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Euswas, P. W. (1991). Professional nurses' view of caring in nursing practice: two preliminary studies in New Zealand (Vol. 5). Ph.D. thesis, , .
Abstract: Two convenience samples of 90 NZ registered nurses responded to two structured questionnaires designed to explore nurses views of caring in nursing practice.The studies demonstrate that nurses see caring as a central concept in their practice. From the response the meaning of caring was found to be multi dimensional, consisting of six components: value, expressive, action, relationship, knowledge and purpose. The value dimension includes areas such as humanistic value and professional value. The expressive component consists of empathy, compassion, trust, concern, sharing and willingness. Action components are helping, comforting, being there, empowering, advocacy, nurturing, advising, touching and performing nursing procedures. The major relationship component is partnership. An important part of the knowledge component is clinical expertise and the purposive component of caring consists of meeting health needs and promoting healing and welfare. The meaning of caring begins to emerge from these studies. However, they do not provide full understanding of caring phenomena. A further in-depth study of actual nursing practice is still in progress
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Fleming, V. E. M. (1991). Towards nursing advocacy: a socio-political process. Ph.D. thesis, , .
Abstract: This thesis provides a reflexive critique of the power structures which constrain nursing actions in the practice setting, an abortion clinic, of the registered nurses who participated in this study. The development of abortion services, like other health services for women, has been based on a medical ideology of health which has created many ethical dilemmas for nurses. One of the most complex of these is the extent to which nurses should fulfil the role of client advocate. While the literature on nursing advocacy has been prolific, published research in this area is scant.The theoretical assumptions of critical social science, provide the basis for the methodological approach of action research adapted in this study. In depth, unstructured interviews involving exchange of dialogue amongst the participants with the researcher focused on the participants' experiences of their own nursing practice, with a view to uncoveing and removing restrasints, which had prevented them fulfililng an advocacy role. Diaries were also kept and used as supplementary research tools.The analysis of the data demonstrates the ways in which nurses interpret their own practice world as a system independent of their own actions. It shows how the shared understandings of the participants were 'ideologically frozen' and power relations inherent in the health care system are deep rooted and subtle, coming to be treated as natural by the nurses, and so denying them their own ability to make changes.It is suggested that opportunities for nurses coming together and engaging in such critically reflexive dialogue may provide a basis for future emancipation from traditional power structures. In this way effective and satisfying nursing practice dependent on emancipatory knowledge and a reinterpretation of power structures may result in an advocacy role for nurses
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Clare, D. J.(see also P.). (1991). Teaching and learning in nursing education: a critical approach. Ph.D. thesis, , .
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Enslow, B. A. (1991). Bonded caring: health care choices of women with dependent children. Ph.D. thesis, , .
Abstract: The question for this study arose from the observation that health care often does not match the client's self-determined needs and desires, and hence is wasted care. As a result, the study proposed to discover what elements are involved when women with dependent children make health care choices and what they want in the way of health care.The exploratory study was conducted using strategies of grounded theory. Fourteen in-depth interviews, involving eleven women, were conducted. The selection of participants and of the questions for the interviews was basef on theoretical sampling. Constant comparative analysis and integrative diagramming were used to analyse the data.The theory that emerged from the data was Bonded Caring and its two essential categories; Interconnectedness and Caring. Bonded Caring requires an intimate and ongoing relationship in which there is development of in-depth knowledge of the unique characteristics of the person(s) involved. It is characterised by a strong and enduring effective quality, and by a concern, worry and serious attention to the needs of the person(s) involved. This concern necessitates the gathering of information about the nature of the needs, and making the best possible choices concerning their management.During this research for knowledge and skills needed to carry out health care, women assess their own knowledge and experience; the level(s) of health care needed by each individual; the availability, competence and expected response of the resource person or health care consultant; the perception of risk associated with a health concern; and the family's culture and life style. The women considered these elements within a structural framework of finite material and personal resources. The women juggled the distribution of these resources in a way that allowed them to select the avenues of health care that provided the best degree of safety and protection of development within the context of their circumstances
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Kavet, M. A. (1991). User and provider perceptions of service quality: an exploratory study of a professional service. Ph.D. thesis, , .
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Madjar, D. I. (1991). Pain as embodied experience: a phenomenological study of clinically inflicted pain in adult patients. Ph.D. thesis, , .
