1,720,992 research outputs found
There's no meaning in chocolate: a narrative study of women's journeys beyond the disruption of depression
No full textProfessional treatment, mainly medical and psychological, dominates research and clinical practice concerning women and their recovery from depression. This thesis challenges the assumption that women cannot be 'experts' actively involved in their own recovery. This study explored the narratives of eighteen women in Aotearoa New Zealand whose lives had been seriously disrupted by depression. They had found ways other than, or in addition to, professional solutions that helped them to live undisrupted meaningful lives. The research used a narrative inquiry approach informed by authors from across the social sciences including Arthur Frank, Jerome Bruner and Rivka Tuval-Mashiach. The underpinning social constructionist understanding of depression is informed by the work of Jane Ussher and Janet Stoppard. The women whose individual narratives provide the core data for the study ranged in age from 32 to 70 years at the time they told their stories. Their lives had been disrupted by depression at different times during the last 50 years of the twentieth century. Five of the women met as a group with the researcher as the analysis began, and their ideas informed significant aspects of the conclusions. The women had all experienced major depressive disorder, although this was not always formally diagnosed. Their recovery had involved a range of responses from outside the professional mainstream including physical, mental, social and spiritual aspects. Each woman had sought and found a 'formula' that was 'right' for her. The narratives showed all the women talked of their experience with depression and recovery in an holistic and contextualised way. They all talked about 'chocolate' solutions which provided symptom relief, and 'deeper' and often more complex sets of solutions which enabled them to discover or re-discover meaningful ways to live. Meaning-making often involved growing spiritual or transpersonal awareness in the broadest sense. A surprising finding was that the patterns of recovery were not related to the severity of the depression at the worst time. Rather, it emerged that the ways the women talked about their recovery journeys mirrored their stories of the 'jolly good reasons' why they were depressed; the more complex and lengthy the story leading up to the worst times, the more complex the formulae required for recovery. The implications of the research for clinical practice and for policy makers are that depression and recovery need to be seen as gendered, contextualised, and holistic. Women need opportunities to discover and take advantage of a range of 'things' so that they can find their own 'right formula' for recovery. This formula may involve professional treatment including anti-depressant medication and psychological therapy, but it is likely to involve many other things as well. This study challenges the notion that recovery needs to be guided by a professional expert, and creates hope for women being able to learn from each other's experiences
It’s a partnership: yeah, right! An analysis of discourses of partnership between Government and Community Organisations in New Zealand (1999-2008)
No full textThis study explored the discourses of partnership between government and community organisations during the term of the fifth Labour-led Government (1999-2008). This government came to power with a policy of building partnerships with community organisations and others, presenting partnership as a rejection of the contractual models of the previous administration. I drew on Foucauldian notions of discourse and governmentality and Gramsci’s theories of hegemony, together with poststructuralism and critical social theory for my theoretical and philosophical frameworks. Applying Fairclough’s (1992) critical discourse analytic approach as a research methodology, I examined the historical, social and political contexts that frame the discourse of partnership, and analysed three sets of texts from the period under review. Two dominant partnership discourses emerged. The first was a community development discourse that can be traced to the 1970s, and which re-emerged in the 1990s as a resistance to the then dominant contractualist discourses of relationship between government and community organisations. The second was a modification of contractualism that drew from third-way discourses out of the United Kingdom, and in which government projects and programmes that involve community organisations were reframed as partnerships while retaining contractual mechanisms and ways of thinking. Drawing on governmentality theory, I suggested that the language of partnership may mask a process in which community organisations were co-opted to take on roles and responsibilities that are ultimately determined by, and in the interests of the government agenda. The research also identified characteristics of genuine partnerships between government and community organisations. Such partnerships were generally framed within a community development discourse and were more resistant to co-optation than partnerships that followed a contractualist approach. This research provides tools and strategies to enable both community organisations and government officials develop and maintain effective working relationships
Shifting Focus: How Registered Nurses in Residential Aged Care Organise Their Work: A Grounded Theory Study
