Nursing and Midwifery

Permanent URI for this collectionhttps://mro.massey.ac.nz/handle/10179/1264

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Start date: 2000End date: 2009

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    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.
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    Safeguarding the practices of nursing : the lived experience of being-as preceptor to undergraduate student nurses in acute care settings : 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) Rummel, Louise G.
    An Heideggerian Hermeneutic approach has been adopted to explore the experience of being-as preceptor to undergraduate student nurses in the acute care setting. This thesis addresses the question: What is the experience of being a preceptor to undergraduate student nurses in an acute care setting? Fifteen preceptor-participants were interviewed twice, with each interview being approximately one hour. Heideggerian Hermeneutical Analysis was used to reveal the experience of preceptors as they precept undergraduate student nurses. The thesis begins by placing nursing education in an historical, socio-political and professional context that provides the background to current New Zealand nursing practice. Student nurses undergoing their nursing education learn the meaning of being a nurse in many different contexts. This research is situated in the acute care context where both preceptors and student nurses engage in the practice of nursing. The methodological background shapes the way the research is presented to explicate the meaning of being-as preceptor. The four data chapters reveal the preceptors' experience and open with dialogue showing how nurses become preceptors. This is followed by exploration of how preceptors assessed where the student was at, moves to preceptors promoting learning and closes with discussion of how preceptors keep students and patients safe. Many practices were uncovered during the revelations of the preceptors as they disclosed to the researcher narratives of their everyday practice world. Common themes that emerge from the data include: Becoming attuned- the call, The Emerging Identity of 'being-as' Preceptor: Keeping the student in mind, Assessing where the student is at: The Preceptor and Preceptee Working and Growing Together, and The Preceptor as Builder of Nursing Practice: Teaching Reality Nursing. A number of common themes support the relational themes which are of greater complexity. A constitutive pattern, the highest form of interpretation that emerges from the data, was Safeguarding the Practices of Nursing. This constitutive pattern lies within every text either directly or is inferred from each participant's dialogue. It contains the central meaning of the thesis. It is constituted from common and relational themes as they present themselves in the analytical process. In this thesis the experience of being-as preceptor is unveiled through the participants' own words as the researcher takes the reader back to the 'things themselves' as is espoused by hermeneutic phenomenology.
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    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.
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    On the margins: nurses and the intermittent care of people with dementia : a discourse analysis : 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) Gilmour, Jean Alison
    The purpose of this research has been to explore the representations and practices of nurses in the context of intermittent care for people with dementia, and to situate their accounts within the wider discourses of dementia care. Discourse, as explicated by Michel Foucault, is the body of knowledge, and the related disciplinary practices, that can be considered to be the truth at a particular time, shaping what is possible to be said, and with the associated power to exclude what cannot be said. In the first section of the thesis it is argued that the concept of dementia is not the description of some pre-determined biological phenomenon but a powerful disciplinary construction informed by a specific historical and cultural perspective, a construction that has major policy implications and ramifications for the representations of dementing illnesses in disciplines such as nursing. Section two of the thesis shifts from the disciplinary representations of dementia produced in published texts, to the representations and everyday practices of the nurses and families who participated in this study. While all the nurses' texts represented the care of the person with dementia as problematic, at times, in the institutional setting, there was considerable diversity apparent in nurses' discursive positionings, and in the associated practices and inscriptions of the person with dementia. The organisational context emerged as a major factor influencing those discursive choices and practices. One research site provided particularly successful respite care as judged by family caregivers' expressions of confidence in the service. The dominant nursing discourse in this site framed the hospital as home-like and the relationship with patients as being family-like. The permeability of social and geographic boundaries at this research site signaled inclusion for family and patients in contrast to the more traditional boundaries demarcating social and physical spaces evident in the other sites. This study highlights the institutional bases of powerful discourses such as biomedicine as well as the existence of alternative discourses. The marginal discourse of care as being family and home-like may lack the authority of biomedical and formal nursing discourses, situated as it were outside the academy, but space is provided in this representation to produce a social environment, and nursing practices, that encourage a sense of relationship and social inclusion for people with dementia and their family caregivers. Dementia has proved to be a fruitful area of study in that the current dominance of biomedical knowledge in nursing literature can be challenged as being marginal to nursing concerns. The subsequence discussion of how nurses have suppressed the knowledge and interests of people with dementia and, indeed, the knowledge of nurses themselves, provides a productive starting point for wider discussion about issues of power/knowledge in nursing representations generally.
