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Item Safeguarding the practices of nursing : the lived experience of being-as preceptor to undergraduate student nurses in acute care settings : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Albany, New Zealand(Massey University, 2001) Rummel, Louise G.An Heideggerian Hermeneutic approach has been adopted to explore the experience of being-as preceptor to undergraduate student nurses in the acute care setting. This thesis addresses the question: What is the experience of being a preceptor to undergraduate student nurses in an acute care setting? Fifteen preceptor-participants were interviewed twice, with each interview being approximately one hour. Heideggerian Hermeneutical Analysis was used to reveal the experience of preceptors as they precept undergraduate student nurses. The thesis begins by placing nursing education in an historical, socio-political and professional context that provides the background to current New Zealand nursing practice. Student nurses undergoing their nursing education learn the meaning of being a nurse in many different contexts. This research is situated in the acute care context where both preceptors and student nurses engage in the practice of nursing. The methodological background shapes the way the research is presented to explicate the meaning of being-as preceptor. The four data chapters reveal the preceptors' experience and open with dialogue showing how nurses become preceptors. This is followed by exploration of how preceptors assessed where the student was at, moves to preceptors promoting learning and closes with discussion of how preceptors keep students and patients safe. Many practices were uncovered during the revelations of the preceptors as they disclosed to the researcher narratives of their everyday practice world. Common themes that emerge from the data include: Becoming attuned- the call, The Emerging Identity of 'being-as' Preceptor: Keeping the student in mind, Assessing where the student is at: The Preceptor and Preceptee Working and Growing Together, and The Preceptor as Builder of Nursing Practice: Teaching Reality Nursing. A number of common themes support the relational themes which are of greater complexity. A constitutive pattern, the highest form of interpretation that emerges from the data, was Safeguarding the Practices of Nursing. This constitutive pattern lies within every text either directly or is inferred from each participant's dialogue. It contains the central meaning of the thesis. It is constituted from common and relational themes as they present themselves in the analytical process. In this thesis the experience of being-as preceptor is unveiled through the participants' own words as the researcher takes the reader back to the 'things themselves' as is espoused by hermeneutic phenomenology.Item The everyday always-thereness of living with rheumatoid arthritis : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Albany, New Zealand(Massey University, 2001) Roy, DianneThis study explores the phenomenon of 'living with rheumatoid arthritis'. Utilising a hermeneutic phenomenological methodology informed by the writings of Martin Heidegger and Hans-Georg Gadamer, the study provides an understanding of the meaning the phenomenon has for the participants and illustrates the impact it has had on their lives. The participants in the study were twenty-five people who have varying experiences of the phenomenon. Eleven participants were people who have the disease, six were partners of people who have rheumatoid arthritis, and eight were adult-aged children whose mother or father has the disease. Drawing primarily on the stories shared by the participants, the study uncovers the everyday realities of living with rheumatoid arthritis and it reveals the taken-for-granted nature of the experience. The interpretation offered in the thesis raises new understandings of the complex phenomenon of 'living with rheumatoid arthritis'. The findings of this thesis show that rheumatoid arthritis is always there in the lives of those who experience the phenomenon, whether as partners, adult children, or the person with the disease. In its always-thereness rheumatoid arthritis becomes part of the background familiarity of their lives. Those who live with rheumatoid arthritis take the experience with them into all other worlds. It permeates, to varying degrees, all aspects of their lives. In the presence of rheumatoid arthritis different things matter and things matter differently. Living with rheumatoid arthritis means finding a new way of being-in-the-world. It means developing and maintaining strategies for being-in-the-world with rheumatoid arthritis. As the strategies are developed, these people come to live in the world in an everyday way that in itself becomes taken-for-granted. They, as I suggest, come to live resolutely with the disease. However, living resolutely with rheumatoid arthritis is always tenuous and at the beck and call of the disease and a myriad of other influences. Resoluteness in the everydayness of living with rheumatoid arthritis can be lost at any time, in any way. Living with rheumatoid arthritis becomes a cycle of always working towards and maintaining the everydayness of resolute coping, while knowing it may be lost at any moment, which will necessitate coming again to pick up the strategies that bring one back to a taken-for-granted everydayness.Item On the margins: nurses and the intermittent care of people with dementia : a discourse analysis : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Palmerston North, New Zealand(Massey University, 2001) Gilmour, Jean AlisonThe purpose of this research has been to explore the representations and practices of nurses in the context of intermittent care for people with dementia, and to situate their accounts within the wider discourses of dementia care. Discourse, as explicated by Michel Foucault, is the body of knowledge, and the related disciplinary practices, that can be considered to be the truth at a particular time, shaping what is possible to be said, and with the associated power to exclude what cannot be said. In the first section of the thesis it is argued that the concept of dementia is not the description of some pre-determined biological phenomenon but a powerful disciplinary construction informed by a specific historical and cultural