http://hdl.handle.net/10179/1264 Tue, 23 Jan 2018 17:23:12 GMT 2018-01-23T17:23:12Z http://hdl.handle.net/10179/5367 Living with acute coronary syndrome and prediabetes : an interpretive description of complex illness : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Wellington, New Zealand Van Wissen, Kim The purpose of this research is to reveal the experience and interpretation people have of cardiovascular disease (CVD) and prediabetes as complex illness. CVD and diabetes are both increasing in prevalence in New Zealand and globally. Prediabetes is known to be precursory to type 2 diabetes; CVD and prediabetes are fast becoming an established comorbidity. As the prevalence of complex illness soars, the experience and interpretation people have of their condition requires deeper appreciation by nurses as members of a practice discipline. This doctoral research draws attention to the experiences as interpreted by participants and subsequently by the researcher, using interpretive description informed by Gadamer and Merleau-Ponty. Thirty three participants with CVD and prediabetes were recruited into this study. Open ended interviews were undertaken in hospital before discharge and then approximately 9 months later in the community. Interviews were transcribed, data managed by NVivo 9 software, data analysed using thematic analysis, and a thematic framework was developed to organise themes. The overarching theme is in/conspicuous detail indicating the visible and the invisible elements of complex illness. The two major themes, invisible disequilibrium and dialogue as caring, foreground further subthemes and embedded subthemes. The major theme invisible disequilibrium describes the experience of illness and is supported by three subthemes: losing equilibrium, becoming embattled and making sense of evolving illness. The second major theme dialogue as caring interprets the experiences participants had and is supported by subthemes: restorative dialogue, caring and constructing illness. Major findings indicate that complex illness is heterogeneous and participants were continually working with and making sense of the conspicuous and less conspicuous detail of ‘the whole’. Further findings include the proclivity of risk (choice) as a function of participants’ lifestyle such as diet type, activity levels, understanding of medications, plus how this risk may in the longer term cause disease and illness. A third major finding is that participants focussed on self-care as part of their construction of illness. This research provided insights into the experiences of people with CVD and prediabetes. It also showed that complex illness is the occurrence of an intricate meshing of personal circumstances, signs and symptoms that requires attending to needs as identified by the patient. This continues the debate concerning how illness affects the lives of individuals, potentially influencing future service planning. Tue, 01 Jan 2013 00:00:00 GMT http://hdl.handle.net/10179/5367 2013-01-01T00:00:00Z http://hdl.handle.net/10179/4772 Making sense of the Director of Nursing structural positioning in New Zealand public hospitals (2006-2012) : a thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Massey University Hughes, Kerri-ann This dissertation reports on research examining and analyzing nursing leadership structures in New Zealand public hospitals, and in particular, the Director of Nursing (DoN) structural positioning. Leadership in hospital nursing is critical if the profession is to meet the challenges facing health services in the 21st century. The research has been undertaken using case study methodology and focuses on how organizational decision-making structures have impacted on nursing leadership in public hospitals. ‘Sense-making’ has been used as a theoretical construct to understand both the formal and informal structures that influence organizational decision-making. Phase one of the research involved examining twenty District Health Board (DHB) organizational and nursing charts. In phase two and three, the Directors of Nursing (DoNs) and the Chief Executive Officers (CEOs) were surveyed using a series of demographic and qualitative questions to draw out understanding of the Director of Nursing (DoN) role. The research has found that the constructs of power and authority influence the decision making processes at the executive level of the DHB. An analysis of the data indicates that the current structural positioning of the DoN is hindered by the existing dual accountability line reporting structures in DHBs and this is a barrier to alignment with Magnet hospital principles which provide evidence of effective patient outcomes. The focus primarily adopted by District Health Boards on professional line reporting only for nursing is not conducive to achieving effective and safe patient outcomes as it removes authority from the DoN and yet places unrealisticexpectations on accountability of how the DoN can achieve effective and safe patient outcomes within the public hospital setting. Content removed due to copyright reasons: Hughes, K.