No full textRegistered nurses in residential aged care work with older people who have complex care needs. Besides providing direct care, these nurses have a wide range of responsibilities which include supervising staff and attending to the smooth running of the care facility. This grounded theory study using dimensional analysis was aimed at answering the question: How do registered nurses organise their work? Indepth interviews were conducted with 10 registered nurses who worked in a range of positions in aged care facilities. Theoretical sampling and constant comparative analysis was used to guide both ongoing data collectiona and data analysis. Categories were examined for their relationships and dimensions to arrive at a substantive grounded theory which I have named 'shifting focus'. Individual and institutional philosophies of care were core elements in the registered nurses' focus of work. There was a relationship between staffing adequacy, individual and institutional philosophies of care, and the focus of registered nurse work. These relationships created conditions where the registered nurse would focus on ensuring the delivery of individualised resident care or focus on getting through the routine of care. The relationship between staffing adequacy, philosophies of care and the registered nurses' focus of work remained consistent when staffing adequacy changed. In instances of decreased staffing adequacy, the participants' focus shifted to either maintaining individualised care or focusing on safety. When the registered nurse aimed to change the philosophy of care, an increase in staffing adequacy enabled some aspects of cultural change to commence. The relationships between residents, family and staff were significant contrasting elements within an individualised philosophy of care, and an institutional philosophy of care. In the former, relationships were valued and developed. In the latter, they were benevolent, functional or conflicted. The significance of this study is that it reveals how registered nurses and management personnel in aged care facilities, can create conditions where the relationships between residents, their families and staff, are valued and developed to result in positive care outcomes. It is recommended that future research be conducted to examine the resources required to maintain an individualised approach to the nursing care of residents in aged care facilities
The Forgotten Feminine
No full textThe topic of my research is the lived experiences of eight psychotherapists and counsellors who consciously work with unusual phenomena as it arises in the therapeutic encounter. Unusual phenomena in this thesis refers to felt experiences which are considered to be beyond the everyday in the Cartesian paradigm and are often referred to as spiritual and/or mystical phenomena. Exploring these phenomena brings to light the potentialities in the vastness of consciousness which is considered to be an integral aspect of human existence in the thesis. I chose Heidegger’s hermeneutic phenomenological methodology for the research because it gives credence to the many and varied possibilities and potentialities both in particular lived experiences and in human existence as a whole. Van Manen’s lived existential provides the framework in which the participants’ experiences are explored. What emerged from the research is that unusual phenomena are not unusual for the participants. Although such phenomena are less visible and therefore less familiar in the everyday world, they are recognizable through their consistent presentation. This includes the participants having a powerful sense of ‘knowing’ which is all-encompassing and is beyond familiar landmarks such as the linear models of time and space. The participants bring their ‘knowing’ into the everyday world through embodiment and through their acknowledgment of the interconnectedness of existence. The expression of interconnectedness is experienced by the participants as lovingness, from which the ability for immediate healing in their therapeutic work becomes apparent. The participants’ accounts show a capacity for accessing the subtleties of human existence which emerge in the phenomenological process as the forgotten feminine of consciousness. The feminine of consciousness is a term used to describe a fundamental state of ‘being’ in contrast to the everyday masculine principle of ‘doing’. The research has implications for psychotherapy and counselling as it illuminates the need for a holistic approach which acknowledges the multidimensionality of human existence
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
The H-bug epidemic: the impact of antibiotic-resistant staphylococcal infection on New Zealand society and health 1955-1963
No full textAn epidemic of staphylococcal infections occurred in New Zealand hospitals and communities from 1955-1963. The 'H', or 'Hospital Bug', a strain of Staphylococcus aureus characteristic of the epidemic, was resistant to the most commonly used antibiotics. Post-operative patients, the frail elderly and mothers and babies were particularly vulnerable to staphylococcal colonization and infection. This thesis places the H-Bug epidemic in its historical context, discussing the ways in which the government and health professionals responded to the rising incidence of staphylococcal infection, and the major effects of the epidemic on medical and hospital practice. It also examines the impact of persistent staphylococcal infection on women and families in the community. Primary sources provided the basis for this thesis. The H-Bug epidemic has gone largely unrecorded except in contemporary documents. Health Department files and Auckland Hospital Board records as well as newspaper clippings were important sources. The New Zealand epidemic was clearly linked to the global pandemic of antibiotic resistant staphylococcal infection, 1946-1966, through medical literature and archival documents. International medical journals, including the New Zealand Medical Journal, published numerous articles on the epidemiology of antibiotic-resistant staphylococcal infection, providing an excellent record of research, case studies, current opinion, and recommended practice. The most valuable contribution to an understanding of the impact and experience of the H-Bug epidemic