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    When two worlds collide : a Heideggerian interpretive phenomenological study into the experience of assessing 'failing' nursing students within clinical practice : a thesis presented in partial fulfillment of the requirements for the degree of Doctorate of Education at Massey University, Palmerston North, New Zealand
    (Massey University, 2015) Dobbs, Sally
    Clinical nurse educators employed by New Zealand polytechnics experience challenges when assessing Bachelor of Nursing students in clinical practice, particularly students who are considered to be “failing”. This phenomenological study sought to explore the experience of clinical assessment and why assessors fail to award “failing” nursing students a fail grade. Fourteen clinical nurse educators, employed within three New Zealand polytechnics were interviewed about their experiences of educating and assessing nursing students’ clinical practice. All participants used a preceptorship model of clinical teaching. The interviews were analysed for key themes using Heideggerian Interpretive Phenomenology. The study revealed tensions for participants between being-in the world-of-nursing as well as being-in the world-of-education. Less than half the participants had not failed a nursing student in clinical practice, despite having concerns about their safety to practice. Participants felt ill prepared for their role as educators and assessors. The phenomenon of care was revealed when assessing failing students. Participants acknowledged that some students are thrown into the world-of-nursing; they wanted to care for students by not failing them and questioned whether assessment should occur in the first year. As students progressed through the programme, participants used the phenomenon of care for the health consumer to make a judgement about a students’ competence. The responsibility to fail nursing students was frequently disburdened to others. The ambiguity of clinical assessment tools, especially the use of competencies, and the lack of progression created challenges for assessors. The threat of students appealing the fail grade inhibited less experienced participants from failing students. Clinical nurse educators lack adequate preparation to educate and assess nursing students. The limitations of this study are its small sample size and lack of generalisability. This study showed that nursing students are passing clinical assessments despite concerns about their competence to practice. Further research is warranted to include a larger sample size and different clinical teaching models, as well as researching the phenomenon of failing from a student perspective.
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    The creation and development of an integrated nursing service within a rural community health team : an action research study : a thesis presented in partial fuflilment of the requirements for the degree of Master of Arts in Nursing at Massey University
    (Massey University, 1995) Cornish, Margaret Elizabeth
    This Action Research study, guided by the philosophy of Critical Social Science, was undertaken to facilitate District and Public Health Nurses working in a multidisciplinary team in a rural area to reflect on and change their practice. The goal was to explore the possibility of combing their two separate roles into one integrated role. The idea was initiated by management who anticipated that an integrated role would ensure survival of their nursing service in the competitive environment created by the New Zealand Health Reforms. The study resulted in planned participative change brought about by this nursing group. Analysis of the process increased knowledge about rural community nursing and showed that the research group created a local theory. Through their reflection the nurses isolated and related factors about their work. From this, they created a model that represented a combined nursing practice while retaining their specialist roles. Using this model the nurses planned strategies that they predicted would bring specific results. During action and evaluation, these strategies were tested and culminated in putting the emergent model into practice. The model has potential to be generalised to other community nursing groups. Analysis of data showed that many factors enhanced the change process. Observation revealed that some group dynamics also had potential to inhibit change. When analysed with the group, the nurses recognised that there was a relationship between these dynamics and their job structure, their socialisation as women and their indoctrination as nurses. It also highlighted differences between how these District and Public Health Nurses think about their work and their roles. This critical reflection increased their self understanding and ensured that any planned change was more likely to endure. For the participants, this study has resulted in a positive sense of the value of their work, a strong sense of group cohesion, a better co-ordinated communication network, and confidence in their ability to make decisions for themselves. This has, in turn, given them a stronger nursing representation within their team and organisation.
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    Nursing care delivery : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Turitea Campus, Palmerston North, New Zealand
    (Massey University, 2001) Hamilton, Charmaine Elizabeth
    The delivery of safe, efficient and effective nursing care requires knowledgeable senior executives and nurses who collaborate, have the common and primary goal of meeting patient need, and a shared understanding of nursing care delivery. The aim of this research was to explicate executives' and nurses' understanding of nursing care delivery in the Crown Health Enterprise (CHE) setting. Between March and December 1997 61 executives or senior nurses from 18 CHEs participated in semi-structured interviews. The interview tapes were transcribed and biographical details and some data relating to organisational structure were summarised. The remaining data were analysed using content analysis. Seven themes were identified. Organisational structure was seen as a self-contained entity. Systems approaches were not used. Planned, systematic and ongoing evaluation of structural change and care delivery was not evident. The resource implications of proposed changes were not canvassed. Little was known about the nature of nursing work in the CHE. There was a desire for closer links between nursing practice and nursing education. The approach to nursing research was fragmented and ad hoc. The findings indicate an overall lack of knowledge about nursing care delivery and the nature of nursing work in the reformed health care environment. It is suggested that the primary reasons for this are the paucity of international and national research on these subjects and a fragmented approach to the management and development of nursing in New Zealand. The findings also suggest a lack of sophisticated resource management and evaluation expertise. To ensure the development of innovative nursing practice/care delivery models and systems that will meet New Zealanders present and future need for nursing care it is strongly recommended that priority be given to identifying the nature and scope of nursing work. It is also recommended that: An independent nursing research unit with a capacity to carry out national and longitudinal research in nursing is established. An independent national agency to oversee the management and development of nursing in New Zealand is established. The Ministry of Health commission a review of health management education.