Abstract: This phenomenological study describes the lived experience of pain inflicted in the context of medically prescribed treatment, explores the meanings of such pain for patients who endured it and for nurses whose actions contributed to its generation, and presents a thematic description of the phenomenon of clinically inflicted pain. The study is informed by phenomenology, both in terms of its premises and orientation, and its research design and method.The participants in the study were 14 adult patients, admitted to hospital following burn injuries, or receiving intravenous chemotherapy upon diagnosis of cancer, and 20 nurses involved in their care. Data collection took place over a period of five months and included participant observation and compilation of field notes, and a total of 89 tape-recorded interviews (48 with patients and 41 with nurses). Through the process of hermeneutic interpretation a number of themes were identified and used to describe the phenomenon of clinically inflicted pain and the structure or the lived experience of the patients and the nurses concerned.The phenomenon of clinically inflicted pain is described in terms of four isolated themes: (1) the hurt and painfulness of inflicted pain; (2) handing one's body over to others; (3) the expectation and experience of being wounded, and (4) restraining the body and the voice. These themes point to the embodied nature of pain experience and the extent to which the person is involved not only in the enduring of pain but also in its generation. The broader lifeworld of clinically inflicted pain, often as punishment and almost always a something avoidable, and in turn being constituted by their experiences in terms of losing and seeking to regain a sense of embodied self and of personal situation, and by changed experiences of lived space and lived time.Nurses who themselves helped to generate pain, frequently overlooked the patient's lived experience and thus the essential nature of inflicted pain as painful, wounding, and demanding cooperation and composure from the patient. Instead, the pain frequently become invisible to nurses involved in its infliction, or when it could not be overlooked or ignored, it was perceived inevitable , non-harmful and even as beneficial to patients' recovery. The strategic responses that nurses adopted to pain infliction included detachment from the perceived impact and consequences of their own actions and objectification of the person in pain as a body-object on whom certain tasks had to be performed. An alternative to the strategy of detachment and objectification was involvement in a therapeutic partnership between the nurse and the patient, where shared control over pain infliction and relief helped to sustain trust in the relationship and preserve personal integrity of the patient and the nurse.The study points to dangers for both patients and nurses when clinically pain is ignored, overlooked or treated with detachment. It also points a way toward nursing practice, that is guided by thoughtfulness and sensitivity to patients' lived experience, and awareness of freedom and responsibility inherent in nursing actions, including those involved in inflicting and relieving pain. The study raises questions about nurses' knowledge, attitudes, and actions in relation to clinically inflicted pain, and highlights the need for nursing education and practice to consider the contribution of a phenomenological perspective to the understanding of human experience of pain, and the nursing role in its generation, prevention and relief
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Euswas, P. W. (1991). The actualized caring moment: a grounded theory of caring in nursing practice. Ph.D. thesis, , .
Abstract: The purpose of this study was to provide a partial theoretical description of the phenomenon of caring in nursing practice. Three practice settings involving cancer patients were selected: hospital, hospice, and community with thirty patients and thirty-two nurses participating in the study. A research design combining a phenomenological perspective and grounded theory strategies was implemented. Data were collected by interview, participant observation and records. The data were analysed by the method of constant comparative analysis.A number of concepts were developed from the data and the theoretical framework of “The Actualized Caring Moment” was formulated to explain how the actual caring process occurs in nursing practice. This caring moment is the moment at which the nurse and the patient realise their intersubjective connectedness in transforming healing-growing as human beings in a specific-dynamic changing situation. The actualized caring moment is a gestalt configuration of three carting moments. The pre-conditions, The on-going interaction, and The situated context.The Pre-conditions, which consist of the nurse, personally and professionally prepared to care, and the patient, a person with compromised health and wellbeing, are pre-requisites for the occurrence of the caring process. The nurses has the qualities of benevolence, commitment, and clinical competency to be ready to care. The patient is a unique person in a vulnerable state and requires assistance from the nurse to meet personal health needs.The on-going interaction, the actual caring process, is the continuity of the nurse-patient interaction moment by moment which brings together six caring elements: Being there, Being mindfully present, A relationship of trust Participation in meeting needs, Empathetic communication, and Balancing knowledge-energy-time. The Situated Context is the situation and environment where the actual caring process is taking place, and this is comprised of circumstances of the nurse-patient meeting and care-facilitating working conditions.The conceptual framework of “The Actualised Caring Moment” offers nurses an opportunity to understand their practice more fully in providing effective nursing service. Consequently, its implications are valuable for education, research, and the development of knowledge focussed on the discipline of nursing
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Hedwig, J. A. (1990). Midwives: preparation and practice. Ph.D. thesis, , .
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Walton, J. A. (1989). The night-time experience of elderly hospitalized adults and the nurses who care for them. Ph.D. thesis, , .
Abstract: This is a report of a study into the night-time experience of elderly hospitilised adults and the nurses who care for them. A grounded theory approach was used for the analysis of data and subsequent generation of a theoretical description an partial explanation of patient experiences, nursing actions and nurse-patient interactions.Data were gathered through observation, interview, document audit and literature review; tow general medical wards in a large regional hospital were the focus of field methods of data collection.It is argued that the night-time experiences of elderly hospitalized adults are to a large degree dependent on the individual patterns of sleep and waking behaviour of these people in their normal environments. If individualised care is given, nurses must be aware of people's usual patterns of behaviour.Nurses working at night engage in a series of complex decision sin the course of their interaction with patients. They work under constraints not present during the daytime, and are highly dependent on co-operation from colleagues on other shifts for information which would enable them to deliver optimum care at night. At the same time, night nurses have access to information from and about patients which would be invaluable to a total assessment of any patient's health state.Considerations of sleep and sleep are relevant to nurses working all shifts. The findings of the study have implications in terms of nurses' knowledge of all aspects of sleep; assessment practices; nurse-patient and nurse-nurse communication; nurse-patient relationships at night; wars management; and the independence of nurses
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Paterson(now Fleming), B. L. (1989). Making a difference: the lived world of nursing practice in an acute care setting. Ph.D. thesis, , .
