School of Health and Social Services

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Start date: 2000Subject: search.filters.subject.Nursing

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    In search of nursing : the long-term impact of the New Zealand health reforms on ward nursing : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Manawatu, New Zealand
    (Massey University, 2012) Teekman, Englebert Cornelis
    This thesis began with my curiosity about why, despite repeated attention to nurses’ health assessment skills (at undergraduate and professional development level), it has remained an under-utilised skill. A focused ethnography was conducted in six acute wards of a provincial New Zealand hospital. Twelve registered nurses were observed and interviewed in the first phase of the research and multiple additional primary data sources were utilised. Early findings indicated that nurses did not undertake health assessment and raised much broader questions about the nature of ward nursing practice and the amount of control ward nurses have over their work environment and their own nursing practice. The research was extended to include seven stakeholders, senior nurses who had good insight and knowledge of ward nursing practice. A structuration theory lens was applied to assist in the analytic process. The findings of this research reveal the long-term impact of the NZ health reforms on ward nursing practice. The introduction of generic management principles and the continuous restructuring of the health care environment have impacted on nursing practice and reduced nurses’ autonomy. Nurses have come to rely on standardised documented processes to provide essential care, relying significantly less on knowledge of a patient’s actual health status. Much recent local and international quantitative research has revealed a number of concerning findings about the reduced time nurses spend at the bedside, the complexity of nursing work flow, the increase in interruptions, missed nursing care, and the vital role nurses have in preventing many adverse events and unexpected deaths. This thesis provides a rich qualitative understanding of the circumstances behind these quantitative findings and reveals that nurses are now struggling to provide care consistent with the ethos of nursing. I argue that challenging the nature of nurse education will not improve nurses’ ability to deliver nursing care. Instead I argue that the current acute ward environment does not support registered nurses to provide the nature of care for which their education has prepared them.
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    Living large : the experiences of large-bodied women when accessing general practice services : a thesis presented in partial fulfillment of the requirements for the degree of Master of Philosophy (Nursing) at Massey University, Palmerston North, New Zealand
    (Massey University, 2011) Russell, Nicola
    The ‘obesity epidemic’ of the past two decades has resulted in numerous studies reporting higher levels of stigma and discrimination experienced by obese/overweight women, both within the health care system and society in the main. Despite general practice being the most utilised point of access for health care services, there has been very little international or national exploration of the experiences of large-bodied women accessing these services. Utilising a qualitative, descriptive research design, this post-structuralist feminist study has enabled a group of large-bodied women to express their stories of accessing general practice services. Eight self identified large-bodied women volunteered to participate in semi-structured face-to-face interviews. Thematic analysis identified seven themes: Early experiences of body perception, Confronting social stereotypes, Contending with feminine beauty ideals, Perceptions of health, Pursuing health, Respecting the whole person and Feeling safe to access care. The women in this study articulated broader interpretations of health and well-being than those teachings reproduced within dominant bio-medical and social discourses of obesity. When these women’s personal context, beliefs and values are silenced by the health care provider, the rhetoric of health care professional claims of patient-centred care has given way to these women experiencing stigmatisation and a sense of ambiguity about general practice services. However, when space is given for multiple interpretations of obesity to exist within the patient-health care provider relationship, these women feel respected, their health needs are satisfied and they are more comfortable to engage in health screening services. Resisting the powerful socio-cultural milieu which supports the superiority of a slim female body as a signifier of both health and beauty presents a challenge for health care professionals to negotiate. I contend however, that giving consideration to the perspectives of large-bodied women and critically reflecting upon one’s own personal beliefs and attitudes about the overweight/obese, presents an opportunity to ensure clinical practice for this population is truly patient-centred.