was, however, provided by the nineteen people who agreed to be interviewed for the study. Interviewees included a wide variety of health professionals and women and their children, all of whom had personal experience or association with the epidemic. In this thesis it is argued that the main focus of the medical response was the prevention and control of hospital cross-infection, both to protect patients and to preserve the public perception of the hospital as a safe venue for care. Although the emergence of resistant strains of staphylococci was widely attributed to the misuse of antibiotics, this thesis contends that the Health Department was reluctant to impose restrictions on medical prescribing and that Health Department official and senior clinicians chose instead to modify hospital environments and clinical practice. Rooming-in was widely introduced to counter the epidemic despite the fact that a trial in 1959, at National Women's Hospital, did not demonstrate a reduction in infection rates among neonates. The concept endured, however, as it held strong appeal for hospital administrators hard pressed to keep wards adequately staffed with trained personnel. It was also supported by women and health professionals who were convinced of the benefits of a close mother-baby relationship from birth. The H-Bug epidemic was eventually resolved by the introduction of the methicillin antibiotics in the early 1960s. As a consequence, confidence in a pharmaceutical solution to infectious disease remained intact until the emergence of multiple antibiotic resistant organisms in the 1980s. The lessons of the H-Bug epidemic had been largely forgotten in the intervening years, ignored until New Zealand clinicians were reminded once again that antimicrobial resistance would inevitably accompany the indiscriminate use of antibiotics and inadequate attention to infection prevention and control
Anxious times: a discourse analysis of women's and health professionals' constructions of the experience of breast cancer
No full textEvery day up to seven women in Aotearoa New Zealand are diagnosed with breast cancer. One in eight women will develop it at some time in their lives, and over 600 die each year, almost two a day (New Zealand Ministry of Health/NZHIS, 2014). In a culture where women’s attitudes, thoughts and reactions towards breast cancer are consistently portrayed as having high emotional content, the likelihood that health professionals might experience emotion aligned to their work with women with breast cancer is also high.
Although a popular topic for media attention and women’s personal narratives, few research studies have investigated breast cancer from the perspectives of both the women who have experienced the disease, and their health professionals. This study is different therefore, in its inclusion of medical practitioners. While not pairs per se as doctor and patient, the perceptions of 17 health professionals were explored alongside the perceptions of 20 women through their constructions of the same discursive object, breast cancer.
Two key questions were central to the study: (1) what were the discourses most predominantly deployed by women and health professionals through which they constructed breast cancer, and (2) what effect did the participants’ positioning in these discourses have on their subjectivities and their discursive practices?
The methodology for the study was post-structuralism, drawing on French philosopher Michel Foucault’s concepts of discourse and power/knowledge. The findings showed two dominant discourses by which the women and the health professionals constructed breast cancer – the medical discourse, and the gender discourse. Breast cancer was constructed in medical and gendered ways as problematic, dangerous, and not straightforward. Application of Foucault’s notion of governmentality showed that through their deployment of these dominant discourses, women’s and health professionals’ behaviour was controlled and conforming. As a result, the emotional impact of breast cancer on both parties was not well articulated or understood, and was shut down within medical encounters.
The findings showed further that the intersection of these two discourses produced significantly anxious or fearful subjects. These findings have important implications for women, and for the education of health professionals who work in the field of breast cancer. This study complements other earlier research which has found that women are fearful of breast cancer and its ramifications, and that there are also associated tensions for health professionals.
Two major recommendations for further investigation, and for education, are: (1) permitting women to communicate more openly with their health professionals, and (2) educating professionals in critical thinking and analysis. This might facilitate better understanding of the meaning of breast cancer for each party, thereby steadying the balance of power between the two through a commonality of discursive construction. The significance of the study is that it opened up opportunities for other discourses and discursive practices to be brought into play, thus creating spaces for additional subjectivities to be heard and recognised
A Poststructural Analysis of the Health and Wellbeing of Young Lesbian Identified Women in New Zealand
No full textNew Zealand is regarded internationally as a forerunner in the recognition of gay rights. Despite the wide circulation of discourses of gay rights and equality, research shows that young women who identify as lesbian continue to be marginalised by society, which constrains their health and wellbeing. This study was an inquiry into the health and wellbeing of young lesbians in New Zealand, from a poststructural feminist perspective. It posed the research question: what are the discourses in play in relation to the health and wellbeing of young lesbian identified women in New Zealand?
