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. The thesis obtains information from a variety of texts that includes established literature (such as medical, sociological, legal, academic and philosophical), newspaper articles, radio or television interviews, internet sources, court reports and proceedings, legal experts and other commentators – and 15 interview based texts, where the focus is on analyses of narratives of parents, doctors and nurses. In the texts gathered for this thesis, there are noticeable differences between the personal experience discourses of parents, the ‘in-between’ discourses of nurses, and the disciplined discourses of physicians. This thesis brings these discourses into conversation with each other suggesting that parental resistance does not occur because of an infrequent and unusual set of circumstances where a few socially isolated and/or ‘difficult’ parents disagree with the treatment desires of paediatric physicians. Instead, 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. Instead an analysis of their discourses and practices is able to illuminate the complex interactions between patients and medical conventions. It is therefore possible to see parents who resist medical advice not as peripheral to the medical encounter but as examples of how patient-physician relationships come to be codified, constructed and crafted through everyday discourses and practices within health care settings.

Te Arawhata o Aorua – Bridge of two worlds is a theory about Maori mental health nurses. The aim of this study was to explore what was occurring amongst Maori mental health nurses and dual competencies. A grounded theory informed by a Maori centred research approach was adopted and conducted with three focus groups of ten Maori mental health nurses situated in one metropolitan and two provincial cities. The research design was informed by Mason Durie?s Maori centred concepts of whakapiki tangata (enablement), whakatuia (integration) mana Maori (control) and integrated with grounded theory to guide the collection and analysis of the data. Audio taping and field notes were used to collect the data and the processes of constant comparative analysis, theoretical sampling and saturation were used to generate a middle range substantive Maori centred grounded theory. One core category was identified as two worlds which describes the main issue that they are grappling with. The basic social psychological process of bridging of tension explains how the two worlds are managed through two subcategories of going beyond and practising differently. Going beyond consists of two components, being Maori and enduring constant challenge that set the philosophical foundation to practice. Practising differently describes three key components as kaitiaki of wairua, it?s about whanau and connecting each are blended into each other and fused into nursing practice. The impressions of the Maori mental health nurses have been interpreted and explained by this theory. The substantive grounded theory provides a model to guide health services appreciation of Maori mental health nurses, for professional development of Maori mental health nurses and to policy writers.

Wellness educators have faced a great challenge to develop strategies to move people toward the adoption of positive lifestyle behaviours. This research explores concepts of self and the impact of Thai culture on the motivation of young college women to engage in health-promoting lifestyle behaviours (HPLBs) in the context of northeastern Thailand. A sequential mixed methods design enables an exploration of the relationships among sense of coherence, identity status, and HPLBs in the first phase, and an inductive analysis of the impact of Thai cultural context in the second phase. In study A, three instruments: the Health-Promoting Lifestyle Behaviors Profile II (HPLP II), the Extended Version of the Objective Measure of Ego Identity Status (EOM-EIS), and the Orientation to Life Questionnaire (SOC-29), were used with 350 senior college women. Sense of Coherence was significantly correlated with achieving a sense of identity, lessening diffusion identity and engaging in health-promoting behaviours. Although a considerable proportion of the variance (26.7 %) for engaging in HPLBs was accounted for by SOC, identity achievement, and identity moratorium, the magnitude of the unexplained variance was considerable. This led to inductive exploration of other variables influencing HPLBs in Study B. By data-driven thematic analysis, the Model of the Mindful Self emerged from in-depth interviews with 25 college women. The model describes three main themes: (a) the cultural background and the surrounding ongoing influences which impact on the development of Thai women's sense of self and their health-related behaviours, (b) the sense of self and identity formation in the Thai context, and (c) the health-related behaviours that stem from the sense of self. Sense of self and its behaviours are socially constructed within the specific culture in which individuals are embedded. The social phenomena and research outcomes are interpreted under the lens of social constructionism. The knowledge generated by this study provides guidance for teaching about health promotion in Thai undergraduate nursing programmes and also provides a basis for initiating health-promoting programmes based on the individual's sense of self for female adolescents in Thailand.