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    "Linking as one" : an intimate breastfeeding moment : 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, 2001) Dignam, Denise Miriam
    Breastfeeding is more than the act of providing nutrition to an infant. It is a dynamic interpersonal process, frequently suggested by both women and authors to be an intimate activity. Health professionals have tended to explore the biophysical aspects of breastfeeding largely ignoring the breastfeeding woman's perspective and the effect social and psychological processes have on breastfeeding success. This grounded theory study drew on a range of data sources to describe breastfeeding womens' experience of intimacy. Data included interviews with twenty women participants, observational field notes, theoretical memos, drawings, literature and pictorial work. The study supported the premise that women experienced moments of intimacy when breastfeeding. Breastfeeding is represented in the basic social psychological process 'linking as one'. Linking as one is the intimate act of gifting, for comfort, pleasure and growth, human milk and human contact to a baby or child. 'Linking as one' is mutually exclusive and mutually satisfying to both participants. It is not all women's experience nor is it associated with every breastfeeding encounter. The findings support a substantive descriptive model of the breastfeeding process that represents and facilitates intimate breastfeeding moments. The model provides a framework for theoretical research, which may lead to further conceptual refinement. The model also provides a framework for education curricula and nursing clinical practice. Clinical application includes the use of concepts as prompts from which to explore interpersonal breastfeeding dynamics with breastfeeding clients. The concepts include breastfeeding comfort, ownership of the breast, mutual gifting and knowing. Exploration of these concepts may enable breastfeeding women to maintain and promote successful breastfeeding experiences.
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    Responding to the call to care : women's experience of breastfeeding in New Zealand : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Wellington, New Zealand
    (Massey University, 2004) McBride-Henry, Karen Sharee
    New Zealand breastfeeding experts have long contended that New Zealand does not have a breastfeeding culture, as demonstrated by anecdotal evidence suggesting that women find breastfeeding difficult to initiate and sustain. A review of the literature indicates that, in New Zealand, breastfeeding knowledge falls within the domain of health care professionals, which marginalises women's own experiential knowledge about breastfeeding. Therefore, this study explores the experience of breastfeeding for women in New Zealand. A reflective lifeworld research methodology underpins this study, allowing the participants' narratives to be explored without the use of pre-existing theoretical frameworks that may close down on aspects of the interpretive analysis. Nineteen women were interviewed for this study, all of whom were New Zealanders who were either breastfeeding at the time of the interviews, or had breastfed within the last two years. Many of the participants had breastfed more than one child. What emerges as the central thesis of this study is that breastfeeding is a priori to unique embodied experiences. A number of sub-themes, which further explicate this central thesis, include: the silencing of the reality of breastfeeding within the public domain, the pervasive influence of society, or 'the they', through the accepted frameworks by which breastfeeding women interpret their individual breastfeeding experiences, and breastfeeding as a means of facilitating close relationships between women and their infants. The findings of this study will assist health care professionals working alongside breastfeeding women, as it offers fresh understandings of what it is to be a breastfeeding woman. It is important that health care professionals lay aside their previously-held perceptions about breastfeeding, and pay careful attention to individual women's experiences prior to planning interventions. If health care professionals value women's embodied breastfeeding narratives, women will be supported to articulate their breastfeeding experiences, thereby increasing women's confidence in their embodied breastfeeding knowledge and capabilities
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    Parental resistance : mobile and transitory discourses : a discursive analysis of parental resistance towards medical treatment for a seriously ill child : 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, 2007) Woods, Martin
