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    Social indicators and geographic research : an exploratory study of spatial variations in the provision of community services and accommodation for elderly people in New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in geography at Massey University
    (Massey University, 1974) Britton, Stephen Graham
    Social Research and Social Learning: The operation of the welfare state system in New Zealand has undoubtedly shaped the national character and influenced at least implicitly, national socio-economic values.1 "A Welfare State is a state in which organised power is deliberately used (through politics and administration) in an effort to modify the play of market forces in at least three directions - first by guaranteeing individuals and families a minimum income irrespective of the market value of their property : secondly by narrowing the extent of insecurity by enabling individuals to meet certain "social contingencies" (for example: sickness, old age and unemployment) which lead otherwise to individual and family crises: and thirdly, by ensuring that all citizens without distinction of status or class are offered the best standard available in relation to a certain agreed range of social services". (Briggs : In Jones 1973 : 65). While several writers have documented the tangible benefits this system has offered to the nation as a whole and various social groups in particular (Baker 1955, Condliffe 1959, Scott 1955 and Sutch 1971) the welfare state concept as practiced in New Zealand has never been geared to actually anticipate or cope with any socio-economic problem outside its limited frame of application. While the Welfare State system originated in the depression era and gained strength into the 1950's, social demands today are increasingly less concerned with what Dunn (1971 : 183) has termed "deficit motives". What is now more worthy of consideration is a system of social organisation and administration that meets the human development motives of an affluent and dynamic society - demands that are not usually considered in the realm of national and political decision making. The need for a shift in the socio-political responsibilities of government was officially recognised in New Zealand at the 1969 National Development Conference, (N. D. C.). The various N. D. C. bodies identified vague and general areas of social concern outside of those issues confronted by the Welfare State system as being worthy of inclusion in Government responsibility. The National Development Conference also revealed to New Zealand government administrators that virtually no action was possible to remedy undesirable states, even if government was prepared to respond, simply because so little was known about the social phenomena in question, and only inadequate information was available on the existing states of New Zealand society. Moreover, there were few documented guidelines to suggest the future trends in New Zealand society and, indeed, what direction New Zealanders might prefer their society to take. New Zealand decision-makers and researchers were lacking in the fundamental tools for planning current and future states and coping with dysfunctions in many social fields. Data deficiencies are further exacerbated by the absence of any background of social inquiry outside of the economic sphere of national and social planning.
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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.