Illness that requires hospitalisation is a potential cause of anxiety for the entire family. Furthermore, increases in technology and specialisation of hospital services have resulted in increasing numbers of patients being transferred to centralised tertiary hospitals. There is limited international and national literature that explores the phenomenon of having one's spouse hospitalised in non-local tertiary centres. Therefore, this study was conducted with the aim of exploring the experiences of those whose spouses were hospitalised in non-local tertiary settings. Understanding of the experiences of 14 people affected by such hospitalisations was underpinned by a Heideggerian phenomenological perspective. Three major themes emerged from this study. Those who have their spouse hospitalised in non-local tertiary settings spend time waiting; a time best described as being-in-suspense. Despite being-in-suspense the research participants adjusted to their understanding of the situation; a period of time interpreted as fitting being out-of-town into being-in-the-world. The final theme that emerged from this study is that there were times when the research participants perceived that they were alone, unable to support or be supported by their spouses: being with and without others. Overall the findings of this research indicate that those whose spouses were hospitalised in a non-local tertiary centre lived day by day, with little or no social support, awaiting outcomes over which they had limited control. The worst potential outcome for these individuals would be that of the spouse's death in the non-local centre. When the outcomes of the non-local hospitalisation could be predicted, the events of living day by day were manageable. It also emerged from conducting this study that in living day by day, the supporting spouse dealt with the circumstances by being focussed on the temporality of the present and a vision of a positive future. However, their spouses were not always able to conceive the future in such a positive way. Nurses and other health professionals must remain cognisant of the fact that while they are familiar with the everydayness of non-local hospitalisations, [abstract incomplete].

The purpose of this research has been to trace the development of the nurse practitioner role in New Zealand. Established in 2001, this advanced nursing practice role was birthed amid controversy as historical forces at play both inside and outside nursing struggled for power to control the future of the profession. Using a discourse analytical approach informed by the work of Michel Foucault, the study foregrounds the discourses that have constructed the nurse practitioner role within the New Zealand social and political context. Discourses, as explained by Foucault, are bodies of knowledge construed to be ‘truth’ and connected to power by reason of this assumption, serving to fix norms and making it virtually impossible to think outside them. Discourses of nursing and of medicine have established systems of disciplinary practices that produce nurses and physicians within defined role boundaries, not because of legislation, but because discourse has constructed certain rules. The nurse practitioner role transcends those boundaries and offers the possibility of a new and potentially more liberating identity for nurses and nursing. A plural approach of both textuality and discursivity was used to guide the analysis of texts chosen from published literature and from nine interviews conducted with individuals who have been influential in the unfolding of the nurse practitioner role. Both professionally and industrially and in academic and regulatory terms dating back to the Nurses Registration Act, 1901, the political discourses and disciplinary practices serving to position nurses in the health care sector and to represent nursing are examined. The play of these forces has created an interstice from which the nurse practitioner role in New Zealand could emerge. In combination with a new state regime of primary health care, the notion of an autonomous nursing profession in both practice and regulation has challenged medicine’s traditional right to surveillance of nursing practice. Through a kind of regulated freedom, the availability of assessment, diagnostic and prescribing practices within a nursing discourse signals a radical shift in how nursing can be represented. The nurse practitioner polemic has revolutionised the nursing subject, and may in turn lead to a qualitatively different health service.

