District nursing clients :perceptions of participation in nursing care : a thesis presented in partial fulfillment of the requirements for the degree of Master of Arts in nursing at Massey University

Abstract

Research on participation in nursing care is sparse in New Zealand, particularly in the district nursing field. No studies were found on participation from the perspective of the New Zealand client of district nursing care. This study initiates steps to fill this gap by examining the question "What are the perceptions of district nursing clients toward participation in their care?". An exploratory descriptive study using a multiple triangulation design provided a background data base and revealed rich, meaningful qualitative information. Thirty eight district nursing clients were interviewed seeking quantitative data which were statistically analyzed and qualitative data which were analyzed using analytic description technique. The district nurse/client relationship studied here provided evidence supporting Kim's (1983a) theoretical framework of collaborative decision making, particularly that the nurse controls the "client's propensity to participate" through "allowance" or "sanctioning" of participation (p.279). This research discovered that from the client's perspective the district nurse guides the client/nurse relationship, encouraging the client's participation through discussion. Client and nurse cooperated and worked together to achieve a mutual goal of selfcare and independence. Study clients acquiesced to the nurse's guidance as a result of preconceived patient/nurse role attitudes and deference to the nurse's professional expertise. A continuum of participation was conceptualized with four perceptions of participation evident in this study: 'Withdrawal' of those who did not wish to participate; 'Acquiescence' or supporting the status quo by consenting without comment; a mid-point of 'Cooperation and Working Together'; and, 'Taking more Control' of care.