perspective, a construction that has major policy implications and ramifications for the representations of dementing illnesses in disciplines such as nursing. Section two of the thesis shifts from the disciplinary representations of dementia produced in published texts, to the representations and everyday practices of the nurses and families who participated in this study. While all the nurses' texts represented the care of the person with dementia as problematic, at times, in the institutional setting, there was considerable diversity apparent in nurses' discursive positionings, and in the associated practices and inscriptions of the person with dementia. The organisational context emerged as a major factor influencing those discursive choices and practices. One research site provided particularly successful respite care as judged by family caregivers' expressions of confidence in the service. The dominant nursing discourse in this site framed the hospital as home-like and the relationship with patients as being family-like. The permeability of social and geographic boundaries at this research site signaled inclusion for family and patients in contrast to the more traditional boundaries demarcating social and physical spaces evident in the other sites. This study highlights the institutional bases of powerful discourses such as biomedicine as well as the existence of alternative discourses. The marginal discourse of care as being family and home-like may lack the authority of biomedical and formal nursing discourses, situated as it were outside the academy, but space is provided in this representation to produce a social environment, and nursing practices, that encourage a sense of relationship and social inclusion for people with dementia and their family caregivers. Dementia has proved to be a fruitful area of study in that the current dominance of biomedical knowledge in nursing literature can be challenged as being marginal to nursing concerns. The subsequence discussion of how nurses have suppressed the knowledge and interests of people with dementia and, indeed, the knowledge of nurses themselves, provides a productive starting point for wider discussion about issues of power/knowledge in nursing representations generally.Item "Linking as one" : an intimate breastfeeding moment : a thesis presented in fulfillment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Palmerston North, New Zealand(Massey University, 2001) Dignam, Denise MiriamBreastfeeding is more than the act of providing nutrition to an infant. It is a dynamic interpersonal process, frequently suggested by both women and authors to be an intimate activity. Health professionals have tended to explore the biophysical aspects of breastfeeding largely ignoring the breastfeeding woman's perspective and the effect social and psychological processes have on breastfeeding success. This grounded theory study drew on a range of data sources to describe breastfeeding womens' experience of intimacy. Data included interviews with twenty women participants, observational field notes, theoretical memos, drawings, literature and pictorial work. The study supported the premise that women experienced moments of intimacy when breastfeeding. Breastfeeding is represented in the basic social psychological process 'linking as one'. Linking as one is the intimate act of gifting, for comfort, pleasure and growth, human milk and human contact to a baby or child. 'Linking as one' is mutually exclusive and mutually satisfying to both participants. It is not all women's experience nor is it associated with every breastfeeding encounter. The findings support a substantive descriptive model of the breastfeeding process that represents and facilitates intimate breastfeeding moments. The model provides a framework for theoretical research, which may lead to further conceptual refinement. The model also provides a framework for education curricula and nursing clinical practice. Clinical application includes the use of concepts as prompts from which to explore interpersonal breastfeeding dynamics with breastfeeding clients. The concepts include breastfeeding comfort, ownership of the breast, mutual gifting and knowing. Exploration of these concepts may enable breastfeeding women to maintain and promote successful breastfeeding experiences.Item Evaluation of community level interventions to address social and structural determinants of health: a cluster randomised controlled trial(BioMed Central, 2009-06-28) Wall, Martin; Hayes, Richard; Moore, Derek; Petticrew, Mark; Clow, Angela; Schmidt, Elena; Draper, Alizon; Lock, Karen; Lynch, Rebecca; Renton, AdrianBackground: In London and the rest of the UK, diseases associated with poor diet, inadequate physical activity and mental illness account for a large proportion of area based health inequality. There is a lack of evidence on interventions promoting healthier behaviours especially in marginalised populations, at a structural or ecological level and utilising a community development approach. The Well London project financed by the Big Lottery 'Wellbeing' Fund and implemented by a consortium of London based agencies led by the Greater London Authority and the London Health Commission is implementing a set of complex interventions across 20 deprived areas of London. The interventions focus on healthy eating, healthy physical activity and mental health and wellbeing and are designed and executed with community participation complementing existing facilities and services. Methods/Design: The programme will be evaluated through a cluster randomised controlled trial. Forty areas across London were chosen based on deprivation scores. Areas were characterised by high proportion of Black and Minority Ethnic residents, worklessness, ill-health and poor physical environments. Twenty areas were randomly assigned to the intervention arm of Well London project and twenty 'matched' areas assigned as controls. Measures of physical activity, diet and mental health are collected at start and end of the project and compared to assess impact. The quantitative element will be complemented by a longitudinal qualitative study elucidating pathways of influence between intervention activities and health outcomes. A related element of the study investigates the health-related aspects of the structural and ecological characteristics of the project areas. The project 'process' will