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Population ageing has been posed as a problem for contemporary governing in relation to the allocation and consumption of finite health care resources, in particular acute hospital care. This thesis explores how nursing practice is a key resource in the management of this ???problem???. Employing Foucault???s concept of governmentality, nursing practice is examined as a form of social government that is central to the regulation of hospital care to older people. A governmentality approach enables consideration of the relationship between the macro political context of governing, as embodied in prevailing political rationalities, and their outworking beyond the arenas of formal government in the micro practices of nurses. Specifically, in this research, it reveals how contemporary entrepreneurial rationalities of governing work at a distance to discursively shape the local practices of nurses in the regulation of hospital care to older people. Discourse analysis of interview texts, literature and documents revealed how enterprise rationality was invested in the discourses circulating in the study site, highlighting the power relationships and subject positions available to registered nurses and outcomes produced in the regulation of hospital care to older people. The analysis details how registered nurses activated a range of technologies and practices as they engaged with enterprise discourses, constituting nursing practice as an activity aimed at making up older people as dischargeable subjects. It shows how enterprise is both a practice and way of thinking that directs us toward a particular truth of hospital, hence nursing, care of older people. The thesis illustrates how changes in the ways of governing hospitals have actively transformed the meaning and practice of nursing in the provision of hospital care to older people. It shows how the values and practices that make entrepreneurial modes of government possible penetrate each layer of an organisation and can create new mentalities or ways of thinking. This was evident in this research whereby an entrepreneurial mode of governance had re-imagined the social practice of nursing as a form of the economic, such that neither recovery, nor health, but discharge assumed pre-eminence as the focus and aim of hospital care for older people and hence the goal of nursing practice. These findings suggest that hospital care of older people has become a political and economic, rather than therapeutic concern. Furthermore, nursing interventions in the hospital care of older people have become administrative rather than therapeutic, with nursing practice focused on individual older people only insofar as they are constituted as part of a population at risk of delayed discharge. The thesis contends that nurses are implicated in the politics of health care in new and different ways amid entrepreneurial rationalities of governing that promote an ethos of risk management, individualism and responsibilisation in relation to health. It argues that the replacement of an ethos of nursing as care based on client need with an ethos of nursing as risk management substitutes the therapeutic intent and practices of nursing with the technical intent of managing risk. In so doing, the thesis illustrates dangers and possibilities arising from the re-framing of health care through entrepreneurial modes of governance. It enables a critically informed consideration of what kind of practice acute care nursing could be into the future and how nurses and others can take action to positively contribute to the futures of older people they provide care to. / Thesis (PhD)--University of South Australia, 2010

It’s like the sun and the tide. The aim of this study was to understand the meaning of ‘being aged’ through the everyday experiences of those who are aged. Philosophically, this interpretive study was informed by hermeneutics and interpretive phenomenology. The writings of two twentieth-century philosophers, Hans-Georg Gadamer and Martin Heidegger, guided the study’s design and research methods. The phenomenon of interest is ‘being aged;’ a thing which is ordinarily taken-for-granted in the everyday. However, much is already spoken and empirically ‘known’ about the phenomenon by those who are not yet aged. Methodologically the study’s design sought to ‘put aside’ those voices and listen in closely to what elders themselves had to say about being in their everyday lives. Individual research conversations were conducted with fifteen participants; four Maori elders aged 71 to 93 and eleven non-Maori elders aged 80 to 97 years. All were living in private residences on Auckland’s North Shore and recruited by way of the general electoral roll. The conversations were focused on gathering the stories of particular everyday events as well as the person’s reflections on aging. Anecdotes drawn from the conversations formed the research text. Hermeneutics informed the interpretive engagement with this text. As a non-Maori researcher, cultural integrity of the text and the interpretations was enhanced through partnership with a Maori advisor. Dwelling hermeneutically with the anecdotal text was a way of listening to the spoken and unspoken words. Four overarching notions were illuminated and form the study’s findings. They are my interpretive descriptions of the ordinary ways of ‘being in the everyday,’ the experiences of ‘being with others’ in advanced age, the announcing of being aged in the uncomfortableness of ‘experiencing the unaccustomed’ and how ‘aging just is’ there in an everyday way. Reflecting phenomenologically on the findings, the meaning of being aged is in its ordinariness. My thesis is that being in the ordinary everyday in advanced age both conceals and reveals the phenomenon of being aged.

It’s like the sun and the tide. The aim of this study was to understand the meaning of ‘being aged’ through the everyday experiences of those who are aged. Philosophically, this interpretive study was informed by hermeneutics and interpretive phenomenology. The writings of two twentieth-century philosophers, Hans-Georg Gadamer and Martin Heidegger, guided the study’s design and research methods. The phenomenon of interest is ‘being aged;’ a thing which is ordinarily taken-for-granted in the everyday. However, much is already spoken and empirically ‘known’ about the phenomenon by those who are not yet aged. Methodologically the study’s design sought to ‘put aside’ those voices and listen in closely to what elders themselves had to say about being in their everyday lives. Individual research conversations were conducted with fifteen participants; four Maori elders aged 71 to 93 and eleven non-Maori elders aged 80 to 97 years. All were living in private residences on Auckland’s North Shore and recruited by way of the general electoral roll. The conversations were focused on gathering the stories of particular everyday events as well as the person’s reflections on aging. Anecdotes drawn from the conversations formed the research text. Hermeneutics informed the interpretive engagement with this text. As a non-Maori researcher, cultural integrity of the text and the interpretations was enhanced through partnership with a Maori advisor. Dwelling hermeneutically with the anecdotal text was a way of listening to the spoken and unspoken words. Four overarching notions were illuminated and form the study’s findings. They are my interpretive descriptions of the ordinary ways of ‘being in the everyday,’ the experiences of ‘being with others’ in advanced age, the announcing of being aged in the uncomfortableness of ‘experiencing the unaccustomed’ and how ‘aging just is’ there in an everyday way. Reflecting phenomenologically on the findings, the meaning of being aged is in its ordinariness. My thesis is that being in the ordinary everyday in advanced age both conceals and reveals the phenomenon of being aged.

