School of Health and Social Services

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    Schizophrenia, a way of being-in-the-world : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University
    (Massey University, 1995) Walton, Jo Ann; Walton, Jo Ann
    This phenomenological study describes what it is like to live with a schizophrenic illness and relates the understanding gained from this descripton to implications for nursing practice. The participants in the study were ten adults who have been diagnosed with schizophrenia, who take regular medication and who are living independent lives in the community. Over a period of sixteen months they were interviewed about the effects of the illness on their everyday lives. During this time they explained the challenges and difficulties which have faced them, both during and long after the resolution of acute illness. As they describe it, schizophrenia is a part of who they are. The narrative contained in this thesis presents the participants' stories in aggregated form, setting their experiences alongside ideas from the early work of Martin Heidegger, whose phenomenological writing informed the analysis and interpretation of the data. As the participants explain, schizophrenia has touched every aspect of their lives. Living with schizophrenia is shown to affect their whole Being-in-the-world. It incorporates Being-with-others, living carefully and taking a stand on life. While hoping for a cure, their reality is of living with a chronic illness which has major effects on their lives. At the same time the participants are shown to define themselves not in terms of their illness and treatment, but in respect of their hopes and dreams and the stance each is taking on his or her own life. In this way their existential predicament is highlighted in the study. Participants are on the one hand very much like all other people, while on the other hand they have to contend with very different concerns than do most others. In itself the description of the experience of schizophrenia contained in the thesis is useful for its potential to increase understanding of the illness by nurses and other health professionals. Further than this, however, the study is shown to have implications in terms of nursing practice and the provision of health care. With regard to the seriously mentally ill the data bring into question some of the theoretical positions which have held sway in nursing for many years. The research demonstrates that it is practicable to attend to the subjective experiences of people who suffer from schizophrenia and to understand their needs and desires from the position of fellow human being, without the need for a guiding theory from which to interpret what they are saying or what their words "really mean." It is argued that relationships between nurses and clients which are based on understanding and trust rather than distance hold promise in the care of those with schizophrenia. Heidegger's concept of solicitude as care for others is addressed in this regard, and is shown to be most appropriate as a basis for nursing care in the mental health arena.
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    From the ward to the home : caring for a family member diagnosed with schizophrenia in New Zealand : this thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Social Policy and Social Work at Massey University
    (Massey University, 1996) Richards-Ward, Leigh Anne; Richards-Ward, Leigh Anne
    The research question examined in this thesis is: 'What are the characteristics and complexities of the informal care provided within a family to a member diagnosed with schizophrenia, in New Zealand? This research question is divided into two parts. The first part examines the characteristics and complexities of the unpaid caring work provided to a family member diagnosed with schizophrenia and the second part explores how this care provision is influenced by the social, political, cultural, legal and economic context of New Zealand. This research is important because first, very little is known about the process and interpretation of care provided to a family member diagnosed with schizophrenia and second, New Zealand places great emphasis upon deinstitutionalisation and community care. Ten women and four of their husbands were invited to participate in this research. These women were the primary informal care-givers of a family member who had experienced the cyclical acute and chronic episodes of schizophrenia. The women's husbands filled a secondary supporting role in relation to the women. The women met to identify themes related to their informal care provision. These themes were translated into an interview guide which acted as a prompt for the researcher while the women and men were articulating their stories of care-giving. Foremost amongst the findings of this research was that the dominant understandings of care should be extended in order to reflect the informal care provided to a family member diagnosed with schizophrenia. The men supported the women's care provision which reflected their family member's unpredictable, changeable and cyclical symptoms of schizophrenia. It was characterised by the primacy of supervision and monitoring and was provided on a continual (flat-line) basis. It was also established that the women were finding it increasingly difficult to meet their informal caring responsibilities, these responsibilities being increased and extended by the Government's actions to reduce both state expenditure and state caring responsibilities. The difficulty the women were experiencing in meeting the complex and changing care needs of their family member indicated that a continuum of care needs to be provided. It is argued that a continuum of care will need to include early intervention services, a range of community-based and institutionally-based mental health services, and a review of the definition of 'mentally disordered' contained within the Mental Health (Compulsory Assessment and Treatment) Act 1992. In order to coordinate and provide such a continuum of care, state, community and family caring responsibilities need to be combined, these three caring agents working collaboratively.