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    Implementing a Critical Care Outreach Team : what difference has it made for nurses? : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University, Albany, New Zealand
    (Massey University, 2011) Davies, Kathryn Erin
    The aim of this study is to describe the implementation of Critical Care Outreach (CCO) and to understand what difference implementing a Critical Care Outreach Team (CCOT) has made to ward nurses in a secondary level general hospital in New Zealand. A CCOT was established at the study hospital in 2006. The aim was to implement an early warning score, to provide education and to share appropriate intensive care skills from CCOT nurses on the wards. Additionally, patients discharged from the Intensive Care Unit were to be followed up. The difference this made to ward nurses in this hospital was unclear. International studies had reported suboptimal patient care on acute wards and the emergence of CCOTs. Research was warranted to gain an understanding of the impact of the service on ward nurses. The methodology chosen for the study was case study, and was underpinned by Change Management Theory and elements of whole system reform (Fullan, 2010). Fullan’s (2007) Change Management Theory of a three phased approach to change management, initiation, implementation and institutionalisation was selected for the study. Data was collected from a nursing focus group, three interviews, and District Health Board documents related to the CCOT. Interviews and nursing focus group data were analysed by thematic analysis and documents analysed by subject. Implementing the CCOT facilitated the shift of late recognition/late intervention of patients to early recognition/early intervention. An area of whole hospital reform occurred. The use of an early warning score promoted more timely patient review, communication between nurses and doctors, improved observation frequency and an environment of objectivity developed. Nurses benefited from education, were empowered to escalate patient concerns, improved their assessment and specific clinical skills, and reported that they were supported by the CCOT. The CCOT has had a positive effect on the early recognition and early intervention of the physiologically unstable patient. The challenge to New Zealand nursing now is to continue to build on the evidence from this study that CCOT has a beneficial impact on ward nurses. The challenge to the District Health Board is to preserve CCOT to ensure that nurses are supported and late recognition/late intervention is truly a phenomenon of the past.
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    Responding to the call to care : women's experience of breastfeeding in New Zealand : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Wellington, New Zealand
    (Massey University, 2004) McBride-Henry, Karen Sharee
    New Zealand breastfeeding experts have long contended that New Zealand does not have a breastfeeding culture, as demonstrated by anecdotal evidence suggesting that women find breastfeeding difficult to initiate and sustain. A review of the literature indicates that, in New Zealand, breastfeeding knowledge falls within the domain of health care professionals, which marginalises women's own experiential knowledge about breastfeeding. Therefore, this study explores the experience of breastfeeding for women in New Zealand. A reflective lifeworld research methodology underpins this study, allowing the participants' narratives to be explored without the use of pre-existing theoretical frameworks that may close down on aspects of the interpretive analysis. Nineteen women were interviewed for this study, all of whom were New Zealanders who were either breastfeeding at the time of the interviews, or had breastfed within the last two years. Many of the participants had breastfed more than one child. What emerges as the central thesis of this study is that breastfeeding is a priori to unique embodied experiences. A number of sub-themes, which further explicate this central thesis, include: the silencing of the reality of breastfeeding within the public domain, the pervasive influence of society, or 'the they', through the accepted frameworks by which breastfeeding women interpret their individual breastfeeding experiences, and breastfeeding as a means of facilitating close relationships between women and their infants. The findings of this study will assist health care professionals working alongside breastfeeding women, as it offers fresh understandings of what it is to be a breastfeeding woman. It is important that health care professionals lay aside their previously-held perceptions about breastfeeding, and pay careful attention to individual women's experiences prior to planning interventions. If health care professionals value women's embodied breastfeeding narratives, women will be supported to articulate their breastfeeding experiences, thereby increasing women's confidence in their embodied breastfeeding knowledge and capabilities
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    'A kind of ritual Pakeha tikanga'-- Maori experiences of hospitalisation : a case study : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University (Albany), New Zealand
    (Massey University, 2008) Barton, Pipi