-A., & Carryer, J.B. Nursing structures in New Zealand public hospitals: Current configurations. Policy, Politics & Nursing Practice, XX(X), 1-10. doi: 10.1177/1527154410393978 Tue, 01 Jan 2013 00:00:00 GMT http://hdl.handle.net/10179/4772 2013-01-01T00:00:00Z http://hdl.handle.net/10179/4729 He iwi ke koutou, he iwi ke matou, engari i tenei wa, tatou, tatou e = You are different, we are different, but we are able to work together : Family Partnership as a model for cultural responsiveness in a Well Child context : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University, Albany, New Zealand Tipa, Zoe Kristen In 2006 the Royal New Zealand Plunket Society embraced a model of communication and practice titled Family Partnership. The Family Partnership model and training is designed to develop the communication skills of professionals working with families in order to acknowledge and enhance the capabilities of parents. It is acknowledged that the degree to which a service is culturally safe is defined by the individual receiving the service. Nurse leaders, educators and peers are consistently required to make judgements as to the extent to which the nurse being observed is culturally safe, without obtaining client feedback. This research examined whether the Family Partnership model could be considered a model for cultural responsiveness with the dual benefit of providing a platform to more accurately assess the cultural competence of Plunket nurse practice. An evaluation design and methodology was used to determine the relationship between Family Partnership training for Plunket nurses in relation to Māori health outcomes. There were two phases in the data collection process. In phase one an online survey was completed by a group of Plunket nurses who had completed Family Partnership training along with a group that had not completed Family Partnership training. Phase two included ten observations and interviews with Plunket nurses and Plunket clients who identified as Māori. A combination of evaluation tables to determine merit and thematic analysis were used for the analysis of the mixed methods data. The results were presented in three sections relating to Plunket nurse practice, client experience and the impact on Plunket as an organisation. All Plunket nurses who participated in the research believed that Family Partnership had a positive impact on their clinical practice. The extent to which their practice had changed was difficult to determine, however the need for ongoing updates in Family Partnership was strongly indicated. Māori Plunket clients were generally satisfied with the Plunket service and their responses aligned with the concepts outlined in Family Partnership communication theory. The relationship between the findings and the principles of the Treaty of Waitangi were highlighted. This research has indicated that cultural responsiveness can be defined as the way in which a service identifies and attempts to meet the needs of the individual. It has discussed the complexity around what constitutes a health outcome for Māori clients and ultimately how cultural competence may be better assessed in practice. Tue, 01 Jan 2013 00:00:00 GMT http://hdl.handle.net/10179/4729 2013-01-01T00:00:00Z http://hdl.handle.net/10179/4727 Living at home after 95 years : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University, Albany, New Zealand Russell, Julia May Globally the number of older people is increasing with the largest increases occurring in those aged over 85 years. Historically little has been written about this group and because of increasing numbers more information is needed to inform the development of future services. The question was how people live in their own home independently after 95 years? This work was informed by narrative gerontology overlaid with a critical gerontological lens to give voice to this group. Through a purposive sampling strategy ten narrators were identified and were interviewed using a semi-structured format. Data analysis was undertaken using thematic analysis with three themes; staying socially connected, managing the physical environment and keeping and ageing well emerging. Further to this, there were associated subthemes, which support and further illuminate the detail of the theme itself. These findings also unsettled the ageist, biomedical view of the oldest-old and what we think we know about them. In this study the narrators gave voice to their lives and what contributed to them living at home independently. Not everyone will live to 95+ years and how this was achieved by this group was the result of their entire lives and showed itself in the resilient characters of these narrators. All of whom considered the benefits of social connectedness, hard work and keeping well as reasons for living independently at home. As well as this, the need to stay mobile and the current contribution of help and support from both family were contributing factors. This research provides considerations for changes in not only the way we view those over 95 years but also the way we consult and provide services to them. There is an urgent need to promote achieving resilience, eliminate ageism and promote a more balanced view of the oldest-old. Tue, 01 Jan 2013 00:00:00 GMT http://hdl.handle.net/10179/4727 2013-01-01T00:00:00Z