also be evaluated. Discussion: The size of the project and the fact that the interventions are 'complex' in the sense that firstly, there are a number of interacting components with a wide range of groups and organisational levels targeted by the intervention, and secondly, a degree of flexibility or tailoring of the intervention, makes this trial potentially very useful in providing evidence of the types of activities that can be used to address chronic health problems in communities suffering from multiple deprivation. Trial Registration: Current Controlled Trials ISRCTN68175121Item Creating intoxigenic environments: Marketing alcohol to young people in Aotearoa New Zealand(Elsevier, 2008-09) McCreanor, Tim; Moewaka Barnes, Helen; Kaiwai, Hector; Borell, Suaree; Gregory, AmandaAlcohol consumption among young people in New Zealand is on the rise. Given the broad array of acute and chronic harms that arise from this trend, it is a major cause for alarm and it is imperative that we improve our knowledge of key drivers of youth drinking. Changes wrought by the neoliberal political climate of deregulation that characterised the last two decades in many countries including Aotearoa New Zealand have transformed the availability of alcohol to young people. Commercial development of youth alcohol markets has seen the emergence of new environments, cultures and practices around drinking and intoxication but the ways in which these changes are interpreted and taken up is not well understood. This paper reports findings from a qualitative research project investigating the meaning-making practices of young people in New Zealand in response to alcohol marketing. Research data included group interviews with a range of Maori and Pakeha young people at three time periods. Thematic analyses of the youth data on usages of marketing materials indicate naturalisation of tropes of alcohol intoxication. We show how marketing is used and enjoyed in youth discourses creating and maintaining what we refer to as intoxigenic social environments. The implications are considered in light of the growing exposure of young people to alcohol marketing in a discussion of strategies to manage and mitigate its impacts on behaviour and consumption.Item Consuming identities: alcohol marketing and the commodification of youth experience(Informa Healthcare, 2005-12) McCreanor, Tim; Moewaka Barnes, Helen; Gregory, Mandi; Kaiwai, Hector; Borell, SuareeMarketing has successfully used the postmodern turn in conceptualisations of the human subject and incorporated contemporary theorising of identities and self into its understanding of the key drivers of consumption. Such developments clearly converge in alcohol marketing practices that target young people where commercialized youth identities available for consumption and engagement are a significant element. This paper reports data from young people that reflect the uptake of such identities and considers the challenges that these developments represent for public health and the wellbeing of young people.Item Resiliency, Connectivity and Environments: Their roles in theorizing approaches to the promoting the wellbeing of young people(Clifford Beers Foundation, 2004-02) McCreanor, Tim; Watson, PeterEarly theory and findings in the area of resilience among young people emphasised individual differences and personality characteristics to explain different reactions to stress and risk. The ‘modern’ resiliency literature views the possible explanatory variables for different outcomes in broader contexts such as family, schools and community. Despite this change over time the individualising, problem focused orientation of resilience approaches continues to obscure the environment, leaving it an under-interrogated factor in youth wellbeing. The importance of this rests on its impact on policy and practice in the fields of youth development and health promotion. In this paper we argue that contemporary resiliency theory and research continue to fall short of the paradigm shift called for by those orienting to environmentally-based public health measures to improve population level wellbeing among young people.Item Youth identity formation and contemporary alcohol marketing(Taylor & Francis, 2005) McCreanor TN; Greenaway A; Moewaka Barnes HE; Borell SS; Gregory MJThis paper considers linkages between contemporary marketing theory and practice, and emerging conceptualizations of identity, to discuss implications for public health concerns over alcohol use among young people. Particular attention is paid to the theorizing of consumption as a component of youth identities and the ways in which developments of marketing praxis orients to such schemata. The authors' analyses of exemplars of marketing materials in use in Aotearoa New Zealand, drawn from their research archive, emphasize the sophistication and power of such forms of marketing. They argue that public health policy and practice must respond to the interweaving of marketing and the self-making practices of young people to counter this complex threat to the health and well-being of young people. © 2005 Taylor & Francis.Item Maori family culture: a context of youth development in Counties/Manukau(Royal Society of New Zealand, 2007) Edwards, Shane; McCreanor, Tim; Moewaka Barnes, HelenThis paper reports on a study designed to bring the voices of young people directly into the social science literature on environmental influences on wellbeing. We analyse accounts from young Maori about their families and the roles they play in their lives in order to focus on strengths and positive resources for the promotion of youth wellbeing. Interview data were gathered from 12 females and 15 males, aged between 12 and 25 years, resident in the Counties/Manukau region. Participants who were managing satisfactorily in their lives were purposively selected for diversity of background and circumstances. Our “lifestory” approach sought narrative accounts of both everyday experience and the highs and lows of life; data were transcribed verbatim and analysed using discursive methods. Clusters of themes relating to family environments including relationships with parents, siblings and extended kin groups emerged. Participants provided detailed and nuanced accounts of family cultures, reporting on conflict, caring, gender issues, sensitivity, discipline, levels of guidance and forms of support.