    Minimal literature exists relating to the experiences of Maori within the New Zealand public hospital system. Maori are highly represented in morbidity and mortality statistics and are high users of the secondary health care system. A Case Study methodology with a Maori centred approach was used to describe Maori experiences of hospitalisation. Multiple sources of evidence were gathered, including participant interviews, statistical data from the New Zealand Health Information Service, and international literature relating to indigenous experiences of hospitalisation. Eleven people (nine female and two males) identifying as Maori, of various iwi (tribal) affiliations and from a range of regions, participated in the interviews. All participants had either been admitted, or cared for by a family member who had been admitted to a medical or surgical ward in a public hospital anywhere in New Zealand within the last 15 years. Participants were aged between 20 to 75 years. All interviews were audio recorded, transcribed and then thematically analysed. A retrospective interrupted time series design was used to examine length of stay for Maori patients receiving treatment in the secondary medical and surgical setting, from 1989-2004. The data included the records of all medical and surgical discharges for Maori and non-Maori from the New Zealand public hospitals. Medical and surgical admissions were screened to include those over the age of 17 years and who had a length of stay greater than 1 day and less than 90 days. From the analysis of all the data three key interpretations emerged: 1. Maori are marginalised within the mainstream health system. 2. Maori believe that the hospital environment is not conducive to healing. 3. Maori experiences in hospital contribute to their decision to leave as soon as possible. The recommendations include the integration of more culturally acceptable and appropriate interventions within secondary and tertiary health services, and a review of the effectiveness of cultural safety education in practice and inclusion/revision of the cultural competence for all health care workers.
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    Qualitative description of the adult patient experience of cancer-related cachexia (CRC) : a pilot study : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing, Massey University, Palmerston North, New Zealand
    (Massey University, 2008) Stubbs, Marika Jane
    This thesis explores the experience of living with cancer-related cachexia (CRC) from the patient perspective. Critique of the literature indicates few examples where patients have had the opportunity to speak. Following a challenging recruitment process, six people living with the syndrome were interviewed to elicit their narrative. Their stories were examined and themes identified relating to their personal feelings and how these affected social interactions. Thematic analysis was applied to produce what is a rich qualitative description of the experience from this small sample. Living with CRC requires development of strategies to survive. Emergent themes included the loss of sense of self and a changing relationship to the social world, social isolation and dissatisfaction with truth-telling by health professionals. Recommendations are made to mitigate the suffering of patients by empowering them through better information and acknowledgement of their condition. The balance between nutrition and wellbeing is re-examined, calling for a reorientation of perspective from a focus on intake towards a focus on quality of life. This clearly falls within the nurse-as patient-advocate paradigm and the relevance and meaning of this research to the nursing profession is explored. Potential areas for further research in regards to both patient experience and nursing practice are extrapolated.
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    A qualitative exploration of emotional competence and its relevance to nursing relationships : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University, Palmerston North, New Zealand
    (Massey University. School of Health Sciences, 2005) Wilson, Stacey Caroline
    This qualitative research project explored the experiences of nurse educators who sought to assess aspects, which could be related to facilitation of emotional competence, in nursing students. Focus groups were conducted in three different educational institutions, offering a Bachelor of nursing degree. Each of the participants had a teaching and assessment role within the school of nursing. The contributions of the nurse educators and their interactions were audio taped, transcribed and then later, analysed using thematic and focus group analysis practices.From the analysis of the experiences of the nurse educators, four predominant themes arose which capture the areas of importance to the participants. Student nurses can develop emotional competence by critically reflecting during classroom and clinical experiences. Continuous consideration must be made within each practicing area of nursing, of the environmental and relational challenges which inhibit or facilitate nurse's ability to practice with emotional competence. Educators and practicing nurses, who work alongside students, must uphold the expectation that emotional competence is a requisite ability and provide opportunities to foster emotional growth and skills to resolve conflict within the culture of nursing.A common view shared by the educators was that the profession of nursing needs to have a clear understanding of what constitutes emotional competence. Strategies to realistically incorporate emotional competence into the educational curriculum and competency based assessment opportunities within nursing education are required.Suggestions are presented from which undergraduate nursing education can facilitate development of emotional competence with those students working toward becoming a registered nurse. Emotional competence is suggested as an essential learning outcome in the movement toward transformative nursing education and a collaborative nursing profession.