Nursing, Midwifery & Health Systems Research Collection
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- PublicationAdventure Playgrounds: an introduction(National Playing Fields Association, 1984)An Adventure Playground is an area fenced off and set aside for children. Within its boundaries children can play freely, in their own way, in their own time. But what is special about an Adventure Playground is that here (and increasingly in contemporary urban society, only here) children can build and shape the environment according to their own creative vision.
- PublicationArticle 31 Action Pack Children's Rights and Children's Play : Resources for Action to Implement Article 31 of the United Nations Convention on the Rights of the Child(PLAY-TRAIN, 1995)
; ;The right rest and leisure, to engage in play is usually missing from any discussions of children's rights. It is all too easy to fall into the trap of thinking only of those rights which are about protections; from poverty, from war and from abuse of every kind. This view will tend to see children as victims. The Article 31 Action Pack focuses on those articles which are about participation. 859
- PublicationUnmarried pregnant women's accounts of their contraceptive practices: a qualitative analysis(Manchester University Press, 1996)This article presents qualitative data on the contraceptive practices of fifty-one unmarried pregnant women selected at a Dublin maternity hospital. Seven categories have been constructed from data to capture the ways in which the women became pregnant, namely 'fertility denial', 'destiny dependence', 'progressive remissness', 'occasional or intermittent risk-taking', 'calculated risk-taking', 'pro-active fertility management', and 'contraceptive failure or misuse'. It is argued that the variations noted in women's experiences in approaching pregnancy occurred against a background of patriarchal discourses that sometimes intersected to produce contradictory effects.
- PublicationGender differences in the responses of parents to their daughter's non-marital pregnancy(Beyond the Pale Publications, 1997-02)
- PublicationThe medicalisation of childbearing norms: encounters between unmarried pregnant women and medical personnel in an Irish context(University College Dublin Press, 1997-05)
- PublicationMarriage and motherhood: the contradictory position of single mothers(Cork University Press, 1997-05)
- PublicationMatrilocality and female power: single mothers in extended households(Elsevier, 1999-11)Based on a qualitative study of non-marital pregnancy and childbearing in the Republic of Ireland, this article reports on the gendered power position of unmarried women who return to their parental homes following their babies' births. It is argued that in matrilocal households, centralised male power associated with the traditional nuclear family is diffused to some extent. Empirical evidence to support this notion is to be found in analysing the position of the putative father as ‘guest’ in the home of his partner and child (the martrilocal household) and also in exploring the relationship between the participant and her own father within that household. In relation to her own father, it was found that reproducing an offspring provided the women with some bargaining leverage vis-à-vis her own father within the family home. These reshaped relationships represent, to some extent at least, the undercutting of centralised male authority within the household. Non-marital childbearing in Ireland has increased sharply in the past 20 years (Central Statistics Office, 1974–1994, 1995, 1996), and there is evidence that many unmarried women who have children return to their parental home after the birth Flanagan & Richardson 1992 and Richardson 1992.1 This article reports on the experiences of a subsample of non-marital mothers who returned to their parental home after the babies' births, and focuses specifically on their gendered power position within the parental home since becoming mothers. The matrilocal2 extended family involved a complex network of relations and, it is argued, was the location where traditional patriarchal structures were found to be undermined. Where relations with the putative father were sustained, the power status of the male partner vis-à-vis the participant and child within the matrilocal extended family was eroded to a considerable extent, compared with the power position traditionally held by the male as presumed head of household3 in the nuclear family. Even in those situations where participants were no longer in relationships with the putative fathers, their power position in the home vis-à-vis their own fathers was frequently altered in their favour with the birth of the baby. The article will begin by outlining the methodological stance adopted in the study. This will be followed by an analysis of data on both participants' and putative fathers' positions within the matrilocal home. Participants' relationships with their own fathers since the babies' births will also be theorised. Since the focus of this article is on gendered power experiences within the home, the actual mothering experiences of the women will not be analysed other than where they mediate power relationships and are relevant to the central issue of the article. In conducting the study, there was no a priori assumption that non-marital childbearing was problematic; however, the stigmatisation of this style of mothering in the past Arensberg & Kimball 1968, Darling 1984, Kilkenny Social Services 1972, O'Hare, Dromey, O'Connor, Clarke, & Kirwan 1987, Smyth 1992 and Viney 1964, women's continued disadvantaged position within marriage (see Delphy 1992, Smart 1984 and Walby 1990), and the sharp increase in non-marital motherhood in Ireland (Central Statistics Office, 1974–1994, 1995, 1996) prompted an exploration of the topic.
