Nursing and Midwifery

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

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Start date: 2010Subject: search.filters.subject.320000 Medical and Health Sciences

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    Exploring the health care experiences of rural Thai people living with acquired valvular heart disease : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Wellington, New Zealand
    (Massey University, 2010) Buatee, Supatra
    Valvular heart disease (VHD) is a preventable disease but it is one of the major causes of chronic illness in developing countries. As this disease is curable by surgery, access to appropriate and effective health care is necessary to prevent people from developing this disease and to treat people with VHD. The voices of people living with this condition will provide direction for health professionals in the development of better health care services for those living with VHD. This qualitative narrative study aimed to explore the experiences of individuals living with VHD. Thirty individuals diagnosed with VHD participated in this study drawn from a population of individuals attending a Thailand provincial hospital. They participated in (open and honest conversation) which was supported by a Thai cultural stance to build the trust necessary for the conversations. Conversations aimed at eliciting information about personal health care experiences were undertaken and lasted from 30 to 90 minutes, all were audio-taped and transcribed verbatim. Multistage narrative analysis methodology was used to identify emerging themes and three major themes emerged: autonomy and life with VHD, the effort of learning for life with VHD, and the maximisation of resources for the management of life with VHD. All of these themes indicated difficulty of access of acceptable and affordable care and difficulty in involvement in health care and illness management. These findings suggest that health care structures, resource distribution and the way professionals interact and communicate are important factors in the health care experiences of individuals living with VHD. Health care services that are based on the principles of equity and balance of power between institutions and clients may support the development of appropriate health care services for all individuals. Culturally-based narrative research is recommended to increase the possibility of expanding ways of knowing with the inclusion of a range of points of views for understanding health care provision. This knowledge is necessary for the development of client-centred and community-based health care services to improve health care outcomes for the rural population in Thailand.
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    Achieving harmony of mind : a grounded theory study of people living with HIV/AIDS in the Thai context : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing, Massey University, Palmerston North, New Zealand
    (Massey University, 2010) Balthip, Quantar
    The aims in this Straussian grounded theory inquiry were to gain better understanding of the meaning of spirituality and of the process of spiritual development in people living with HIV/AIDS in the Thai context. In Western contexts, spirituality has been described as the essence of human existence. However, in the Thai context, where Buddhist teachings underpin the understanding of life as body and mind, rather than as body, mind and spirit, the concept of spirituality is little understood by lay people. This gap in understanding called for an inductive approach to knowledge generation. HIV/AIDS is a life-altering and deeply stigmatized disease that results in significant distress and calls into question the meaning and purpose of life for many who are diagnosed with the disease. Nevertheless, some Thai people living with the disease successfully adjust their lives to their situation and are able to live with peace and harmony. These findings raise questions firstly as to the process by which those participants achieved peace and harmony despite the nature of the disease and the limited access to ARV drugs at the time of that study; and secondly as to whether or not the peace and harmony that they described could be linked to the Western concept of spirituality. Data were gathered from 33 participants from the South of Thailand, who had lived with HIV/AIDS for 5 years or more, were aged 18 years or older, and were willing and able to participate in this study. Purposive, snowball and theoretical sampling techniques were used to select participants. Data collection using in-depth interviews and participant observation methods was undertaken over a nine-month period in 2006. The process of data analysis was guided by Strauss and Corbin’s grounded theory and resulted in the development of a substantive theory. The substantive theory of Achieving Harmony of Mind comprises two categories: struggling to survive and living life. Each category has two subcategories: encountering distress (tukjai) and overcoming distress (longjai), and accomplishing harmony in oneself and discovering an ultimate meaning in life respectively. The metaphor of ‘an eclipse’ was used to describe the process of the development of mind of people living with HIV/AIDS and represents the extent to which the individual’s mind is overshadowed by the diagnosis of HIV/AIDS and its consequences. Diagnosis of this disease turns participants’ lives upside down. Yet selective disclosure of one’s HIV status, resulting in the receiving of support and connectedness with others, enables participants to find meaning and purpose in life that enables them to recover the will to live and to attempt to stabilise their lives by learning to live with HIV/AIDS. Most participants were able to adjust their mind to accept their new situation and find new self value enabling them to feel free from the shadow of HIV/AIDS and live life with HIV/AIDS as normal. Fewer participants found an ultimate meaning in life – consistent with Buddhist teachings about suffering and uncertainty, and the impermanence of life that links with an understanding of ‘nonself’ – that enabled them to obtain peace and harmony of mind (kwarmsa-ngobjai). It is this latter stage that represents spirituality in Buddhist terms. This form of spirituality differs significantly from that found in other religions because it does not involve an engagement with a divine and transcendent reality. The findings of this study enhance knowledge about spirituality in the Thai context, and provide a guide for health professionals and education curricula with the aim of achieving more holistic care for patients.