised and paid for it. This thesis also shows that, despite the differences between the Maori and pakeha women, their relationship is generally co-operative and the potential for them to learn from one another exists. Through their collective involvement in the Aotearoa Community Workers Association the women have found ways to work towards a partnership which is based on an understanding of the rights of Maori as the indigenous people of Aotearoa. This research serves as a celebration of the women's experiences and knowledge of community work in Aotearoa. It is documented in a way that other women community workers can use to reflect on their own work. The challenge of any research and action is to not only record people's experiences, but also to use our knowledge, both written and oral, to provide an explanation of our current reality in order to , if necessary, change this reality. This dissertation, as part of a social process, has attempted to achieve this aim.
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.
Pain as embodied experience : a phenomenological study of clinically inflicted pain in adult patients : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University
(Massey University, 1991) Madjar, Irena
This phenomenological study describes the lived experience of pain inflicted in the context of medically prescribed treatment, explores the meanings of such pain for patients who endured it and for nurses whose actions contributed to its generation, and presents a thematic description of the phenomenon of clinically inflicted pain. The study is informed by phenomenology, both in terms of its premises and orientation, and its research design and method. The participants in the study were 14 adult patients, admitted to hospital following burn injuries, or receiving intravenous chemotherapy upon diagnosis of cancer, and 20 nurses involved in their care. Data collection took place over a period of five months and included participant observation and compilation of field notes, and a total of 89 tape-recorded interviews (48 with patients and 41 with nurses). Through the process of hermeneutic interpretation a number of themes were identified and used to describe the phenomenon of clinically inflicted pain and the structure of the lived experience of the patients and nurses concerned. The phenomenon of clinically inflicted pain is described in terms of four related themes: 1) the hurt and painfulness of inflicted pain; 2) handing one's body over to others; 3) the expectation and experience of being wounded, and 4) restraining the body and the voice. These themes point to the embodied nature of pain experience and the extent to which the person is involved not only in the enduring of pain but also in its generation. The broader lifeworld of clinically inflicted pain involves patients in the experience of constituting such pain, often as punishment and almost always as something unavoidable, and in turn being constituted by their experiences in terms of losing and seeking to regain a sense of embodied self and of personal situation, and by changed experiences of lived space and lived time. Nurses who themselves helped to generate pain, frequently overlooked the patient's lived exerience and thus the essential nature of inflicted pain as painful, wounding, and demanding cooperation and composure from the patient. Instead, the pain frequently became invisible to nurses involved in its infliction, or when it could not be overlooked or ignored, it was perceived as inevitable, non-harmful, and even as beneficial to patients' recovery. The strategic responses that nurses adopted to pain infliction included detachment from the perceived impact and consequences of their own actions and objectification of the person in pain as a body-object on whom certain tasks had to be performed. An alternative to the strategy of detachment and objectification was involvement in a therapeutic partnership between the nurse and the patient, where shared control over pain infliction and relief helped to sustain trust in the relationship and preserve personal integrity of the patient and the nurse. The study points to dangers for both patients and nurses when clinically inflicted pain is ignored, overlooked, or treated with detachment. It also points a way toward nursing practice that is guided by thoughtfulness and sensitivity to patients' lived experience, and awareness of freedom and responsibility inherent in nursing actions, including those involved in inflicting and relieving pain. The study raises questions about nurses' knowledge, attitudes, and actions in relation to clinically inflicted pain, and highlights the need for nursing education and practice to consider the contribution of a phenomenological perspective to the understanding of human experience of pain, and the nursing role in its generation, prevention, and relief.
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.