243Scopus© Citations 2
- PublicationSingle pregnant women's encounters in public: changing norms or performing roles?(Social Care Ireland, 2000-01-01)This paper presents data on single pregnant women's encounters in public in an Irish context. Data were collected using in-depth interviews, which were analysed using a grounded theory strategy. The study was conducted in Dublin City and 51 unmarried women whose ages ranged from 16-36 participated. Findings suggested that while dominant public discourses on non-marital childbearing within the culture were negative (albeit challenged) at the time data were being collected, responses from others whom participants interacted with in verbal face-toface encounters in public were generally (though certainly not exclusively) experienced as positive in tone. An attempt is made to explain the discrepancy between the mainly negative macro messages and mainly positive micro messages by drawing on Erving Goffman's theory of dramaturgy; it would seem that at the micro-level of interaction, a 'performance' was being acted out that may be at variance with definitions of non-marital pregnancy expressed by those beyond the encounter.
- PublicationPathways to participation: openings, opportunities and obligations(Wiley, 2001-04)The United Nations Convention on the Rights of the Child has raised the profile of children's participation in the United Kingdom. Hart's ‘ladder of participation’ has been the most influential model in this field. This paper offers an alternative model, based on five levels of participation: 1. Children are listened to. 2. Children are supported in expressing their views. 3. Children's views are taken into account. 4. Children are involved in decision‐making processes. 5. Children share power and responsibility for decision‐making. In addition, three stages of commitment are identified at each level: ‘openings’, ‘opportunities’ and ‘obligations’. The model thus provides a logical sequence of 15 questions as a tool for planning for participation.
1790Scopus© Citations 690
- PublicationHIV-positive patients' experiences of stigma during hospitalisation(Elsevier, 2001-11)
;The aim of the research to be presented in this article was to explore, within an Irish context, HIV positive patients' experiences of hospitalisation, and particularly their experiences of nursing care. This paper reports on one of the dominant themes to emerge in the study - the experience of stigma among persons living with HIV during their hospitalisation. A volunteer sample of 10 former in-patients of hospitals in the Republic of Ireland’s capital, Dublin, were interviewed in depth, and data were analysed using a qualitative content analysis. Findings indicate that while some participants experienced stigma from nurses, such stigma was stratified according to the means by which the disease had been contracted, with drug users expressing the greatest feelings of stigma from nurses. Data also suggest that the location of nursing care favoured by many participants was segregated care in specialist units, because it enabled them to avoid being discredited by other patients who did not have the virus, as well as potentially offering social support from like-situated others. Finally, patients experienced breaches in confidentiality because of institutional policies that made their disease conspicuous, and from some nurses' nonchalance in handling information about their disease. The analysis draws on Goffman's conceptualisations of stigma to explain the social process underlying participants' accounts. 2152Scopus© Citations 46
- PublicationAlcohol consumption among 11-16 year olds:"Getting around" structural barriers?(Blackwell (Wiley), 2001-12)
; ; ; ; ;This paper presents qualitative data from Irish children and adolescents on their experiences in relation to alcohol consumption. A sample of 78 participants (average age 11.5 years) was selected. A proportion of this initial sample were interviewed at intervals over a period of 3 years. The participants’ consumption patterns were analyzed and four categories were generated: covert unsanctioned, overt unsanctioned, overt sanctioned, and peer unsanctioned. As the children got older, peer drinking became a stronger feature of the data; however, it mediated other patterns of behavior. Although the children displayed agency in circumventing adult rules relating to alcohol consumption, the participants were subjected to structural constraints by virtue of their status as children. Moreover, the agentic powers of the participants were procured through their social network rather than arising from an essentialist agency possessed by each individual child. The impact of childhood as a structural dimension weakened to some extent as the participants got older and had more freedom to circumvent adult-defined barriers to alcohol consumption. 364Scopus© Citations 7
- PublicationStaff nurses' perceptions of supernumerary status compared with rostered service for Diploma in Nursing students(Blackwell (Wiley), 2002-06)