It’s like the sun and the tide. The aim of this study was to understand the meaning of ‘being aged’ through the everyday experiences of those who are aged. Philosophically, this interpretive study was informed by hermeneutics and interpretive phenomenology. The writings of two twentieth-century philosophers, Hans-Georg Gadamer and Martin Heidegger, guided the study’s design and research methods. The phenomenon of interest is ‘being aged;’ a thing which is ordinarily taken-for-granted in the everyday. However, much is already spoken and empirically ‘known’ about the phenomenon by those who are not yet aged. Methodologically the study’s design sought to ‘put aside’ those voices and listen in closely to what elders themselves had to say about being in their everyday lives. Individual research conversations were conducted with fifteen participants; four Maori elders aged 71 to 93 and eleven non-Maori elders aged 80 to 97 years. All were living in private residences on Auckland’s North Shore and recruited by way of the general electoral roll. The conversations were focused on gathering the stories of particular everyday events as well as the person’s reflections on aging. Anecdotes drawn from the conversations formed the research text. Hermeneutics informed the interpretive engagement with this text. As a non-Maori researcher, cultural integrity of the text and the interpretations was enhanced through partnership with a Maori advisor. Dwelling hermeneutically with the anecdotal text was a way of listening to the spoken and unspoken words. Four overarching notions were illuminated and form the study’s findings. They are my interpretive descriptions of the ordinary ways of ‘being in the everyday,’ the experiences of ‘being with others’ in advanced age, the announcing of being aged in the uncomfortableness of ‘experiencing the unaccustomed’ and how ‘aging just is’ there in an everyday way. Reflecting phenomenologically on the findings, the meaning of being aged is in its ordinariness. My thesis is that being in the ordinary everyday in advanced age both conceals and reveals the phenomenon of being aged.

It’s like the sun and the tide. The aim of this study was to understand the meaning of ‘being aged’ through the everyday experiences of those who are aged. Philosophically, this interpretive study was informed by hermeneutics and interpretive phenomenology. The writings of two twentieth-century philosophers, Hans-Georg Gadamer and Martin Heidegger, guided the study’s design and research methods. The phenomenon of interest is ‘being aged;’ a thing which is ordinarily taken-for-granted in the everyday. However, much is already spoken and empirically ‘known’ about the phenomenon by those who are not yet aged. Methodologically the study’s design sought to ‘put aside’ those voices and listen in closely to what elders themselves had to say about being in their everyday lives. Individual research conversations were conducted with fifteen participants; four Maori elders aged 71 to 93 and eleven non-Maori elders aged 80 to 97 years. All were living in private residences on Auckland’s North Shore and recruited by way of the general electoral roll. The conversations were focused on gathering the stories of particular everyday events as well as the person’s reflections on aging. Anecdotes drawn from the conversations formed the research text. Hermeneutics informed the interpretive engagement with this text. As a non-Maori researcher, cultural integrity of the text and the interpretations was enhanced through partnership with a Maori advisor. Dwelling hermeneutically with the anecdotal text was a way of listening to the spoken and unspoken words. Four overarching notions were illuminated and form the study’s findings. They are my interpretive descriptions of the ordinary ways of ‘being in the everyday,’ the experiences of ‘being with others’ in advanced age, the announcing of being aged in the uncomfortableness of ‘experiencing the unaccustomed’ and how ‘aging just is’ there in an everyday way. Reflecting phenomenologically on the findings, the meaning of being aged is in its ordinariness. My thesis is that being in the ordinary everyday in advanced age both conceals and reveals the phenomenon of being aged.

It’s like the sun and the tide. The aim of this study was to understand the meaning of ‘being aged’ through the everyday experiences of those who are aged. Philosophically, this interpretive study was informed by hermeneutics and interpretive phenomenology. The writings of two twentieth-century philosophers, Hans-Georg Gadamer and Martin Heidegger, guided the study’s design and research methods. The phenomenon of interest is ‘being aged;’ a thing which is ordinarily taken-for-granted in the everyday. However, much is already spoken and empirically ‘known’ about the phenomenon by those who are not yet aged. Methodologically the study’s design sought to ‘put aside’ those voices and listen in closely to what elders themselves had to say about being in their everyday lives. Individual research conversations were conducted with fifteen participants; four Maori elders aged 71 to 93 and eleven non-Maori elders aged 80 to 97 years. All were living in private residences on Auckland’s North Shore and recruited by way of the general electoral roll. The conversations were focused on gathering the stories of particular everyday events as well as the person’s reflections on aging. Anecdotes drawn from the conversations formed the research text. Hermeneutics informed the interpretive engagement with this text. As a non-Maori researcher, cultural integrity of the text and the interpretations was enhanced through partnership with a Maori advisor. Dwelling hermeneutically with the anecdotal text was a way of listening to the spoken and unspoken words. Four overarching notions were illuminated and form the study’s findings. They are my interpretive descriptions of the ordinary ways of ‘being in the everyday,’ the experiences of ‘being with others’ in advanced age, the announcing of being aged in the uncomfortableness of ‘experiencing the unaccustomed’ and how ‘aging just is’ there in an everyday way. Reflecting phenomenologically on the findings, the meaning of being aged is in its ordinariness. My thesis is that being in the ordinary everyday in advanced age both conceals and reveals the phenomenon of being aged.