View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by ResearchArchive at Victoria University of Wellington The Primacy of the Nurse in New Zealand 1960s-1990s: Attitudes, Beliefs and Responses over Time by Barbara Gay Williams A thesis submitted to the Victoria University of Wellington in fulfilment of the requirements for the degree of Doctor of Philosophy Victoria University of Wellington 2000 Abstract Exploring the past, and pulling ideas through to the present, to inform the future can make a valuable contribution to nurses and nursing in New Zealand. By gaining some understanding of the attitudes and beliefs nurses held, and how these influenced their responsiveness, we can learn what active responses might help inform our future. Nurses in New Zealand, as individuals and within the profession as a whole, reveal the primacy of the nurse – nurses who have made and can continue to make a difference to the health of the peoples of New Zealand. A hermeneutic process was used to interpret material, from international texts, national texts and public records over four decades, the 1960s to 1990s. This was supplemented and contrasted with material from twelve oral history participants. Analysis of the material led to the emergence of four themes: Nurses’ decision-making: changes over time; An emerging understanding of autonomy and accountability; Nurses as a driving force; and Creating a nursing future. These four themes revealed an overall pattern of attitudes, beliefs and responses of the New Zealand Registered Nurse. The themes surfaced major revelations about the primacy of the nurse in New Zealand, nurses confident in their ability to take the opportunity, seize the moment, and effect change. The contribution this thesis makes to the discipline of nursing is an understanding of how the nurse actively constructs the scope of a professional response to the context. The thesis demonstrates how nurses can learn from the past, that the attitudes and beliefs that underpin our active responses can either move us forward, or retard our progress. As nurses we can also learn that to move forward we need particular attitudes, beliefs and responses, that these are identifiable, and are key factors influencing our future, thus ensuring the continued primacy of the nurse. II Acknowledgements The completion of this thesis would not have been possible without the assistance and support of the participants, supervisors, family, friends and colleagues. I am deeply indebted to the twelve participants who generously supported my work, made time for the interviews, and commented on the first round of tapes and the selection of what was to be included in the final work. Their willingness to let me use their real names and experiences over time, has in my view considerably enhanced the value of the work and I am especially grateful for their trust. My supervisors and the staff at Victoria University of Wellington provided support and encouragement, especially Cheryle Moss whose perceptive and challenging comments assisted me in the exploration of my ideas throughout the period of the study. My children, David and Susan, supplied moral support and encouragement, and acted as a ‘help desk’ at times when the mysteries of computer technology threatened to defeat me. Friends kept me on track by asking how the work was going – keeping me working at times when other priorities were all too tempting, and providing helpful comment. Colleagues provided valuable feedback and helpful suggestions at the research schools, made me appreciate being part of a wider group seeking to share and explore issues pertaining to nurses and nursing, and in both formal and informal general discussion on the topic. I am also grateful to the Nursing Education and Research Foundation (NERF) who assisted me with a financial grant that enabled me to purchase a quality tape deck for the interviews, some of which will be included in the NERF oral history archive. III The Primacy of the Nurse in New Zealand 1960s - 1990s: Attitudes, Beliefs, and Responses over Time. Table of contents Abstract.............................................................................................................II Acknowledgements...........................................................................................III Key to frequently used abbreviations...............................................................VIII List of figures and tables..................................................................................IX The referencing style used for the participant’s accounts..............................X Chapter One – Why the primacy of the nurse?...........................................1 Reasons for choosing the time period: 1960s–1990s......................................3 Positioning the thesis .......................................................................................5 Thesis style and flow ........................................................................................7 Chapter Two: Methodology.........................................................................13 Methodological principles................................................................................15 Introduction to the framework ........................................................................23 The framework, its processes and the research question..............................................24 Application of the framework – methodology in action ................................................29 Commentary on analysis of source material.................................................................48 Creating the account – the process..................................................................57 The metaphor of the quilt ................................................................................60 Assumptions and limitations of the study........................................................69 Chapter Three: The nursing context. .........................................................75 The term ‘Nurse’..............................................................................................78 The use of the title ‘Nurse’...........................................................................................78 IV International influence on the term ‘Nurse’..................................................................79 Major changes in nursing education ..............................................................85 ‘Basic’ nursing education................................................................................86 The development of schools of nursing .........................................................................87 Major events over the four decades. .............................................................................90 Post basic education.........................................................................................104 The beginnings – seeking university education opportunities.......................................104 The 1970s - Programmes at Massey and Victoria Universities begin .........................110 Changes in the 1980s and 1990s...................................................................................111 Major changes in clinical practice ..................................................................113 Transition to a qualified workforce...............................................................................113 Development of nursing modes of practice...................................................................121 The cyclical nature of workforce availability ...............................................................124 Nursing regulation...........................................................................................130 Statutory legislation......................................................................................................131 Self-regulation ..............................................................................................................132 Nursing organisations in New Zealand ..........................................................134 Chapter Four: Nurses’ decision- making: changes over time....................145 What is decision-making?................................................................................147 The effect of an evolving environment on decision-making over time ..........148 Changing patterns of decision-making ...........................................................170 Changes in attitudes and beliefs over time......................................................173 Response: decision-making in nursing education and clinical practice........194 Participants responding to making decisions, and supporting others ..........211 V Participant vignettes.........................................................................................232 Vignette One: (Lee Mathias).........................................................................................233 Vignette two: (Margaret Bazley)...................................................................................242 Chapter Five: An emerging understanding of autonomy and accountability ..............................................................................................257 Exploring the terms..........................................................................................260 Autonomy. .....................................................................................................................262