The methodology employed was a poststructural feminist discourse analysis, drawing on the philosopher Michel Foucault’s concepts of genealogy and the history of the present. Interviews with young lesbians were conducted in 2012 amid public debate around same-sex marriage. Historical data sources were the extant texts Broadsheet, a feminist periodical with strong health and wellbeing emphasis, and Hansard, a record of New Zealand parliamentary debate. Issues of these publications were selected from the early 1970s, during which the second wave feminist movement emerged, and the mid-1980s when the campaign for Homosexual Law Reform took place in New Zealand.
The discourse analysis made visible the production of multiple ‘truths’ of young lesbian health and wellbeing. Young lesbian participants were able to position themselves as legitimate subjects endorsed by psychological and biomedical scientific communities, and as lesbian wives and mothers. Queer discourse enabled the refutation of fixed modes of sexual and gender identity. The findings also showed that young lesbians continued to be subject to heteronormative and patriarchal discourses, which legitimised their marginalisation, exclusion, and victimisation, and restricted the spaces in which they could feel safe. Further, the ability of the participants to challenge the effects of heteronormative and patriarchal discourses on their wellbeing was limited by dominant psychological and healthy lifestyles discourses, which produced them as individualised subjects of neoliberal responsibility.
Findings also pointed to a restriction of possibilities for young lesbian health and wellbeing in New Zealand. The publically and legally sanctioned availability of lesbian marriage seemed to have pushed lesbian relationships further under the rubric of ‘the family’. Broadsheet magazine in the early 1970s, and mid-1980s was a surface of emergence for alternative discourses of lesbianism such as radical feminism to circulate. Radical feminist discourse problematised heterosexuality and its institutions of marriage and the family, and created space for lesbian community development and a political lesbianism to emerge. Through radical feminist discourse, compulsory heterosexuality could be articulated as a women’s health issue.
Addressing the issue of narrowing lesbian possibilities involves supporting young women to creatively expand the range of possible lesbian spaces and selves that are available to them. The rethinking of practices of radical lesbian space-making may facilitate the production and circulation of alternative discourses on lesbianism. Important possibilities for lesbian health may be found in societal health and wellbeing discourses which challenge the notion of individual responsibility, foregrounding analysis of heteropatriarchy, as well as governmental and social responsibility for effecting change
There's No Meaning in Chocolate: A Narrative Study of Women's Journeys Beyond the Disruption of Depression
No full textProfessional treatment, mainly medical and psychological, dominates research and clinical practice concerning women and their recovery from depression. This thesis challenges the assumption that women cannot be 'experts' actively involved in their own recovery. This study explored the narratives of eighteen women in Aotearoa New Zealand whose lives had been seriously disrupted by depression. They had found ways other than, or in addition to, professional solutions that helped them to live undisrupted meaningful lives. The research used a narrative inquiry approach informed by authors from across the social sciences including Arthur Frank, Jerome Bruner and Rivka Tuval-Mashiach. The underpinning social constructionist understanding of depression is informed by the work of Jane Ussher and Janet Stoppard. The women whose individual narratives provide the core data for the study ranged in age from 32 to 70 years at the time they told their stories. Their lives had been disrupted by depression at different times during the last 50 years of the twentieth century. Five of the women met as a group with the researcher as the analysis began, and their ideas informed significant aspects of the conclusions. The women had all experienced major depressive disorder, although this was not always formally diagnosed. Their recovery had involved a range of responses from outside the professional mainstream including physical, mental, social and spiritual aspects. Each woman had sought and found a 'formula' that was 'right' for her. The narratives showed all the women talked of their experience with depression and recovery in an holistic and contextualised way. They all talked about 'chocolate' solutions which provided symptom relief, and 'deeper' and often more complex sets of solutions which enabled them to discover or re-discover meaningful ways to live. Meaning-making often involved growing spiritual or transpersonal awareness in the broadest sense. A surprising finding was that the patterns of recovery were not related to the severity of the depression at the worst time. Rather, it emerged that the ways the women talked about their recovery journeys mirrored their stories of the 'jolly good reasons' why they were depressed; the more complex and lengthy the story leading up to the worst times, the more complex the formulae required for recovery. The implications of the research for clinical practice and for policy makers are that depression and recovery need to be seen as gendered, contextualised, and holistic. Women need opportunities to discover and take advantage of a range of 'things' so that they can find their own 'right formula' for recovery. This formula may involve professional treatment including anti-depressant medication and psychological therapy, but it is likely to involve many other things as well. This study challenges the notion that recovery needs to be guided by a professional expert, and creates hope for women being able to learn from each other's experiences
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