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    The foster caregiving relationship with newborns who have feeding difficulties : a thesis presented in partial fulfilment of the requirements for the Master of Arts endorsed in Psychology at Massey University, Albany, New Zealand
    (Massey University, 2018) Hann, Nari
    The purpose of this study was to expand on foster care and attachment literature by investigating how the relationship is impacted between a foster caregiver and newborn who experiences feeding difficulties. The most common types of feeding difficulties experienced include reflux, allergies, colic, arousal to feed, and sucking problems, with prenatal methamphetamine exposure being the most frequently cited reason for causality. Newborns who have been prenatally exposed to methamphetamine are at higher risk of preterm births. Prematurity has been widely associated with developmental issues in newborns, such as poor sucking reflexes. All newborns discussed in this study were of Māori descent, highlighting a possible association between Māori children in care and feeding difficulties. This association is thought to be strengthened by the social determinants faced by many Māori, and the punitive neo-liberal nature of the welfare system. Phenomenological interpretive analysis was used to understand the experiences of seven foster caregivers who were highly skilled in caring for newborns with feeding difficulties, and how the feeding difficulties could impact the attachment relationship and contribute to placement breakdowns. Additionally, the strategies that foster caregivers used to minimise the impact of the difficulty and optimise attachment interactions were explored. The feeding difficulties of newborns were found to make attachment interactions more difficult to achieve, but due to the fortitude of the caregivers in providing the best opportunities for newborns in their care, attachment interactions were reportedly always accomplished. Although feeding difficulties placed extra demand on the caregiver role, the commitment and motivation of the caregivers, and the intervention strategies they used to reduce the impact, promoted bonding and stabilised placements. Therefore, feeding difficulties were not associated with placement breakdowns. Rather, unanticipated extended placement timeframes, which impacted the caregiver’s ability to provide a consistent and stable environment, were found to be more detrimental to the placement stability. Understanding feeding difficulties and their impact on attachment for babies in foster care is crucial when caring for the nation’s most vulnerable citizens and ensuring that they have the greatest opportunities for healthy development from the start of their lives.
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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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    Impact of physical activity levels on infant measures and maternal health : a thesis presented in partial fulfillment of the requirements for the degree of Master in Science in Nutritional Science at Massey University, Albany Campus, Auckland, New Zealand
    (Massey University, 2004) Jabrani, Shabnam
    Five hundred and four pregnant women participated in this study. The objective was to examine the association between selected sociocultural characteristics and physical activity on the course of pregnancy, labor, delivery infant measures and maternal health. The participants were from the European (71%), Maori (20%) and Pacific communities (9%) in New Zealand. On average, pregnant women spent 20 hours each day in sedentary activities, such as sleeping, sitting, and standing. Urban women were found to be more sedentary than rural women. There was no difference in the activity patterns by ethnicity. During the seventh month of pregnancy the low income group and beneficiaries were found to be more sedentary than others. The need for some birth interventions was found to increase with time spent in sedentary activity. Sedentary activity was significantly related to the need for an episiotomy. The results also showed that the more active the women the lesser the need for pain relief. The need for syntocin and epidural anesthesia almost halved as the number of minutes spent in moderate high activity increased. The more the number of minutes spent in sedentary activity in the seventh month, the longer the duration of labor. However, the duration of sleeping was associated with a shorter duration of labor. Duration of physical activity did not affect birth weight, but time spent in sedentary activity was found to impact on the gestational age of the baby. The more sedentary mothers had a shorter gestational term and the more active the subjects the more likely they were to go full term. Sedentary activity during pregnancy was found to affect weight gain between the fourth to seventh months of pregnancy. The more time women spent on moderate low to moderate high activity, the less was the weight gain. Thus standing and sitting were not beneficial for a good pregnancy outcome. It was very clear that pregnant women would need to get more active. Furthermore, physical activity during pregnancy did not affect post partum weight retention. There may be other lifestyle characteristics such as diet both during and after pregnancy, or change in activity patterns postpartum that may have affected post partum weight retention.
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    Saving lives and changing dirty nappies : illuminating nursing in the neonatal nurse practitioner role : the New Zealand experience : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University
    (Massey University, 2000) Jones, Bronwyn
    In New Zealand Neonatal Nurse Practitioners (NNPs) have been practicing in an advanced nursing role since 1994. The nature of expert nursing makes it difficult for NNPs to articulate the nursing component of the NNP role. It is essential that the expert nursing component of the NNP role be documented to maintain the role within the culture of nursing. Aim: The aim of this thesis was to explore and describe how expert nursing is incorporated in the NNP role, in the New Zealand context. Method: An explorative design, using multiple data collection methods, was used. These methods included questionnaires, interviews, journal-keeping (journalling), and analysis of written data. All NNPs in current practice were sent questionnaires (n=18) and a purposive sample of 5 NNPs agreed to be interviewed and keep journals. Standing orders, job descriptions and other written data from each of the three neonatal services that employ NNPs was compared and analysed. Results: Fifteen NNPs (83.3%) responded to the questionnaires. Results showed that NNPs tend toward a nursing identity, but see themselves as sitting between nursing and medicine. Professional issues were important to the NNPs. There was some ambivalence toward the NNPs leadership role in the questionnaire results, but interview and journal data showed the NNPs performing a multifaceted leadership role. Neonatal Nurse Practitioners are committed to post-graduate education, with a tendency toward preferring that to be in a nursing school with access to medical resources. The qualitative data revealed six themes derived from practice. They were 'a consciousness of baby', 'orientation to family', 'uniqueness of NNP care', 'leadership', 'culture of nursing' and 'NNP experience of advanced practice'. Expert nursing was embedded in the clinical themes and implicated in the professional themes of NNP practice. Conclusions: Expert nursing is inherent in the practice of the NNP role in New Zealand. Neonatal Nurse Practitioners practice in a unique role in the care of sick babies, incorporating medical skills with nursing philosophy and expertise. Education needs to address some of the issues of nursing in this advanced practice role. There is a need for institutional support for the NNP role. The NNP group needs to develop as a support and educational network.