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    Neonatal nursing in Fiji : exploring workforce strategies to help Fiji achieve Sustainable Development Goal 3, Target 3.2 : a thesis presented in partial fulfilment of the requirements for the degree of Master in International Development at Massey University, Palmerston North, New Zealand
    (Massey University, 2019) Manuel, Ireen
    In Fiji 124 neonates lost their lives in 2017. While rates have improved in the Pacific, Fiji’s neonatal mortality rate has remained stagnant. The neonatal workforce struggles to meet the demands of this vulnerable population. Neonatal mortality is a global health challenge which is reflected in Sustainable Development Goal 3, target 3.2. This target aims to end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births by 2030. My research set out to explore and provide some understanding of the development needs of neonatal care globally and review the workforce challenges for nurses in this speciality area in Fiji. Improving the continuum of care for neonates will be critical if Fiji is to achieve Sustainable Development Goal 3, target 3.2. To answer these research questions, I adopted a qualitative methodology. I conducted four semi-structured interviews in Fiji and interpreted qualitative primary and secondary data. In doing so, I came across challenges that were present within programmes, service designs and national policies. Some of these challenges were easily fixed and did not need policy interventions, but rather individual willingness to change. Others required state interventions and long-term commitment and willingness. When applying the rights-based approach to health framework, my findings showed that the hardworking workforce in Fiji is still trying to change an organisational culture to a point where the workforce can feel fully inclusive and able to make evidence-based decisions as a team. The profound effects of not being able to do this is detrimental to the positive outcome for the neonates in their care. It was evident that health has many determinants and the problem relating to neonatal mortality is complex. My research showed that the neonatal nursing workforce were committed to reform and an effective health care service with adequate capacity and consumables is needed to run a well-functioning neonatal service. The key conclusions of my research are that there needs to be better collaboration between all sectors, evidence-based research practice and empowerment of the neonatal nursing workforce in Fiji. This is necessary if the government of Fiji is to achieve a neonatal workforce that can support it to achieve the critical Sustainable Development Goals target of reducing neonatal mortality.
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    Pregnancy outcomes in Nepal : an investigation of the relationships between socioeconomic factors, maternal factors and foetal and maternal outcomes in a Pokhara sample : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University
    (Massey University, 1999) Poudel, Pratima
    Good maternal reproductive health is a prerequisite for the health of babies and families. Social, cultural, economic and health systems also affect the wellbeing and survival of women during pregnancy and childbirth. In Nepal, a developing country, women are discriminated against in terms of legal status, access to education, access to food, and access to relevant health care services (Tuladhar, 1996). Where women do not have access to such services, maternal, perinatal, and infant mortality rates are comparatively high (The Ministry of Health & UNICEF, 1996). There is a scarcity of research on the relationships between socioeconomic and maternal factors and pregnancy outcomes in the Nepalese context. The intention of the present study was to gain a greater understanding of factors affecting the health and behaviour of pregnant women in Nepal. Based on Mosley & Chen's (1984) and Maine's (1995) models of maternal and child survival, these factors were investigated to examine the relationships between socioeconomic and proximate determinants and pregnancy outcomes. Data were collected on a cross-sectional basis from 215 women who gave birth at Western Regional Hospital, Pokhara, Nepal. Analyses revealed that, antenatal care utilisation, and nutritional intake were related to socioeconomic determinants such as income, residence, parental qualifications, maternal occupation, ethnicity and religion. Furthermore, socioeconomic factors explained the greatest variance in birth weight, followed by general health behaviour and obstetric condition variables. The addition of reproductive health and behaviour variables did not add significantly to the explanation of variance in birth weight. Obstructed labour was studied in terms of length of labour, and the result revealed that, mode of delivery (normal or instrumental), gestational age, mother's age, and age at marriage were significantly related to the length of labour. Maternal mortality of 14.15 and perinatal mortality of 29 per 1000 live birth were reported during the study period of two months. Findings are discussed in relation to previous literature. Limitations of the study and implications for future research are also discussed. Findings suggest that, the maternal and child health care services in the Western Region of Nepal need improvement. Strategic development of health care services with cost-effective and quality health services through primary health care and the Safe Motherhood programme are found to be a necessity for this region.
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    Evaluation of a service delivery programme : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 1987) Russell, Gail Robin
    The present study is an evaluation of the service delivery programme offered at the Palmerston North Plunket-Karitane family unit. The study had three aims: firstly, to replicate and extend an investigation conducted on a similar programme in Dunedin; secondly, to examine the eitiology and intensity of stress experienced by the service delivery staff; and thirdly, to systematically evaluate programme process and outcome. Results obtained in the present study were in many respects similar to those obtained in the Dunedin study, but some significant differences are also noted. Although valuable information pertaining to the causes of stress was obtained, the service delivery staff recorded stress levels comparable to other working women. Process and outcome evaluation data indicated that the programme was functioning in accordance with its aims and objectives, however recommendations for programme modification and improvement are offered.