;Background/rationale. In the Republic of Ireland, the amount of clinical teaching expected of staff nurses has increased substantially in the wake of the transfer of nursing education to universities, and the advent of supernumerary status for students. A modicum of previous research noted that staff nurses are unclear about their role in relation to facilitating the clinical learning of supernumerary students.. Aims of the paper. To explore staff nurses' perceptions of their role in the facilitation of learning for university-educated diploma students in the clinical area and their attitudes towards these students.. Design/methods. Sixteen staff nurses were interviewed in depth using semi-structured interviews. Data were analysed qualitatively, using content analysis, with the help of the software package NUD*IST.. Findings. Among the central themes to emerge, upon which this article is focused, was participants' perceptions of supernumerary status compared with rostered service for diploma students. Data suggested that the rostered status of students was generally favoured by staff nurses over and above supernumerary status because, unlike supernumerary students, rostered students did not disrupt the existing social structure within the clinical setting. Both structuration theory and role theory are drawn upon to explain the reproduction of the prevailing social structure, where the concentration is on getting through nursing work with little emphasis on the supervised learning of supernumerary students.. Study limitations. This study is constrained by eliciting only the views of staff nurses. Further studies are required of student nurses' experiences of rostered service and supernumerary status.. Conclusions. Because staff nurses are part of the system within which they work, they need to modify their role to include active student teaching as a legitimate component of that role.. 982Scopus© Citations 9
- PublicationMidwifery practice and the crisis of modernity: implications for the role of the midwife(Elsevier, 2004-06)
;Almost since its inception, the concept of modernity was found to display tensions between its emancipatory potential to liberate the human subject from the manacles of tradition, and the application of reason to co-ordinate and control the natural world through scientific knowledge. This paper presents a qualitative analysis of in-depth interviews with 12 midwives about their role in the Irish maternity services and argues that, in a period of late modernity, these tensions continue to manifest themselves in the context of the midwife's role. Although the contemporary period is marked by a loss of faith in scientific truths, widely contested obstetric knowledge and practices continue to exercise mastery over nature while undermining a central feature of the midwife's role-the liberation of the autonomous subject. Drawing on the theory of communicative action developed by the critical theorist Jurgen Habermas, it is argued that the midwife's role in facilitating the autonomous choices of women through communicative action is impeded by the colonization of the lifeworld of labour and childbirth by the technocratic system of obstetrics. Although participants reported that their role involved empowering women and facilitating choices through dialogue congruent with communicative action, data also suggested that participants used strategic communication with clients aimed at achieving particular ends. The use of strategic communication was linked to the way in which the midwife's role is determined to a large extent by the practices and protocols of obstetrics, and also to the notion of client passivity. The instrumental rationality of obstetrics is linked to an outcome orientation to power and money, and a political economy perspective of medicine. It appears that communicative action between midwives and obstetricians is important in bringing about structural changes to facilitate the conditions for communicative action between midwives and their clients. 2057Scopus© Citations 68
- PublicationNurses' Experiences of Distance Education Programmes(Blackwell (Wiley), 2005-01)
;Aim. This paper reports on a study exploring the experiences of nurses undertaking distance education (DE) programmes. Background. While DE has many advantages in terms of the flexibility, autonomy and freedom that it affords to learners, the literature reports that students undertaking these programmes can also experience feelings of being disconnected and isolated. Methods. A convenience sample of 15 participants was selected, and data were collected using in-depth interviews. Data were analysed using a qualitative design that drew most heavily on the methodological procedures of grounded theory. Findings. Habermas’ theory of communicative action was found to be relevant to the interpretation of data and four categories were constructed to explain participants’ experiences in relation to DE, namely: lifeworld lamented; lifeworld experienced; lifeworld ceded and learning within a bounded system. These categories reflect the manner in which participants experienced the lifeworld component (the interactive and subjective dimensions) and the system component (objective and outcome oriented dimensions) of the educational realm. While data indicated diversity in how the boundedness of the programmes was experienced, overall such standardized, instrumental courses were viewed favourably by participants within the limitations of their own personal circumstances. Conclusion. Distance education as a means of disseminating nursing knowledge should be strengthened. The challenge for nurse educators is to develop DE programmes that minimize their limitations and maximize their potential. 402Scopus© Citations 17
- PublicationModes of rationality in nursing documentation: biology, biography and the 'voice of nursing'(Blackwell, 2005-06)
