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    Loneliness among older people living in long term care settings in New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Health at Massey University, Albany, New Zealand
    (Massey University, 2016) Bogati, Rubina
    Introduction Loneliness is a major problem experienced by older people living in long term care settings. Among older people, loneliness has been associated with poorer physical and mental health. However, there is limited information known about the prevalence of loneliness and socio-demographic and health characteristics associated with loneliness, among older people living in long term care settings in New Zealand. Methodology This study used a cross-sectional correlational design to explore the degree of loneliness among older people living in long term care settings in New Zealand and the socio-demographic and heath characteristics associated with loneliness. Methods included a demographic data sheet, the Barthel Index to measure functional independence, the EQ-5D-5L and EQ-VAS to measure health and wellbeing, the geriatric depression scale to measure depression, and the De-Jong Gierveld loneliness scale to measure loneliness. Between December 2015 and April 2016, data from 36 participants were collected using predominantly face to face interviews. Results The mean age of participants was 81 years (95% CI: 77.81-84.42). Analysis revealed older people experienced marginal loneliness (M = 2.36, 95% CI: 1.76-2.96). Logistic regression predicted loneliness was almost twice as likely to occur in older people with low perceived health (OR = 1.78, p = .04) and was more than twice as likely to occur in those with fewer social networks (OR = 2.53, p = .03). Logistic regression also predicted that those with fewer social networks were three times more likely to experience social loneliness (OR = 3.18, p < .00). Conclusion Loneliness is prevalent among older people living in long term care settings in New Zealand and is associated with lower levels of perceived health and fewer social networks. Further research with a larger population is needed to understand loneliness, the factors associated with it, and more importantly, strategies to reduce it.
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    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, Kaye
    Increasing 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.
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    End-of-life care for elderly within aged residential care facilities : views and perceptions from their next-of-kin : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science with an Endorsement in Health Psychology at Massey University, Manawatu Campus, New Zealand
    (Massey University, 2015) Barnes, Hayley Maree
    By 2051, the number of people aged 65 and over will account for 1.33 million of New Zealand’s population (Statistics New Zealand, 2006). This has created attention as to what current practices and facilities are available to this cohort of New Zealand’s population, and what more we can do to make sure we provide adequate services. Limited literature provides insight into what takes place within aged-residential care (ARC) facilities during end-of-life (EoL), especially within New Zealand, even though approximately 40% of those aged 85 and above in New Zealand do already die in ARC facilities (Gibb, 2014). This project investigates the experiences and perceptions of EoL care for elderly within ARC facilities, from the perspective of their next-of-kin (NoK)/family member. Eleven NoK/family members who experienced the passing of their elderly relative within an ARC facility, were recruited as participants. The study used a qualitative method with semi-structured interviews. The interviews were then transcribed, and analysed using thematic analysis on Dedoose, a web-based application, to draw themes from the data. Questions were kept broad and open, so that participants would be able to relay their story as openly as possible without interruptions. The findings are presented under ten major themes which includes; the occurrence of a ‘crisis’ for their elderly relative, the responsibility and adjustment to the role of NoK, changes in the elderly relative’s personality, the effort and kindness experienced within the ARC facility, reflection of the conversations participants had with their elderly relative, the multi-dimensional effect of pain, the process of letting go and anticipatory grief, expectations of the ‘good death’, the influence family has on the experience of being the responsible NoK/family member, and the participants experience of grief while managing the funeral. The interpretation of the results highlighted the extended period that is considered to be EoL and its care within an ARC facility, as opposed to only the last few days before death. This research enables an insight of what entails EoL care within the environment of the ARC facility, as well as allowing the NoK/family member to share the story of their experience.