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 job creation to training, 1840-1990 : a descriptive analysis of the development and demise of job creation policy as the mainstay of state responses to unemployment in New Zealand : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Social Policy at Massey University, Palmerston North, New Zealand
(Massey University, 1994) Mulengu, Andrew Punabantu
New Zealand, for much of the present century has been regarded by other English speaking nations as boldly experimenting in the development of social policy; but is currently taking the dismantling of the welfare state further than most western countries. This thesis provides a historical analysis of job creation for the unemployed, which was provided by the state on a relatively large scale (relative to the size of the New Zealand population), from the earliest days of colonisation in the 1840s until it was virtually phased out inthe mid-1980s. The thesis examines the competing ideas and interests which conditioned the adoption, growth, fluctuations in the eventual demise of job creation as the mainstay of the New Zealand state's responses to unemployment. In particular, it examines the impact of the various sets of ideas about work and human nature which were brought to New Zealand in the course of colonisation by the British; and the extent to which the colonisers were able to recreate patterns of work and dependency from Britain. The study of job creation in New Zealand is a history of conflict based on class interests. One task of the thesis is to show how the state has responded in different periods to demands from working men for the 'right to work'. However, it is also a history of the reinforcing of ancient divisions of labour along lines of gender and ethnicity, and of the relative privileging of 'pakeha' (white, European) men in terms of their access to paid work provided by the state. Job creation for the unemployed has been a site of both conflict and compromise between (mainly male) labour and capital throughout the post-colonisation period in New Zealand. This thesis provides an in-depth study of the ways in which such conflict and compromise contributed to the development, form and eventual demise of job creation in New Zealand.
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.
Schizophrenia, a way of being-in-the-world : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University
(Massey University, 1995) Walton, Jo Ann; Walton, Jo Ann
This phenomenological study describes what it is like to live with a schizophrenic illness and relates the understanding gained from this descripton to implications for nursing practice. The participants in the study were ten adults who have been diagnosed with schizophrenia, who take regular medication and who are living independent lives in the community. Over a period of sixteen months they were interviewed about the effects of the illness on their everyday lives. During this time they explained the challenges and difficulties which have faced them, both during and long after the resolution of acute illness. As they describe it, schizophrenia is a part of who they are. The narrative contained in this thesis presents the participants' stories in aggregated form, setting their experiences alongside ideas from the early work of Martin Heidegger, whose phenomenological writing informed the analysis and interpretation of the data. As the participants explain, schizophrenia has touched every aspect of their lives. Living with schizophrenia is shown to affect their whole Being-in-the-world. It incorporates Being-with-others, living carefully and taking a stand on life. While hoping for a cure, their reality is of living with a chronic illness which has major effects on their lives. At the same time the participants are shown to define themselves not in terms of their illness and treatment, but in respect of their hopes and dreams and the stance each is taking on his or her own life. In this way their existential predicament is highlighted in the study. Participants are on the one hand very much like all other people, while on the other hand they have to contend with very different concerns than do most others. In itself the description of the experience of schizophrenia contained in the thesis is useful for its potential to increase understanding of the illness by nurses and other health professionals. Further than this, however, the study is shown to have implications in terms of nursing practice and the provision of health care. With regard to the seriously mentally ill the data bring into question some of the theoretical positions which have held sway in nursing for many years. The research demonstrates that it is practicable to attend to the subjective experiences of people who suffer from schizophrenia and to understand their needs and desires from the position of fellow human being, without the need for a guiding theory from which to interpret what they are saying or what their words "really mean." It is argued that relationships between nurses and clients which are based on understanding and trust rather than distance hold promise in the care of those with schizophrenia. Heidegger's concept of solicitude as care for others is addressed in this regard, and is shown to be most appropriate as a basis for nursing care in the mental health arena.
Reclaiming the last rites (rights) : women and after-death policy, practices and beliefs in Aotearoa/New Zealand : 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
(Massey University, 1995) Hera, Jean
This thesis develops an ecofeminist analysis of women's roles in after-death work and ritual in Aotearoa/New Zealand. The thesis describes and analyses the male takeover, and accompanying professionalization of death which has removed death out of the hands of the lay women in the family and community who previously held this role, and which has removed dying, death and after-death practices and ritual out of the home and into the institution. A bicultural emphasis has been adopted for this research into death which involves Maori, the first nation tribal peoples of Aotearoa/New Zealand and Pakeha, people of European (particularly British) descent who have colonized Aotearoa. The thesis examines both the differing and related experiences of Maori and Pakeha in relation to changing and evolving after-death policy, practices and beliefs in Aotearoa/New Zealand. It also considers the value of after-death experiences in the home and in the community and the choices and restrictions of today that relate to this. A triangulation of research methods is used: public records research to produce an historical social policy analysis of death, the action research of the Palmerston North Women's Homedeath Support Group which is an initiative to demystify and reclaim after-death knowledge and choices, and eighteen in-depth interviews which provide women's stories of their after-death experiences. The research aims to contribute to a process which seeks to demystify death and assist women and the wider community to reclaim control over the last rites (rights).