This research takes an autoethnographical approach to exploring the connections between being a nurse, doing nursing work, and experiencing a mental illness. Data is comprised of autoethnographical stories from 18 nurses. Drawing on Lyotard’s (1988) postmodern philosophy of ‘regimes of phrases’ and ‘genres of discourse,’ the nurses’ stories yielded three motifs: Nursing, Tangata Whaiora (people seeking wellness) and Bullying. Motifs are recurring topical, emotional and contextual patterns which have been created in this research by means of the formation of collective stories from the content of the nurses’ stories, artwork, fictional vignettes and poetry. Interpretation of the motifs was undertaken by identifying and exploring connected or dissenting aspects within and between the motifs. Using Fine’s (1994) notion of hyphenated lives, the spaces between these aspects were conceptualised as hyphens. The Nursing motif revealed a hyphen between the notion of the nurses as selfless and tireless carers, and the mastery requirements of professionalism. The nurses’ hope for caring, belonging, expertise and ‘goodness’ were also features of the nursing motif. The Tangata Whaiora motif revealed the hyphen between being a compliant patient and a self-determined person seeking wellness, and also foreshadowed the notion that the nursing identity does not ‘permit’ the dual identities of nurse and tangata whaiora. This research has found that nurses who have experienced, or are vulnerable to, mental illness negotiate a nexus of hyphens between societal, professional and personal expectations of the nurse. Ongoing unsuccessful negotiation of their identities is exhausting and leads to enduring distress. At times, negotiation is not possible and the nurse is immobilised in a differend of silence and injustice. At such times, the only resolution possible for the nurse is to leave the nursing profession. Bullying surfaced as a feature of the hyphen between the nursing and tangata whaiora identities, as well as being a part of each identity as colonising, silencing and/or discriminatory acts. Successful negotiation between and among the nursing and tangata whaiora hyphens requires a radical restructuring of the nursing image and culture across the education, workplace and personal/clinical areas. Three strategies are proposed for the discipline of nursing to achieve this change: transformatory education, a conscientisation programme, and mandatory emancipatory clinical supervision.

This research takes an autoethnographical approach to exploring the connections between being a nurse, doing nursing work, and experiencing a mental illness. Data is comprised of autoethnographical stories from 18 nurses. Drawing on Lyotard’s (1988) postmodern philosophy of ‘regimes of phrases’ and ‘genres of discourse,’ the nurses’ stories yielded three motifs: Nursing, Tangata Whaiora (people seeking wellness) and Bullying. Motifs are recurring topical, emotional and contextual patterns which have been created in this research by means of the formation of collective stories from the content of the nurses’ stories, artwork, fictional vignettes and poetry. Interpretation of the motifs was undertaken by identifying and exploring connected or dissenting aspects within and between the motifs. Using Fine’s (1994) notion of hyphenated lives, the spaces between these aspects were conceptualised as hyphens. The Nursing motif revealed a hyphen between the notion of the nurses as selfless and tireless carers, and the mastery requirements of professionalism. The nurses’ hope for caring, belonging, expertise and ‘goodness’ were also features of the nursing motif. The Tangata Whaiora motif revealed the hyphen between being a compliant patient and a self-determined person seeking wellness, and also foreshadowed the notion that the nursing identity does not ‘permit’ the dual identities of nurse and tangata whaiora. This research has found that nurses who have experienced, or are vulnerable to, mental illness negotiate a nexus of hyphens between societal, professional and personal expectations of the nurse. Ongoing unsuccessful negotiation of their identities is exhausting and leads to enduring distress. At times, negotiation is not possible and the nurse is immobilised in a differend of silence and injustice. At such times, the only resolution possible for the nurse is to leave the nursing profession. Bullying surfaced as a feature of the hyphen between the nursing and tangata whaiora identities, as well as being a part of each identity as colonising, silencing and/or discriminatory acts. Successful negotiation between and among the nursing and tangata whaiora hyphens requires a radical restructuring of the nursing image and culture across the education, workplace and personal/clinical areas. Three strategies are proposed for the discipline of nursing to achieve this change: transformatory education, a conscientisation programme, and mandatory emancipatory clinical supervision.

