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Rural Elderly and Community Nurses' Perspectives

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Rural Elderly and Community Nurses' Perspectives An Ethnographic study to understand the concept of rural Thai elderly resilience: Rural elderly and community nurses’ perspectives Wilaiwan Pathike BNS (Srinakharinwirot University, Nakhonnayok), MS (Community Medicine, Khon Kaen University), RN. Thesis submitted in total fulfilment for the degree of Doctor of Philosophy (Nursing) of the University of Newcastle, NSW, Australia October 2016 i Declaration The thesis contains no material which has been accepted for the award of any other degree or diploma in any university or other tertiary institution and, to the best of my knowledge and belief, contains no material previously published or written by another person, except where due reference has been made in the text. I give consent to the final version of my thesis being made available worldwide when deposited in the University’s Digital Repository**, subject to the provisions of the Copyright Act 1968. **Unless an Embargo has been approved for a determined period. Signed: ___________________________ (Wilaiwan Pathike) ii Acknowledgement Conducting the PhD project over the past several years has been incredibly enjoyable, rewarding and at times a challenging endeavour. Several people are acknowledged for their support during this journey. Firstly, my academic supervisors, Professor Anthony Paul O’Brien and Dr Sharyn Hunter are acknowledged for their tireless efforts in guiding my work, but also for helping with my enthusiasm and motivation levels during the more difficult times of the PhD process. Our continuous e-mail correspondence and countless meetings have effectively shaped my progress. For their immeasurable experience, which was always apparent, especially during the times of greatest need, I am truly thankful. Grateful thanks to all the staff of the University of Newcastle, especially the School of Nursing and Midwifery, Faculty of Health and Medicine, the University Libraries including all of its librarians, the Graduate School, Learning Development, IT-Service, International Office, and Security for their pleasant, effective support throughout my study period. During the data collection phase, I would like to thank Associate Professor Khanitta Nuntaboot, my study mentor from the Faculty of Nursing, Khon Kaen University, Thailand. Her suggestions were useful and her support kept me heading in the right direction during the data collection phase. I would also like to give special thanks to Roi-Et Provincial Health Office and Srisomdej District Health Office who assisted me during my research study. To the four Tambon iii Health Promoting Hospitals, I offer my appreciation. I am thankful to all the participants that gave my study their full concentration in assisting with developing an understanding of the concept of resilience, as well as allowing me to observe them during their everyday lives. My deepest thanks also go to the English language assistants, Methinee Laoprom and Thanapol Thamnuvat, who translated the Thai transcripts to accurate English, as well as Fran Flavel and Angela Smith who assisting with the editing process throughout my thesis. I appreciate their hard work and patience at the various stages throughout the completion of this research manuscript. As I am an international student staying 4,677 miles away from home, I would like to give my sincere thanks to Dr Christian Brooks and his family, (Jeffrey, Carol, Mil, Nana-B, also the Brooks and Young family siblings) for their warmth and physical and emotional support. I also extend my thanks to the Match family (Michael, Nattakarn, George, and little Henry) for their very kind support. These families have given me a sense of belonging whilst I have been living in Australia. They helped me to feel secure and enabled me to learn and experience the Aussie culture. Thanks also to my PhD friends for their encouragement, support, and inspiration and for sharing enjoyable times together. Thanks especially to Pe Napa, Pe Im, Pe Dit, Pe Nok and Pe Kack who were Thai students, Gary and Joanne who were domestic students, as well as the school’s lecturers, and the school officers. Importantly, I offer my sincere gratitude and appreciation to my dear parents and family who gave me strong support. My parents: my father, Veera and my mother iv – Poungprai who are my central love supports. They gave me passion, inspiration, energy, tolerance, good will and pushed me to complete. I also extend my appreciation to my younger brother Nantawat who signed the documentation for being my guarantor, allowing me to come and complete my degree in Australia. As well as my other family members: my three aunties, Pa Young, Pa Pung and Pa Joy who nursed me and have taken care of me since birth. My thankfulness goes to all my kinship families: Pathike and Ponchana. Financially, a PhD can be demanding, and I would not have been able to undertake such a project had it not been for the financial support of the University of Newcastle, School of Nursing and Midwifery, Faculty of Health and Medicine, Australia and the Srinakharinwirot University, Thailand, who authorised this support on behalf of the Thai government. v Abstract This ethnographic doctoral research study documents and clarifies the concept of resilience among Thailand (Thai) provincial elderly. The significance of this research is highlighted by the increasing global and Thai ageing population, with a concurrent decrease in the traditional family support of older persons in provincial areas. The Thai elderly who live in rural provinces are naturally affected by challenges in their lives, which is further compounded by chronic disease and geographic isolation. Resilience however, is poorly understood in the context of the rural Thai elderly existence, particularly so in relation to the contribution of the primary health care agencies and community nurses’ roles. This study describes the concept of older people’s resilience in the rural Thai community together with the perspectives obtained from their community nurses. The ethnography involved fieldwork, semi-structured interviews, and non- participant observation in four Tambon Health Promoting Hospitals (THPHs) and local villages. The study participants included 35 elderly rural Thai people who were willing to be interviewed and 7 community nurses, of which two were interviewed twice. In total, 44 semi-structured interviews and 340 hours of non- participant observation were conducted. A comprehensive qualitative thematic analysis using Nvivo10 was conducted to analyse the data collected. The key thematic findings from the older persons included ‘living well every day, ‘adversity and rural Thai older people’, and ‘elderly resilience. In terms of the community nurses’ perspectives, resilience consisted of three subthemes: vi ‘resilience-what is it?’, ‘overcoming adversity’, and ‘everyday nursing experience - resilience in rural Thai elders. The thematic findings of this study clarify, interpret, and deepen the understanding of the concept of resilience among rural Thai elderly and their community nurses. Understanding and providing care to support elderly resilience can lead to better health outcomes and health prevention strategies being developed in rural Thai aged care. Resilience planning could also contribute to the promotion of healthy interventions to improve primary health care that is supportive of rural Thai elderly in their communities. This study is also considered a valuable source of information for Thailand community nurses to use in the consideration of health promotion interventions to sustain and support healthy ageing for the rural Thai elderly population. vii Table of contents Declaration .............................................................................................................. i Acknowledgement ................................................................................................. ii Abstract .................................................................................................................. v Table of contents ................................................................................................. vii List of Tables ....................................................................................................... xii List of Figures ..................................................................................................... xiii Research sites Map ............................................................................................. xiv Glossary of terms and abbreviations used in the thesis ................................... xv Chapter One: Introduction and background ..................................................... 1 Introduction ......................................................................................................... 1 Background of the study ...................................................................................... 3 Thai elderly ...................................................................................................... 3 Thailand ........................................................................................................... 3 Thai culture and family configuration ............................................................. 5 Quality of life and the impact of culture and family configuration ................. 6 Health care services ......................................................................................... 8 Resilience ........................................................................................................
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