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]
From unconscious to self-conscious : cognitive rehabilitation from the perspective of symbolic interactionism : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Social Policy and Social Work at Massey University
(Massey University, 1996) Sutherland, Deborah
There is increasing awareness and concern that psychosocial problems prevent people with brain damage reestablishing an acceptable quality of life. Changes in perception and cognition appear to alter a person's relationships, preventing a successful reintegration into the community. As a result, many researchers and rehabilitation practitioners have been calling for more holistic models of recovery which recognise the psychosocial domain and which offer strategies to counteract these problems. In this study, the principles of symbolic interactionism are used to explore the experience of four people with traumatic brain injury. A life history was collected for each person and the four life histories were examined for common patterns and themes. A videocamera was then used to record their daily life in a residential rehabilitation programme. The film collected included formal one-to-one therapy sessions, group situations and informal interaction in the living areas, dining room and passageways etc. The four people (and also those with whom they interacted) were shown selected excerpts from this film and interviewed about what was happening. Several common themes emerged from this process and these themes are examined within a theoretical framework which recognises the central role of a dual, interacting and interpreting self, creating meaning through an adapting and accommodating process. Theory and literature about brain damage and about inner brain processes is revisited from this perspective of the person as a meaning negotiator and some conclusions are reached about the impact of brain damage upon lived experience. In particular, the role of a moral self or an inner conjured audience is considered, as well as the role of emotional intersubjectivity within relationships. Some new insights are offered as to how people resolve the problem of continuing to interact with their world when it is difficult for them to make sense of it or interpret it, and how other people's responses influence this process. The findings of the research suggest adaptations to both settings and relationships may be necessary for a successful recovery after brain injury. The importance of providing scaffolding of the meaning-negotiating process during a liminal period of recovery is noted. Some suggestions are offered as to interactive strategies which foster adaptive, purposeful and independent lifestyles. The thesis concludes that because realities are created through interaction, the principles of symbolic interactionism should become more central in the designing of rehabilitation programmes.
From the ward to the home : caring for a family member diagnosed with schizophrenia in New Zealand : this thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Social Policy and Social Work at Massey University
(Massey University, 1996) Richards-Ward, Leigh Anne; Richards-Ward, Leigh Anne
The research question examined in this thesis is: 'What are the characteristics and complexities of the informal care provided within a family to a member diagnosed with schizophrenia, in New Zealand? This research question is divided into two parts. The first part examines the characteristics and complexities of the unpaid caring work provided to a family member diagnosed with schizophrenia and the second part explores how this care provision is influenced by the social, political, cultural, legal and economic context of New Zealand. This research is important because first, very little is known about the process and interpretation of care provided to a family member diagnosed with schizophrenia and second, New Zealand places great emphasis upon deinstitutionalisation and community care. Ten women and four of their husbands were invited to participate in this research. These women were the primary informal care-givers of a family member who had experienced the cyclical acute and chronic episodes of schizophrenia. The women's husbands filled a secondary supporting role in relation to the women. The women met to identify themes related to their informal care provision. These themes were translated into an interview guide which acted as a prompt for the researcher while the women and men were articulating their stories of care-giving. Foremost amongst the findings of this research was that the dominant understandings of care should be extended in order to reflect the informal care provided to a family member diagnosed with schizophrenia. The men supported the women's care provision which reflected their family member's unpredictable, changeable and cyclical symptoms of schizophrenia. It was characterised by the primacy of supervision and monitoring and was provided on a continual (flat-line) basis. It was also established that the women were finding it increasingly difficult to meet their informal caring responsibilities, these responsibilities being increased and extended by the Government's actions to reduce both state expenditure and state caring responsibilities. The difficulty the women were experiencing in meeting the complex and changing care needs of their family member indicated that a continuum of care needs to be provided. It is argued that a continuum of care will need to include early intervention services, a range of community-based and institutionally-based mental health services, and a review of the definition of 'mentally disordered' contained within the Mental Health (Compulsory Assessment and Treatment) Act 1992. In order to coordinate and provide such a continuum of care, state, community and family caring responsibilities need to be combined, these three caring agents working collaboratively.