This research takes an autoethnographical approach to exploring the connections between being a nurse, doing nursing work, and experiencing a mental illness. Data is comprised of autoethnographical stories from 18 nurses. Drawing on Lyotard’s (1988) postmodern philosophy of ‘regimes of phrases’ and ‘genres of discourse,’ the nurses’ stories yielded three motifs: Nursing, Tangata Whaiora (people seeking wellness) and Bullying. Motifs are recurring topical, emotional and contextual patterns which have been created in this research by means of the formation of collective stories from the content of the nurses’ stories, artwork, fictional vignettes and poetry. Interpretation of the motifs was undertaken by identifying and exploring connected or dissenting aspects within and between the motifs. Using Fine’s (1994) notion of hyphenated lives, the spaces between these aspects were conceptualised as hyphens. The Nursing motif revealed a hyphen between the notion of the nurses as selfless and tireless carers, and the mastery requirements of professionalism. The nurses’ hope for caring, belonging, expertise and ‘goodness’ were also features of the nursing motif. The Tangata Whaiora motif revealed the hyphen between being a compliant patient and a self-determined person seeking wellness, and also foreshadowed the notion that the nursing identity does not ‘permit’ the dual identities of nurse and tangata whaiora. This research has found that nurses who have experienced, or are vulnerable to, mental illness negotiate a nexus of hyphens between societal, professional and personal expectations of the nurse. Ongoing unsuccessful negotiation of their identities is exhausting and leads to enduring distress. At times, negotiation is not possible and the nurse is immobilised in a differend of silence and injustice. At such times, the only resolution possible for the nurse is to leave the nursing profession. Bullying surfaced as a feature of the hyphen between the nursing and tangata whaiora identities, as well as being a part of each identity as colonising, silencing and/or discriminatory acts. Successful negotiation between and among the nursing and tangata whaiora hyphens requires a radical restructuring of the nursing image and culture across the education, workplace and personal/clinical areas. Three strategies are proposed for the discipline of nursing to achieve this change: transformatory education, a conscientisation programme, and mandatory emancipatory clinical supervision.

This research takes an autoethnographical approach to exploring the connections between being a nurse, doing nursing work, and experiencing a mental illness. Data is comprised of autoethnographical stories from 18 nurses. Drawing on Lyotard’s (1988) postmodern philosophy of ‘regimes of phrases’ and ‘genres of discourse,’ the nurses’ stories yielded three motifs: Nursing, Tangata Whaiora (people seeking wellness) and Bullying. Motifs are recurring topical, emotional and contextual patterns which have been created in this research by means of the formation of collective stories from the content of the nurses’ stories, artwork, fictional vignettes and poetry. Interpretation of the motifs was undertaken by identifying and exploring connected or dissenting aspects within and between the motifs. Using Fine’s (1994) notion of hyphenated lives, the spaces between these aspects were conceptualised as hyphens. The Nursing motif revealed a hyphen between the notion of the nurses as selfless and tireless carers, and the mastery requirements of professionalism. The nurses’ hope for caring, belonging, expertise and ‘goodness’ were also features of the nursing motif. The Tangata Whaiora motif revealed the hyphen between being a compliant patient and a self-determined person seeking wellness, and also foreshadowed the notion that the nursing identity does not ‘permit’ the dual identities of nurse and tangata whaiora. This research has found that nurses who have experienced, or are vulnerable to, mental illness negotiate a nexus of hyphens between societal, professional and personal expectations of the nurse. Ongoing unsuccessful negotiation of their identities is exhausting and leads to enduring distress. At times, negotiation is not possible and the nurse is immobilised in a differend of silence and injustice. At such times, the only resolution possible for the nurse is to leave the nursing profession. Bullying surfaced as a feature of the hyphen between the nursing and tangata whaiora identities, as well as being a part of each identity as colonising, silencing and/or discriminatory acts. Successful negotiation between and among the nursing and tangata whaiora hyphens requires a radical restructuring of the nursing image and culture across the education, workplace and personal/clinical areas. Three strategies are proposed for the discipline of nursing to achieve this change: transformatory education, a conscientisation programme, and mandatory emancipatory clinical supervision.