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Item 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, IreenIn 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.Item In search of self : the hospitalisation experiences of children with cancer : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University(Massey University, 2001) Rochecouste, VéroniqueCancer is the second most common cause of death in children in the Western world. The diagnosis and treatment process is painful and distressing, and is carried out in the hospital environment. This environment is foreign to most children, and influences children's coping with the experience of having cancer. Research in this area has focussed on assessing coping responses, and designing interventions for the pain, distress and anxiety associated with the medical procedures. There have also been studies which have measured the prevalence of emotional and behavioural difficulties in children with cancer. No studies have been conducted into children's experiences of hospital expressed in their own terms. The aim of the present study was to elicit the hospital experiences of children with cancer. Interviews were conducted with seven children, aged 5 - 15 years, who had completed treatment for cancer within the previous two years. An interpretive phenomenological design was utilised in order to gain and analyse accounts of the participants' perceptions and experiences. Findings suggest that the experiences can be interpreted in terms of two themes underlying the experiences of children with cancer, and their coping responses. The first theme is 'Retaining a sense of self-as-normal', which describes efforts to 'Maintain links with familiar people' and 'Becoming 'at home' in hospital'. The second theme is 'Incorporating multiple selves', which are 'Self-as-body-in-pain', 'Self-as-confined', 'Self-as-patient' and 'Self-as-survivor-living-with-cancer'. Success in retaining a sense of self-as-normal both affects, and is influenced by, the incorporation of multiple selves. Implications of these themes for practice in terms of the assessment of coping responses, design of interventions, and the measurement of outcomes, are suggested.Item Gender, power and practices in tension : mixed-sex rooming in hospital : a thesis presented in partial fulfilment for the requirements for the degree of Master of Arts in Women's Studies at Massey University(Massey University, 2000) Burrell, Beverley AnnUsing a feminist poststructural framework this study analyses interview reports and the complex contextual elements existing in the uncommon event of sharing one's bedroom space with a stranger of the opposite sex whilst in hospital. Dilemmas of gender sensibility, patients' rights and privacy are evident for the eight women interviewed for this study who experienced mixed-sex rooming (MSR) in New Zealand hospitals. Sex differentiation and gender difference significantly influence the conditions upon which social relationships evolve. This research examines the significance of the category 'woman' and the impact of gender and patient norms, including the foundations on which any objection to MSR might rest. Deconstruction revealed tensions around spatial confines and the operation of institutional power and authority at macro and micro levels. Conflicts between, the rhetoric of health reform, and the practices affecting patients' right to choose, and privacy, are discussed in the wake of the New Zealand health services restructuring of the 1990s and the re-organisation of patient accommodation, marked by mixing the sexes, thereby raising the question of whether gender is rendered somehow irrelevant. It is concluded that particular interests are served by MSR and that patient concerns risk being neglected where choice is withheld. The exertion of institutional power was found to override some patients' choice. Patient acceptance of the practice is conditional in respect to preservation of their privacy, especially in regard to toileting and washing. Assumptions about gender persist even though mixing the sexes would appear to relegate gender to a neutral state. Recourse to blanket policies is found to be inappropriate when it is individual patients' rights that health professionals are bound to respect.Item The experience of hospitalization first time for an acute medical illness : a thesis submitted to Massey University of Palmerston North in partial fulfillment of the requirements for the degree of Master of Arts in Nursing(Massey University, 2000) Blockley, Colette EvonneThis research focused on exploring and describing patients' experience of their first hospitalization for an acute medical illness. Twelve participants who had experienced their first hospitalization within the last two years were involved. Unstructured, open-ended interviews were employed to obtain data. Thematic analysis (Burnard, 1991) was used to provide a detailed systematic description of issues addressed in the interviews. Six main themes emerged from the participants' stories. Waiting was the predominant theme that emerged from the participants' experiences in the accident and emergency department. Once admitted to the ward, the need to know, support, environmental issues (which included the physical environment, privacy and safety issues) are the themes that emerged from the data. On discharge and post discharge, lack of information was a theme that had significance for the majority of the participants. The implications of these findings for practitioners who work in an acute hospital setting, especially with patients who have not previously experienced an acute hospitalization, are explored.Item Feeding practices and growth of preterm infants discharged from the Neonatal Intensive Care Unit at Auckland City Hospital until twelve months corrected age : a thesis presented in partial fulfilment of the requirements for the degree of Masters in Science in Nutrition and Dietetics at Massey University, Albany, New Zealand(Massey University, 2014) Vitali, Jennifer Angela-JaneBackground: Preterm infants are unique in their physiological, developmental and nutritional needs. Previous research regarding the preterm infant has focused on interventions within the hospital setting. Recently the lack of research in the post discharge period has been highlighted. The period after discharge poses a vulnerable period as previous intensive care, growth and nutritional monitoring of the infant are no longer readily available. The aim of this study was to identify current breastfeeding, complementary feeding, feeding practices and growth of preterm infants after hospital discharge from the Neonatal Intensive Care Unit (NICU) at Auckland City Hospital until twelve months corrected age. Method: Infants who were born preterm (<37 weeks’ gestation) were recruited from Auckland City Hospital NICU, a tertiary care level hospital. Homes visits were undertaken at four months after discharge and at twelve months corrected age to collect anthropometric measurements. Online surveys were administered at four months post discharge and at six, nine and twelve months corrected age. Data collected included demographic information at birth, mode of feeding, age of introduction of complementary foods and types of foods introduced to infants. Data were analysed using descriptive statistics. Group comparisons were made using Pearson’s chi-square (2), Fishers Exact test and paired T- tests. Differences were considered significant at P< 0.05. Results: Sixty-eight preterm infants were recruited from the NICU at Auckland City Hospital of whom the majority (76%) were born moderate to late preterm. The median (range) age of babies was 34 weeks (24+2 - 36+6 weeks) and their mean (± SD) birth weight was 2.03 ± 0.65 kg. At hospital discharge 73% of the infants were exclusively breastfed. By four months after discharge this had decreased to 46%, and by 12 months corrected age, only 21% of babies continued to be breastfed. The mean chronological age of complementary food introduction was 23 ± 4.4 weeks (range 12 - 34 weeks). The majority of the babies (84%) started complementary feeding within the recommended age range. The most common first food was baby rice (45%) and infants showed increasing variation in their diet from six until twelve months corrected age. Z-scores for weight, length and head circumference were calculated using UK-WHO data. There was a significant decrease in mean Z-scores for weight, length and head circumference between birth and hospital discharge. The majority of infants regained this deficit by four months and twelve months corrected age. Although, there were a few infants found to be at risk of growth faltering. Conclusion: This study shows that the majority of preterm infants discharged from the NICU are breastfed at discharge, although, breastfeeding declines significantly by four months after discharge and thereafter. The majority of infants are introduced to complementary feeding appropriately although the choices of early complementary foods need to be addressed to include high energy nutrient dense foods. Lastly, growth in the post discharge period of these infants was adequate to support and maintain growth for the majority of infants, more research is needed to determine the feeding practices over this time which impacted on growth.Item Finding a place for music therapy practice in a hospital child development service : research exegesis in partial fulfilment of the requirements for the degree of Master of Music Therapy at the New Zealand School of Music, Wellington, New Zealand(Massey University, 2012) McGann, Helen SianDevelopment Service (CDS) in New Zealand, looking at the issues involved in setting up this practice during a student placement over a period nine months. The research is an exploratory case study (Yin 2009) which aims to identify issues through secondary analysis of clinical documentation, using thematic analysis to code and analyse the clinical data. Five core issues were revealed which included: working with team members, interacting with the children’s family, issues in the implementation of the intervention, reflections on the student’s experience and working within hospital policies and procedures. A case vignette is used to describe an example of arising issues and important factors when working with team members and family. The results of the study suggest that service development is a complex process, showing the importance of collaboration within the multidisciplinary team and involving family members in sessions. In terms of beginning a new music therapy practice in this specific setting, it was found that music therapy was filling a gap in what the child development team could provide. It was also found that there are several factors to consider when establishing a paid position within the service. It is important to create a balance between working within the medical framework philosophy of the hospital and providing a holistic and an empathetic level of care for the families. The project aims to inform other music therapy practitioners and students beginning or establishing work in new settings.Item A music therapy student's exploration of single session music therapy for children on a paediatric ward using action research methodology : a dissertation presented in partial fulfilment of the requirements for the degree of Master of Music Therapy at the New Zealand School of Music, Wellington, New Zealand(Massey University, 2010) Kaenampornpan, PornpanThis study aimed to answer the question “How can I, as a music therapy student in a paediatric ward, provide children with beneficial single session music therapy?” In order to answer this question, action research methodology was employed. This methodology allowed the researcher to monitor and question her actions in order to improve her practice. Furthermore, principles from music therapy and other disciplines were applied and adapted. The researcher’s practice would be made more appropriate, therefore, for a paediatric ward where only brief information about the children was provided and limited time was available to work with them. There were four cycles in the study. The challenges and concerns that emerged through the course of this research were 1) how to approach the children or get the music therapy session underway, 2) how to provide suitable sessions for the different needs and developmental stages of the children; 3) how to be more aware of the children’s needs, and 4) how to maintain my inspiration. All the findings from these concerns were formulated into some helpful principles that played an important role during the course of this study. The principles are: 1) being flexible; 2) keeping the patients’ and the therapist’s control in balance; 3) being sensitive to children’s responses and to their needs; 4) being familiar with background knowledge; 5) being able to build a rapport in a short time; 6) being available; 7) being open-minded; and 8) being able to reduce the therapist’s anxiety. It is recommended that these principles be employed in other contexts where the therapist has little time at his/her disposal to assess or establish a rapport with the children, and where it is hard to predict the situation or plan the session ahead.Item The effect of music therapy on self-reported affect in hospitalised paediatric patients : a thesis submitted to the New Zealand School of Music in partial fulfilment of the requirements for the degree of Master of Music Therapy(Massey University, 2009) Armstrong, Ruth ElizabethThe present research examines the effect of music therapy on the affect of hospitalised children. It took place on a paediatric ward of a New Zealand public hospital. This study aimed to investigate the role of music therapy in addressing patients’ psychosocial needs. Literature on the impact of hospitalisation, and on the use of music therapy in hospitals and paediatrics was reviewed. The research involved an audit of the therapist’s clinical notes from music therapy sessions over the course of seven months. The clinical notes included measurements of children’s mood from the beginning and end of sessions, using McGrath’s (1990) Affective Facial Scale. It was hypothesised that mood measures following music therapy would be higher than pre-music therapy scores. Statistical analysis of the facial scale data did not show a significant difference between ‘before’ and ‘after’ measures. These results were discussed with regard to a ceiling effect (this is, the measurements indicated patients were at the happy end of the scale before the music therapy session, so there was little room on the scale for mood to improve following music therapy). The measurement of emotion did not prove to be straightforward. The hospital environment may have influenced the patients’ responses in a number of ways. These environmental influences are discussed with reference to examples from the clinical notes. The usefulness of facial scales in this context is discussed, as well as other limitations of the research. Suggestions for future research include the use of other mood measures, and the inclusion of measurements of parental mood and how this affects the child.