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    An excellent preparation for marriage and families of their own : Karitane nursing in New Zealand, 1959-1979 : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in History at Massey University
    (Massey University, 2001) Courtney, Lesley
    The Karitane baby nurse is qualified to undertake the care of young children and babies. Before qualification she has had sixteen months of intensive instruction and practical experience in a Karitane Hospital under the eye of the visiting physicians and the matron and sisters. In addition she has had four months' practical work in private homes under the supervision of the Plunket nurse and bureau secretary. The Karitane nurse will do everything possible to ensure the highest standard of health and happiness for the child under her care......She is not a general-trained nurse and should not be asked to carry the responsibility of a child who is not well. The aim of the Karitane nurse is to help the mother to accept full care of her child with competence and confidence....The Karitane nurse will be there to help the mother and to guide and support her with the problems of mothercraft. A close and understanding relationship between the mother and the Karitane nurse is an essential foundation for an efficient service....The Society would like mothers to understand that the Karitane nurse holds a responsible position, and that her status in the household should be that of a trained children's nurse. Karitane nursing is an arduous profession....It is in the interests of the parents to ensure that the nurse's health and strength is safeguarded and that she is not overloaded with household duties In this way the Karitane nursing service will remain a popular one.1 1 The Royal New Zealand Society for the Health of Women and Children (RNZSHWC), 'Rules for Karitane Nurses, Scope and Duties', circa 1960s, DU:HO, AG-145-27 By the time these 'Rules' were issued, the training of Karitane nurses was already under threat. They illustrate, however, the key characteristics of the Karitane nurse: she was not trained to deal with sick children, and although trained in an institution, her final place of work was in family homes, but she was not to be mistaken for a domestic servant.
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    He iwi ke koutou, he iwi ke matou, engari i tenei wa, tatou, tatou e = You are different, we are different, but we are able to work together : Family Partnership as a model for cultural responsiveness in a Well Child context : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University, Albany, New Zealand
    (Massey University, 2013) Tipa, Zoe Kristen
    In 2006 the Royal New Zealand Plunket Society embraced a model of communication and practice titled Family Partnership. The Family Partnership model and training is designed to develop the communication skills of professionals working with families in order to acknowledge and enhance the capabilities of parents. It is acknowledged that the degree to which a service is culturally safe is defined by the individual receiving the service. Nurse leaders, educators and peers are consistently required to make judgements as to the extent to which the nurse being observed is culturally safe, without obtaining client feedback. This research examined whether the Family Partnership model could be considered a model for cultural responsiveness with the dual benefit of providing a platform to more accurately assess the cultural competence of Plunket nurse practice. An evaluation design and methodology was used to determine the relationship between Family Partnership training for Plunket nurses in relation to Māori health outcomes. There were two phases in the data collection process. In phase one an online survey was completed by a group of Plunket nurses who had completed Family Partnership training along with a group that had not completed Family Partnership training. Phase two included ten observations and interviews with Plunket nurses and Plunket clients who identified as Māori. A combination of evaluation tables to determine merit and thematic analysis were used for the analysis of the mixed methods data. The results were presented in three sections relating to Plunket nurse practice, client experience and the impact on Plunket as an organisation. All Plunket nurses who participated in the research believed that Family Partnership had a positive impact on their clinical practice. The extent to which their practice had changed was difficult to determine, however the need for ongoing updates in Family Partnership was strongly indicated. Māori Plunket clients were generally satisfied with the Plunket service and their responses aligned with the concepts outlined in Family Partnership communication theory. The relationship between the findings and the principles of the Treaty of Waitangi were highlighted. This research has indicated that cultural responsiveness can be defined as the way in which a service identifies and attempts to meet the needs of the individual. It has discussed the complexity around what constitutes a health outcome for Māori clients and ultimately how cultural competence may be better assessed in practice.
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    Needs assessment and decision making in the Plunket nurse setting : what's the story? : a thesis presented in partial fulfilment of the requirements of the degree of Master of Philosophy (Nursing), Massey University, Wellington, New Zealand
    (Massey University, 2011) Hussey, Alison Louise
    Programmes delivered to populations of young children have had a high profile in recent years, as the relationship between childhood health and long term wellbeing is emphasised and funders and policy makers seek effective interventions to reduce health outcome disparity between some groups of children. Plunket nurses are employed by the Royal New Zealand Plunket Society (Inc) (Plunket) to deliver a programme of contacts to families with children aged from birth to five years, under a primary health care programme known as the Well Child Framework (Ministry of Health, 2010c). Seven universal or ‘core’ visits result in an assessment of family health need which informs decisions about the additional support offered to reduce risk to child health outcomes and improve health equity. This study was undertaken to clarify how Plunket nurses think about needs assessment, describe how Plunket nurses make decisions when planning care, and explore the influences on Plunket nurse needs assessment and decision making. A constructivist paradigm provided the framework for qualitative interviews with seven Plunket nurses. Data were analysed using narrative and thematic methods to construct three group narratives. The findings add to knowledge of New Zealand well child practice established through the limited previous studies in the Plunket nurse setting. Plunket nurses’ relationships with families emerged as the foundation for needs assessment, a process study participants described as complex, where a range of social, economic and community determinants are considered to establish family resilience and identify risks to child health outcomes. Decisions about planned care are contingent on family participation and agreement, and are influenced by peer and Clinical Leader supervision, the nurse’s knowledge and experience, and the available referral options. The study findings emphasise the importance of facilitative funding models to accommodate the unpredictable nature of work with families in the community, and consistent leadership to translate the underpinnings of service specifications to the reality of practice. Support for the Clinical Leader role, and further research to establish Plunket nurse professional development needs and to improve understanding of the dynamics in relationships between Plunket nurses and families are recommended.