; ; ; ; ; ; ; ;This article is based on a discourse analysis of the complete nursing records of 45 patients, and concerns the modes of rationality that mediated text-based accounts relating to patient care that nurses recorded. The analysis draws on the work of the critical theorist, Jurgen Habermas, who conceptualised rationality in the context of modernity according to two types: purposive rationality based on an instrumental logic, and value rationality based on ethical considerations and moral reasoning. Our analysis revealed that purposive rationality dominated the content of nursing documentation, as evidenced by a particularly bio-centric and modernist construction of the workings of the body within the texts. There was little reference in the documentation to central themes of contemporary nursing discourses, such as notions of partnership, autonomy, and self-determination, which are associated with value rationality. Drawing on Habermas, we argue that this nursing documentation depicted the colonisation of the sociocultural lifeworld by the bio-technocratic system. Where nurses recorded disagreements that patients had with medical regimes, the central struggle inherent in the project of modernity became transparent--the tension between the rational and instrumental control of people through scientific regulation and the autonomy of the subject. The article concludes by problematising communicative action within the context of nursing practice 852Scopus© Citations 37
- PublicationThe focus group method: insights from focus group interviews on sexual health with adolescents(Elsevier, 2005-12)
; ; ;This article concerns the manner in which group interaction during focus groups impacted upon the data generated in a study of adolescent sexual health. Twenty-nine group interviews were conducted with secondary school pupils in Ireland, and data were subjected to a qualitative analysis. In exploring the relationship between method and theory generation, we begin by focusing on the ethnographic potential within group interviews. We propose that at times during the interviews, episodes of acting-out, or presenting a particular image in the presence of others, can be highly revealing in attempting to understand the normative rules embedded in the culture from which participants are drawn. However, we highlight a specific problem with distinguishing which parts of the group interview are a valid representation of group processes and which parts accurately reflect individuals' retrospective experiences of reality. We also note that at various points in the interview, focus groups have the potential to reveal participants' vulnerabilities. In addition, group members themselves can challenge one another on how aspects of their sub-culture are represented within the focus group, in a way that is normally beyond reach within individual interviews. The formation and composition of focus groups, particularly through the clustering of like-minded individuals, can affect the dominant views being expressed within specific groups. While focus groups have been noted to have an educational and transformative potential, we caution that they may also be a source of inaccurate information, placing participants at risk. Finally, the opportunities that focus groups offer in enabling researchers to cross-check the trustworthiness of data using a post-interview questionnaire are considered. We conclude by arguing that although far from flawless, focus groups are a valuable method for gathering data about health issues. 2488Scopus© Citations 105
- PublicationWhat characterizes 'the usual' preoperative education in clinical contexts?(Blackwell (Wiley), 2005-12)
;The literature on preoperative education is dominated by studies that employ experimental designs to measure the effects of structured programs on patient outcomes. These studies predominantly compare structured preoperative educational interventions with the usual care that patients receive. However, the notion of what the “usual” care comprises is largely elusive and unexplored. This study aimed to understand how the usual preoperative education is practiced in a number of surgical clinical units at one particular hospital in Ireland. Twelve experienced surgical nurses were interviewed in depth. A qualitative strategy resembling grounded theory was employed to analyze the data. The findings indicated that the content and quality of the preoperative education that patients received depended largely upon the individual nurse caring for the patient. Although there was a generic content of preoperative education that all participants identified as important, this related to physical and technical issues, and to the transmission of administrative or procedural information. Perspectives on the process of delivering preoperative education were diverse. The vast majority did not relate to the formal language of the discourses of teaching and learning; nonetheless, their descriptions of engaging in their work indicated the application of some elements of educational theory. The data suggested that the use of teaching tools was inconsistent, depending on their availability and the practices of individual nurses. On the whole, the usual care as described by participants in our study may be characterized as uneven, variable, and mutable. We conclude by raising some methodological issues relating to the use of the usual care in control groups in experimental studies on preoperative education. 668Scopus© Citations 10
