Woods, M. (2008). Parental resistance. Mobile and transitory discourses: A discursive analysis of parental resistance towards medical treatment for a seriously ill child. Ph.D. thesis, , .
Abstract: This qualitative thesis uses discourse analysis to examine parental resistance towards medical treatment of critically ill children. It is an investigation of the 'mobile and transitory' discourses at play in instances of resistance between parents, physicians and nurses within health care institutions, and an examination of the consequences of resistance through providing alternative ways of perceiving and therefore understanding these disagreements. The philosophical perspectives, methodology and methods used in this thesis are underpinned by selected ideas taken from the works of Michel Foucault and Pierre Bourdieu and supported by relevant literature in the fields of media, law, children, parenting, caring, serious childhood illness, medicine and nursing. It is argued that from an examination of interview based texts, parental resistance is an omnipresent but transitory occurrence that affects many of the interactions between the parents of seriously ill children and clinical staff. It is maintained that within these interactions, the seeds of this resistance are sown in both critical decision making situations and in everyday occurrences between doctors, nurses and parents within healthcare institutions. Contributing factors to parental resistance include the use of power games by staff, the language of medicine, forms of symbolic violence, the presence or absence of trust between parents and medical staff, the effects of medical habitus, and challenges to the parental role and identity. Overall, it is proposed in this thesis that parents who resist treatment for their seriously ill child are not exceptions to the normative patient-physician relationship.
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Apelu, J. (2008). Pacific community mental health nurses' experiences of working for a district health board in New Zealand. Ph.D. thesis, , .
Abstract: This study explored the perspectives of Pacific nurses on what it is like for them to work in a Pacific community mental health (PCMH) service within a district health board. Five Pacific Island nurses who worked in the three Pacific community mental health services based in the Auckland region participated in the project. The study employed narrative inquiry to gather data through focused storytelling method. The results of the study have indicated that PCMH nursing is a unique nursing field as well as highlighting significant practice issues for nurses. Complex service infrastructure and language have been found to be the major contributing practice constraints. The findings suggest the need for district health board authorities, Pacific mental health service management, professional nursing education and development programs to consider addressing these practice issues to prevent further increase in the problem of PCMH nurses shortage and enhance recruitment and retention of these nurses.
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Esera, F. I. (2001). If a client is operating from a Samoan world view how can s/he be holistically and appropriately treated under the western medical model? Ph.D. thesis, , .
Abstract: This paper is an analysis of the cultural and traditional factors that the author presents as essential considerations in the treatment of Samoan people who have been diagnosed with a mental illness. Just as important to any clinical diagnosis, is the spiritual nature of Samoan culture and traditions, which inform belief systems. A full understanding of these will explain how the traditional beliefs and cultural values of Samoan people have an impact on their perception of mental illness, its causes and cures. The thesis places emphasis on 'ma'i -aitu', the Samoan term for most ailments pertaining to the mind or psyche. The focus is on defining 'ma'i -aitu' as part of a Samoan world view and likewise a description of a similar type of manifestation in the Papalagi (western) context of a psychiatric disorder and how treatment and management is usually undertaken. The issues addressed in this paper aim to highlight the Samoan client's world view from a Samoan perspective of mental illness which then poses the question of how they can be managed holistically and appropriately under the Papalagi medical system. Furthermore, it questions if the traditional belief system of Samoans run deeper than originally thought and can the replacement thereof by a foreign culture be responsible for the increased mental problems in Samoans living in New Zealand? This paper emphasises the importance of integrating the western medical model and Samoan health models, for appropriate mental health service delivery to Samoan people.
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Mockford, A. (2008). An exploratory descriptive study of the needs of parents after their young child is discharged from hospital following an admission with an acute illness. Ph.D. thesis, , .
Abstract: This study investigated issues surrounding the high numbers of preventable admissions of young children with acute illnesses, particularly amongst Maori and Pacific children. It focuses on what happens once these children are discharged. Its aims were to find out what the expressed needs of parents were, as they cared for their child, once home. Whilst there has been a small amount of international research undertaken in this area, there is little known about expressed parent need in the New Zealand context. This exploratory descriptive study involved parents of under five year old children, who had been admitted to a hospital, with one of five acute illnesses. Eighteen parents were surveyed over the telephone. This study found the parents expressed a need for reassurance and advice once home, and that they worried about their child getting sick again. It highlighted gaps in discharge planning and support. None of the parents had received a written discharge plan for their child. Only five parents had received either a contact number for advice or a referral back to their primary care provider. This study found that whilst some parents considered their discharge needs had been met, others considered that they had not. Four local discharge practice opportunities to support these families were recommended, these included, providing parents and caregivers with an individualised written discharge plan, giving a contact number for advice after discharge, offering a follow-up phone call in the first 48 hours, and ensuring that all children have a referral back to their primary health care provider. Areas for further research were highlighted, including the need for a larger study to explore and compare the needs of rural and urban parents, and Maori and Pacific parents.
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Southwick, M. (2001). Pacific women's stories of becoming a nurse in New Zealand: A radical hermeneutic reconstruction of marginality. Ph.D. thesis, , .
Abstract: This thesis examines Pacific women's experiences of becoming a nurse and their first year of practice post-registration, within the New Zealand context. The participants' stories of being students and beginning practitioners are inter-woven with the author's own reflections as a nurse and nurse educator who also claims a Pacific cultural heritage. To create the space in which the stories can be laid down, the thesis includes a description of the migration and settlement of Pacific peoples in Aotearoa/New Zealand. This description shows how Pacific people have been systematically stigmatised and locked into marginalised positions by mainstream dominant culture. The thesis deconstructs, what the author describes as, taken-for-granted and self perpetuating conceptualisations of marginality that currently underpin most theoretical explanations and proposes a reconstructed map of marginality. This deconstructed/reconstructed map of marginality is used as a template through which the experiences of the participants are filtered and interpreted. Radical Hermeneutics provides a philosophical underpinning for this project that has as one of its objectives the desire to resist reducing complexity to simplistic explanation and superficial solutions. The thesis challenges nursing to examine its role in reproducing the hegemonic power of dominant culture by applying unexamined cultural normative values that create binary boundaries between 'them' and 'us'. At the same time the thesis challenges Pacific people to move past hegemonically induced states of alienation and learn how to walk in multiple worlds with confidence and power.
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