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.
Male breadwinner households and work : alterations in the transition to a liberal welfare regime : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Social Policy at Massey University, Palmerston North, New Zealand
(Massey University, 1997) Barrett, Patrick Neville
This thesis examines how the nexus between households and work in New Zealand has been altered by the transition from a wage earner cum social expenditure welfare regime to a liberal welfare regime. The proposition that welfare regimes are characterised by distinctive institutional arrangements and labour market outcomes is explored at the micro-level through household life and work histories. Life and work history data from a small number of Palmerston North male breadwinner households was used to examine the way individuals' lives have been affected by the institutional context at distinctive historical epochs. The thesis discusses the implications for household labour market activity and experience in each regime. Strong cultural and normative continuities are noted despite the trend towards dual earner households. Variation in the potential for labour market mobility across regimes is observed in terms of changing opportunities for skill acquisition. Change in the experience of unemployment and subsequent labour supply responses is examined. Increasing employment insecurity is found to be an outcome of increasing risk of job loss, declining levels of input into jobs and declining levels of protection from adversity in employment relationship. With fewer employment opportunities in the liberal regime, yet with increasing welfare selectivism, the nexus between households and work is found to be characterised by a greater level of income necessity. Households' responses include the supply of "additional" labour - an added-worker effect - whereby they take whatever work can be found, often lower paid and with poor conditions. The examination at the micro-level of how household labour market activity and experience had been altered by the transition to the liberal regime was found to enhance the understanding of change in the interface between work and welfare.
Enabling participation through partnership : emancipatory research : the potential for change for disabled people : 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
(Massey University, 1998) Boyles, Pauline; Boyles, Pauline
This thesis presents an example of emancipatory research used within the field of disability studies. It argues that research can be conducted in a way which more directly addresses the needs of disabled people and involves them in its design and delivery. The key questions examine the role of emancipatory research in enabling disabled people to take control of their lives and to accomplish change in their immediate environment. Secondary questions explore the contribution of critical theorists Brian Fay and Stuart Rees in informing a model of emancipatory research and their work has been adapted to act as a framework for the thesis. The challenges researchers face when embarking on this type of research are confronted in a realistic and constructive way. It is argued that the achievement of a definition of 'emancipatory' more often depends on the attitudes and values of the researcher and the resulting impact on those whose lives are central to the research. The thesis describes how a group of twelve disabled students formed the Disability Action Research Group (DARG), identified some goals for change in their immediate environment and subsequently developed a disability equity training package to be delivered to the staff of Victoria University. The journey from action research group to the development of a training group with a legal status instigated by the students of DARG is presented, offering some landmarks for others wishing to engage in similar activities.. The key theme of partnership represents the potential for alliances between disabled people as well as with their nondisabled allies. "Enabling participation through partnership" underpins every aspect of this thesis and reflects its fundamental principles.
