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Item Healthcare assistant decision-making and information behaviour in long-term care settings : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy, Massey University, Palmerston North, New Zealand(Massey University, 2025-08-21) Burrow, MarlaHealthcare assistants (HCAs) are an unregulated workforce who provide most of the care to those living in Aged Residential Care (ARC) in Aotearoa New Zealand. Despite being the essential workforce for the aged care sector, there is a paucity of literature regarding how healthcare assistants make decisions in their everyday work. Increased demand for aged care and health workforce shortages have led to HCAs often working under pressure and required to make decisions about all manner of care. This study explores the direct care decision-making of HCAs. Critical ethnography underpinned by Elfreda Chatman’s small world theory informed data collection. Direct observations and semi-structured interviews provided data on participant characteristics, decision types, the decision-making environment and information landscape. Experimental vignettes explored decision-making in uncertainty by progressively manipulating three dimensions of knowing: knowledge of the environment of care, knowledge of the resident (familiarity), and knowledge as (HCA) experience. Small world and decision-making theories framed data analysis. Decisions were conceptualised as decision schemas associated with specific care actions. Routine, easy and more difficult decisions were identified. Decisions were influenced by the institutional schedule, availability of resources, and the rules of work. Resident attributes, HCA traits, and task prioritisation influenced how decisions were actioned. Frequent informal handovers between HCAs supported situational awareness of resident and communal care demands. Vignette data provided two compelling findings: the more uncertainty, the higher the frequency of advice sought from an experienced HCA, and HCAs took an active role in assimilating new residents into institutional care routines. Models are offered conceptualising the interplay of tensions, certainty, uncertainty and risk with the constructs, attributes and traits used to frame decisions. Professional implications are related to the provision of safe care to residents and the support of HCAs. Study findings clarified opportunities for the co-creation of strategies to address concerns and better advocate for residents. Nurse educators/managers and registered nurses can support HCAs by sharing information considered to be of relevance to the work and decisions they make. Study findings further highlighted the influence of institutional routines and the value HCAs placed on information held by experienced HCAs.Item Registered nurses' experiences with, and feelings and attitudes towards, interRAI-LTCF in New Zealand in 2017 : a thesis presented in partial fulfillment of the requirements for the degree of Master of Philosophy in Health at Massey University, Albany, New Zealand(Massey University, 2017) Vuorinen, MinnaBackground The International Resident Assessment Instrument for Long Term Care Facilities (interRAI-‐LTCF) is a web-‐based assessment tool designed to comprehensively assess older adults (>65 years) living in aged residential care. InterRAI-‐LTCF is used in over thirty countries, but in 2015 New Zealand (NZ) was the first country where it was made mandatory in all facilities. No previous research about Registered Nurses’ (RN) views on interRAI-‐LTCF in NZ has been conducted. The purpose of this study was to explore RNs’ experiences, feelings and attitudes towards interRAI-‐LTCF, and what they believed would improve their experiences. Methods The study was qualitative, using an exploratory and descriptive approach. Twelve interviews were conducted 18 months after interRAI-‐LTCF became mandatory in NZ. The interview questions were based on a United Theory of Acceptance and Use of Technology (UTAUT) model with some modifications. Findings were analysed thematically. Results The findings reveal that RNs of all ages embrace technology, and have mostly positive attitudes towards interRAI-‐LTCF as a standardised and comprehensive assessment tool. Limited value however is seen in dementia and end of life care. RNs report good experiences with trainers and venues, but inconsistency between training courses. Negative feelings towards interRAI-‐LTCF were caused by insufficient time to complete assessments, often due to duplication of data entry and insufficient RNs trained. RNs also feel apprehensive about the annual Assessment & Intelligence Systems, Inc. (AIS) competency tests. RNs believe the development of automated care plans and an automated password retrieval system would improve their experience. They also suggested that specific cultural considerations for Māori residents should be reviewed. Conclusion Overall RNs supported the use of interRAI-‐LTCF as a comprehensive assessment tool. Duplication in data entry, insufficient training, and the annual AIS tests caused most stress and negative feelings. Recommendations were made to rectify this. Key Words Older adults, interRAI-‐LTCF, Registered Nurses, aged residential care, UTAUTItem Clinical decision making by registered nurses in residential aged care : a critical realist case study : a thesis presented in fulfilment of requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Albany, New Zealand(Massey University, 2016) Milligan, KayeIncreasing numbers of people are living longer and projections indicate that a greater number of frail elders will require support from the residential aged care sector. Registered nurses are the principal health care professional with sustained oversight of residents and make many of the clinical decisions that affect the health and outcomes of care of the residents. This thesis explains the clinical decisions that registered nurses make in the New Zealand residential aged care sector. The study was undertaken using a critical realist case study framework. This case study describes the clinical decisions the registered nurses make and explains the social structures through causative factors that intersect to cause, redirect, or block the clinical decisions. The data collection methods were participant observation, interview, and document analysis in three residential care facilities. Fourteen registered nurses participated in the study. Data analysis included reasoning processes whereby patterns from the data were reviewed within current knowledge, and explanations developed. The clinical decisions represent the comprehensive nature of nursing practice in this sector. Physical and mental health, and the management of behavioural issues in the context of gerontology are significant foci of nursing frail elders. Three causative factors inherent to the social structure of residential aged care were identified that generate, redirect, or block the clinical decisions. These causative factors are: the relationships the registered nurses develop with the resident, their family, and the general practitioner, which are embedded within the registered nurse role; the specific context of the residential aged care sector in which risk aversion, financial constraints, and limited support for the development of the registered nurses prevails; and the individuality of each registered nurse whose knowledge and agency affects their concern for, and management of, the residents. This thesis presents a comprehensive explanation of the complexity of the registered nurses’ clinical decisions. It identifies that some clinical decisions reside within a zone of certainty, as the registered nurse makes the decision to act or to not act. Other clinical decisions reside within the zone of uncertainty, as the registered nurse experiences indecision, and may ‘wait and watch’ or seek advice. Recommendations for practice focus on the clinical decisions within the zone of uncertainty, the subsequent ongoing professional development requirements, and the need for clinical support and clinical leadership.Item A feminist study of older women's health and health promotion : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing, Massey University(Massey University, 2000) Milligan, KayeOlder women experience changes in their health as they age but continue to experience health and wellness, and to promote their health. In this feminist study, nine women who are chronologically aged over 70 years have described their understandings of their own health and health promotion. The participants live in their own homes and manage their lives. They also purchase meals on wheels, and may have other people do household and personal cares which they used to do themselves. This thesis outlines discourses which are currently representative of understandings of older women's health and which provide the context in which older women experience health. This context is dominated by health professionals, especially in medicine, who represent older women's health in terms of decline and deterioration. This conflicts with the representations by these older women. Nursing is located in the range of discourses, but is found to be most aligned with medicine and therefore replicates knowledge of older women's health in terms of decline and loss. Nursing has also failed to generate knowledge of positive aspects of older women's health. In order for nursing to provide health care which is appropriate for older women, an emphasis on health and wellness from the perspective of older women needs to be further developed. Nursing has a strong invitation to work with elders in a different way to all other health professionals.