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    Te Arawhata o Aorua, Bridging two worlds : a grounded theory study : a thesis presented in partial fulfillment of the requirements for the degree of Masters of Philosophy in Nursing at Massey University (Albany), New Zealand
    (Massey University, 2008) Baker, Maria
    Te Arawhata o Aorua – Bridge of two worlds is a theory about Maori mental health nurses. The aim of this study was to explore what was occurring amongst Maori mental health nurses and dual competencies. A grounded theory informed by a Maori centred research approach was adopted and conducted with three focus groups of ten Maori mental health nurses situated in one metropolitan and two provincial cities. The research design was informed by Mason Durie's Maori centred concepts of whakapiki tangata (enablement), whakatuia (integration) mana Maori (control) and integrated with grounded theory to guide the collection and analysis of the data. Audio taping and field notes were used to collect the data and the processes of constant comparative analysis, theoretical sampling and saturation were used to generate a middle range substantive Maori centred grounded theory. One core category was identified as two worlds which describes the main issue that they are grappling with. The basic social psychological process of bridging of tension explains how the two worlds are managed through two subcategories of going beyond and practising differently. Going beyond consists of two components, being Maori and enduring constant challenge that set the philosophical foundation to practice. Practising differently describes three key components as kaitiaki of wairua, it's about whanau and connecting each are blended into each other and fused into nursing practice. The impressions of the Maori mental health nurses have been interpreted and explained by this theory. The substantive grounded theory provides a model to guide health services appreciation of Maori mental health nurses, for professional development of Maori mental health nurses and to policy writers.
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    How can midlife nurses be supported to deliver bedside care in the acute clinical services until retirement? : a thesis presented in partial fulfilment of the degree of Master of Philosophy (Nursing), Massey University, Turitea, Palmerston North, New Zealand
    (Massey University, 2008) Dodsworth, Caroline
    As the baby boomer generation move inexorably towards retirement and the requirement for health care services increases, the supply of nurses available to provide care at the patient bedside is forecast to fall significantly short of demand. This thesis has explored the perspectives of midlife nurses, asking what it would take to keep them in bedside practice until retirement. These nurses have provided insights which offer employers of valuable senior nurses, suggestions for maximising their potential. Through the use of questionnaires and focus groups nurses aged 45 years and over were asked what the employer can do to ensure that they are able to continue to work at the patient bedside until they reach the age of retirement. The results of this research demonstrate a workforce of nurses who are passionate and committed to their profession, but feeling disillusioned and disempowered. The nursing environment has changed over the span of their career and they find the increased workload, together with increasing professional demands, too hard to cope with. They feel they have no control over their workload, their shift patterns, or the expectations of their patients and colleagues. They want their experience to be recognized but they do not want to have to prove competency; they want to have a voice but they are unwilling to pursue postgraduate education to learn how to become visible and emancipated.
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    The New Zealand nurse practitioner polemic : a discourse analysis : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing, Massey University, Wellington, New Zealand
    (Massey University, 2007) Wilkinson, Jillian Ann
    The purpose of this research has been to trace the development of the nurse practitioner role in New Zealand. Established in 2001, this advanced nursing practice role was birthed amid controversy as historical forces at play both inside and outside nursing struggled for power to control the future of the profession. Using a discourse analytical approach informed by the work of Michel Foucault, the study foregrounds the discourses that have constructed the nurse practitioner role within the New Zealand social and political context. Discourses, as explained by Foucault, are bodies of knowledge construed to be ‘truth’ and connected to power by reason of this assumption, serving to fix norms and making it virtually impossible to think outside them. Discourses of nursing and of medicine have established systems of disciplinary practices that produce nurses and physicians within defined role boundaries, not because of legislation, but because discourse has constructed certain rules. The nurse practitioner role transcends those boundaries and offers the possibility of a new and potentially more liberating identity for nurses and nursing. A plural approach of both textuality and discursivity was used to guide the analysis of texts chosen from published literature and from nine interviews conducted with individuals who have been influential in the unfolding of the nurse practitioner role. Both professionally and industrially and in academic and regulatory terms dating back to the Nurses Registration Act, 1901, the political discourses and disciplinary practices serving to position nurses in the health care sector and to represent nursing are examined. The play of these forces has created an interstice from which the nurse practitioner role in New Zealand could emerge. In combination with a new state regime of primary health care, the notion of an autonomous nursing profession in both practice and regulation has challenged medicine’s traditional right to surveillance of nursing practice. Through a kind of regulated freedom, the availability of assessment, diagnostic and prescribing practices within a nursing discourse signals a radical shift in how nursing can be represented. The nurse practitioner polemic has revolutionised the nursing subject, and may in turn lead to a qualitatively different health service.