Evaluation of the "contact-challenge method" in social work practice education : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy at Massey University, Albany, Auckland, New Zealand
(Massey University, 1998) Napan, Ksenija; Napan, Ksenija
This thesis examines the importance of integrating theory, practice and experience which is considered to be essential for effective social work education. We live in a globally interconnected world and a holistic and ecological worldview has been utilised to explore relevant theories as well as research in order to develop a method of teaching and learning which attempts to continually improve social work education. Two studies were conducted in order to evaluate and further improve the Contact-Challenge Method. The main aim of the method is to utilise the personal experiences of students, their communication with social work clients, skills training and field work experience in order to help them better integrate theories learnt during social work education. Action research has been used as a research method for evaluation and further development of the Contact-Challenge Method because of its participatory and empowering nature. It is argued that education, social work and research are inevitably value laden and that social work students need to examine their own value base in order to develop a value base for effective social work. It is also argued that social work education has to reflect those values, which arc prescribed by the Code of Ethics of the profession. Learning theory, skills training and the student's personal experience are equal elements of social work education. Values and principles that permeate social work practice should be utilised in the teaching-learning process of social work. The Contact-Challenge Method evaluated in this thesis is focused on modelling social work values and on maximising student-student learning as well as learning from clients and their families. Three theories have been used in the development of evaluation of this method: Experiential Learning Theory, Choice Theory and Adult Learning Theory (Andragogy). The principles and ideas of these three theories have been incorporated in the Contact-Challenge Method and have been carried through in practice in both studies, in Croatia and in Aotearoa- New Zealand. Research into student learning and motivation as well as on the transfer of skills learned in laboratory settings to practice, provided valuable findings that helped in the development and evaluation of the Contact-Challenge Method. Throughout the thesis learning is understood to be a holistic process. In both studies students learned on many levels using cognition, emotions, prior experiences and their theoretical knowledge. Social work education has the advantage that students may learn simultaneously about content and process. Students were expected to take responsibility for their own learning and for creating quality time with their clients. This contributed to the effective integration of theory, practice and experience and to the utilisation of problem solving processes in order to attain learning outcomes set at the beginning of the course. The basic assumptions of this thesis are that: Social work clients and social work practitioners are irreplaceable source of knowledge and practice wisdom for social work students. Setting individual outcomes in the process of learning encourages students to take charge of their own learning. Focusing only on intellectual work in social work schools and only on practical work in social work practice placements cannot produce competent social workers. This thesis proposes an integrative approach to teaching and learning social work where theory, practice and experience are integrated in order to produce change in knowledge, skills, values and attitudes. At the same time it provides a context where students' individual learning outcomes can be achieved and the quality of life of social work clients can be improved.
People, policies and practice : social work education in Aotearoa/New Zealand from 1949-1995 : 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
(Massey University, 1998) Nash, Elizabeth Gillian Mary Amaryllis
This thesis is a case study of the history of social work education in Aotearoa/New Zealand between 1949, when the first professional course for social work was established, and 1995, when the social services Industry Training Organisation was formed. It traces influences responsible for shaping social work education. Key questions focus on the nature and provision of education for social workers, how this has changed over time and why. Three organisations (the New Zealand Association of Social Workers, the New Zealand Social Work Training Council and the New Zealand Council for Education and Training in the Social Services) had degrees of authority over policy making, setting standards, accrediting courses, or advising governments in matters relating to social work education. These provide a focal point for the research. Key people in the field of social and community work contributed their personal views and histories, adding depth to this account through their oral data. This history has been organised into three chronological periods. It is argued that in the earliest period social workers recognised their professional identity in a common pursuit. Later, they claimed professional autonomy, making efforts to consolidate it although state and employer interests were converging and distancing themselves from those of educators and the social work profession. Most recently, social work is diversifying and the fragmentation which is occuring reflects national and international economic and political systems. The reduction in state responsibility for the direct provision of welfare is shaping social service provision and education and national trends reflect the international scene. It is argued that people, policies and practice have each in their own way influenced the changes that have taken place in the provision and styles of social work education. This study has documented and discussed these influences (covert and overt) and the constraints affecting them. The implications for the future of social work education are inextricably intertwined with the delivery of social work services. Concerns are expressed over the directions currently being taken in both spheres.
Exploring personal and political issues of identity for white Maori women : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Social Policy and Social Work at Massey University
(Massey University, 1999) Bevan, Kelly
The aim of this research is to explore the personal and political issues of identity for white Maori women in Aotearoa. This was inspired by recognition that the lives of white Maori women are not accounted for in our present society. The life stories of eight women from multi-tribal backgrounds were gathered in semi-structured, in-depth interviews. My life story was written and incorporated both as a reason for conducting this research and as data. The focus of the study is on Maori women, which reflects my gender and cultural identity. Hence my Mana Wahine and Kaupapa Maori values influenced the methodology and theoretical concepts used to add meaning to the narratives. A desire to produce research which would empower and not further colonise those I was researching led me to utilise a structural analysis framework for the structure and analysis of the research. The strategy of 'researching back' was used to locate colonising aspects in the theoretical and historical literature. The design is qualitative, the method is kaupapa Maori and a strategy of multiple triangulation is used. I utilised storytelling in gathering data and content analysis to locate the narrative themes. The participants identify as tangata whenua. The findings support this chosen position and highlight the influential social, political and legislative factors which have shaped their identification processes.

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