- PublicationMasculinities and young men's sex education needs: problematising client centred health promotion approaches(Oxford Journals, 2005-12)
; ; ;In recent decades, dominant discourses in health promotion have emphasized empowerment, client participation and the notion of people identifying and being facilitated to meet their own health needs. However, there has been little analysis of the concept of ‘need’ and the possibility, at least, that the fulfilment of some such self-defined needs are not in the interest of social justice and equality. In this article, we present an account of the sex education needs of secondary school pupils from their own perspectives, and problematize the concept of self-identified needs in health education. Twenty-nine focus group interviews were conducted with 226 secondary school pupils in Ireland, and data were subjected to a qualitative analysis. Findings suggested that young men tended to prioritize practical guidance that would provide them with the skills and confidence to take the lead in sexual encounters, and display competence in the act of penetrative sex. We argue that these self-defined sex education needs emanate from a culture of traditional masculinity where, for a male, one's place in the pecking order is derived from one's capacity to conquer, lead and display mastery with regard to sex. In the discussion, we attempt to unpack the notion of clients identifying their own needs and the concept of empowerment as it relates to our data, in the context of gender-based structural inequalities 179Scopus© Citations 14
- PublicationSexuality as an aspect of nursing care for women receiving chemotherapy for breast cancer in an Irish context(Elsevier, 2006-02)
;In this article, findings are presented from a study that aimed to explore the perceptions and experiences of a sample of nurses in addressing sexuality as an aspect of care for women receiving chemotherapy for breast cancer. A sample of 10 oncology nurses was selected from oncology units at three hospitals in Ireland, and each participant was interviewed in depth. A qualitative strategy was employed to analyse data. Findings indicated that participants tended to construct sexuality in broad terms, and were well aware of the effects of chemotherapy on a person's sexuality. In addition, they considered sexuality education to be a legitimate and important aspect of their role. However, they also revealed that they avoided addressing sexuality with patients, or encountered structural obstacles in doing so. Some participants expressed anger and frustration when discussing barriers to incorporating sexuality into their practice. A strong theme in data was participants' perceptions that they were not adequately prepared in either pre-registration or post-registration programmes to incorporate sexuality as a dimension of patient care, although post-registration programmes were more likely to furnish them with knowledge about sexuality. Finally, participants' views on sexuality care are considered in the context of Irish culture which until recently was dominated by Catholic Church teachings. 1289Scopus© Citations 40
- PublicationNurse-related factors in the delivery of preoperative patient education(Blackwell (Wiley), 2006-06)
;Aims and objectives. This article aimed to explore the factors relating to nurses themselves that influence the delivery of preoperative patient education in everyday surgical clinical contexts at one large general adult teaching hospital in Ireland. Background. As landmark studies of preoperative education undertaken in the UK in the 1970s identified the superiority of structured programmes of patient education over and above ‘regular’ preoperative care, there have been many intervention/outcome experimental studies carried out in this area. However, there has been little interpretative work conducted that explores the regular, or ‘usual’ preoperative education given to patients in everyday surgical units. Methods. A sample of 12 experienced surgical nurses was selected and each participant was interviewed in depth. Data were analysed using a qualitative strategy resembling grounded theory. Results. Findings indicate that preoperative education was variously interpreted by participants, and participants’ accounts suggested that different understandings and practices by nurses resulted in patients receiving different levels of care. In addition, diverse levels of knowledge and experience of individual nurses resulted in unevenness in the type of preoperative education that patients received. A number of participants advocated a more formal method of preparation for nurses in the area of preoperative education. Finally, in some surgical areas, specialist nurses worked side-by-side with regular ward nurses and their input in preoperative education was largely seen by participants in a positive way, particularly in view of the structural constraints that ward nurses faced. Conclusions. We conclude that nurse-related factors in preoperative education do not arise in a vacuum, but rather are related to the wider organizational practices and culture. The difficulties with preoperative education identified in data may be addressed through organizational investment in preoperative education. Relevance to clinical practice. This paper produces evidence for nurses and clinical nurse managers about how nurse-related factors impede preoperative education, and may provide a starting point for how to begin to address obstacles to better preoperative care. 3527Scopus© Citations 22