Abstract: This study examines the practice world of twenty two registered nurses working in medical and surgical wards of an acute general hospital in New Zealand. It is argued that nursing practice is a complex, context-specific, activity and needs to be studied using methods that do not assume an objective, context-free reality.The work of Patricia Benner (1984) guided this study which utilized a qualitative research approach to enter the lived world of nursing practice. Through descriptions of work days and a sharing of clinical exemplars, an understanding of the broader context of nursing practice was gained, areas of skilled performance in nursing emerged, and the meaning of making a difference for the nurses in the study examined. The central role of mutual advice and support in facilitating significant incidents in practice was apparent.An examination of the types of experiences which challenge current practice and change it in some way provided insight into the importance of experience in developing clinical expertise and the vital role of local knowledge in facilitating practice. Nursing practice emerged as crucial to patient welfare and safety in the acute care setting
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Young, W. A. (1989). District nursing clients: perceptions of participation in nursing care. Ph.D. thesis, , .
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Walton, J. A. (1989). Nursing practice in New Zealand hospitals: staff nurses and enrolled nurses: an investigation into the nature and organisation of nursing practice. Ph.D. thesis, , .
Abstract: Review of the preparation and initial employment of nurses
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Bassett-Smith, J. L. (1988). Midwifery practice: authenticating the experience of childbirth. Ph.D. thesis, , .
Abstract: The purpose of this grounded theory study was to identify, describe and provide a conceptual explanation of the process of care offered by midwives and the effects of that care on women's experiences of childbirth on hospital. Ten couple participants and their attendant midwives provided the major source of data. The primary data collection methods used in this study were participant observation during each couple's experience of labour and birthing, antenatal, hospital and postnatal interviews with couples along with formal and informal interviews with midwives.Constant comparative analysis of data eventuated in the identification, in the context of this study denotes a process that is engaged in by both midwives and birthing women in order to establish practice, and the experience of giving birth, as being individually genuine and valid.Authenticating is multifaceted and is seen to include the intertwined and simultaneously occurring phases of 'making sense', 'reframing', 'balancing' an 'mutually engaging'.The process of authenticating is proposed as a possible conceptual framework for midwifery practice. It identifies the unique contribution the midwife can make to a couple's experience of childbirth and serves in a conceptual way to unite the technical and interpersonal expertness of the midwife. The conceptual framework of authenticating legitimizes 'being with' women in childbirth and facilitates a women-centred approach to care with consequent implications for practice, education and research
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Goffe, R. (1988). Nursing practice in a hospital context: the subjective experience of four female nurses. Ph.D. thesis, , .
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Christensen, D. J. C. (1988). The nursed passage: a theoretical framework for the nurse-patient partnership. Ph.D. thesis, , .
Abstract: This study focussed on nursing practice in action. The research goal was to identify nursing-relevant dimensions within a person's experience of being a hospital patient undergoing elective surgery. In order to discover and conceptualize the underlying processes which are present as patients are nursed through this experience, an open question was posed – What is happening here? A qualitative research method ws the most appropriate means of discovering an answer to this question.The particular method chosen was the grounded theory approach developed by Glaser and Strauss. Data were collected in five surgical wards of a large city hospital over a period of five months. The research participants were twenty-one patients and the nurses involved in their care. Primary sources of data were interviews and the nursing records. These were augmented by field notes and accounts of observed incidents relating to the care of each patient.Using the inductive strategies of the grounded theory method, numerous descriptive concepts were generated during the data analysis. These were ordered within an integrating social process derived from anthropology. By this means a founded theory in the form of a theoretical framework – the Nursed Passage – was developed. Within this passage the patient is the passage and nursing is translated into action through the agency of the nurse.The Nursed Passage is a patterned partnership with three key elements. Firstly, the temporal element, characterised by ongoing movement and constant change, is conveyed in the sequence of phases or stages. Secondly the participative element is portrayed as a patterned relationship in which both nurses and patient are actively involved in progressing the patient through the passage. Finally, the contextual element recognises complex factors within the nursing environment which have an impact on the shape of the relationship between patient and nurse.This theoretical framework, generated from the reality of nursing as it occurs in one setting, assigns a specific shape to the encounter between nurses and patient. It identifies the contribution nursing alone can make to optimise each patient's hospital experience. In this way it both complements and facilitates the work of medical and other colleagues with whom nurses work. Thus it serves to revalue nursing in terms that can maximally utilise the registered nurse's knowledge and skill for the benefit of all concerned. Consequently, it has the potential value for nursing practice, education and research
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