    This qualitative thesis uses discourse analysis to examine parental resistance towards medical treatment of critically ill children. It is an investigation of the 'mobile and transitory' discourses at play in instances of resistance between parents, physicians and nurses within health care institutions, and an examination of the consequences of resistance through providing alternative ways of perceiving and therefore understanding these disagreements. The philosophical perspectives, methodology and methods used in this thesis are underpinned by selected ideas taken from the works of Michel Foucault and Pierre Bourdieu and supported by relevant literature in the fields of media, law, children, parenting, caring, serious childhood illness, medicine and nursing. The thesis obtains information from a variety of texts that includes established literature (such as medical, sociological, legal, academic and philosophical), newspaper articles, radio or television interviews, internet sources, court reports and proceedings, legal experts and other commentators - and 15 interview based texts, where the focus is on analyses of narratives of parents, doctors and nurses. In the texts gathered for this thesis, there are noticeable differences between the personal experience discourses of parents, the 'in-between' discourses of nurses, and the disciplined discourses of physicians. This thesis brings these discourses into conversation with each other suggesting that parental resistance does not occur because of an infrequent and unusual set of circumstances where a few socially isolated and/or 'difficult' parents disagree with the treatment desires of paediatric physicians. Instead, it is argued that from an examination of interview based texts, parental resistance is an omnipresent but transitory occurrence that affects many of the interactions between the parents of seriously ill children and clinical staff. It is maintained that within these interactions, the seeds of this resistance are sown in both critical decision making situations and in everyday occurrences between doctors, nurses and parents within healthcare institutions. Contributing factors to parental resistance include the use of power games by staff, the language of medicine, forms of symbolic violence, the presence or absence of trust between parents and medical staff, the effects of medical habitus, and challenges to the parental role and identity. Overall, it is proposed in this thesis that parents who resist treatment for their seriously ill child are not exceptions to the normative patient-physician relationship. Instead an analysis of their discourses and practices is able to illuminate the complex interactions between patients and medical conventions. It is therefore possible to see parents who resist medical advice not as peripheral to the medical encounter but as examples of how patient-physician relationships come to be codified, constructed and crafted through everyday discourses and practices within health care settings.
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    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.
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    '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].
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    The mindful self : sense of self and health-promoting lifestyle behaviours among Thai college women : a thesis presented in fulfillment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, New Zealand
    (Massey University, 2007) Mongkhonsiri, Pitsini
    Wellness educators have faced a great challenge to develop strategies to move people toward the adoption of positive lifestyle behaviours. This research explores concepts of self and the impact of Thai culture on the motivation of young college women to engage in health-promoting lifestyle behaviours (HPLBs) in the context of northeastern Thailand. A sequential mixed methods design enables an exploration of the relationships among sense of coherence, identity status, and HPLBs in the first phase, and an inductive analysis of the impact of Thai cultural context in the second phase. In study A, three instruments: the Health-Promoting Lifestyle Behaviors Profile II (HPLP II), the Extended Version of the Objective Measure of Ego Identity Status (EOM-EIS), and the Orientation to Life Questionnaire (SOC-29), were used with 350 senior college women. Sense of Coherence was significantly correlated with achieving a sense of identity, lessening diffusion identity and engaging in health-promoting behaviours. Although a considerable proportion of the variance (26.7 %) for engaging in HPLBs was accounted for by SOC, identity achievement, and identity moratorium, the magnitude of the unexplained variance was considerable. This led to inductive exploration of other variables influencing HPLBs in Study B. By data-driven thematic analysis, the Model of the Mindful Self emerged from in-depth interviews with 25 college women. The model describes three main themes: (a) the cultural background and the surrounding ongoing influences which impact on the development of Thai women's sense of self and their health-related behaviours, (b) the sense of self and identity formation in the Thai context, and (c) the health-related behaviours that stem from the sense of self. Sense of self and its behaviours are socially constructed within the specific culture in which individuals are embedded. The social phenomena and research outcomes are interpreted under the lens of social constructionism. The knowledge generated by this study provides guidance for teaching about health promotion in Thai undergraduate nursing programmes and also provides a basis for initiating health-promoting programmes based on the individual's sense of self for female adolescents in Thailand.