A Fine Balance Children’s Community Nurses perceptions and practices regarding children’s rights to health: A Discourse analysis. Jill Sye A thesis presented in partial fulfillment of the requirements for the degree of Masters of Health Science Auckland University of Technology New Zealand February 2008 Attestation of Authorship I hereby declare that this submission is my own work and that, to the best of my knowledge and belief, it contains no material published or written by another person nor material which to a substantial extent has been accepted for the qualification of any other degree or diploma or university or other institution of higher learning, except where due acknowledgment is made in the acknowledgments. Acknowledgements Firstly, I thank my partner Tim and children Rowan and Leith for their tolerance and support. My special thanks to my friends and neighbours, the "village" that I hold dear, in particular: Gaelene, Kate, Jenz, and Anne for listening, reading and commenting. I also want to express appreciation for the services of my very capable transcriber Jan and computer formatting advisor Sue. Also, to the global village- the international children's rights commentators that replied to my emails when I was grappling with the big issues. Thanks to: my colleagues and the management at Waitemata District Health Board for their support, and CTA funding; NZNO for the conferences, the opportunity to participate in child health at a national level, and the NERF scholarship awarded to assist with financing the study; I particularly want to thank the participants who shared their insights and demonstrated their love and care for the children and families that they strive to serve. It was a privilege to have spent time with them and my study would not have been possible without them. I would especially like to thank my supervisors Debbie Payne and Tineke Water for their professional advice, guidance, support, and time. i Table of Contents Abstract .............................................................................................................................. 1 Chapter 1: Introduction .................................................................................................. 2 Background to Study .......................................................................................................... 2 Assumptions ................................................................................................................... 3 Current relevance for the study ...................................................................................... 5 Children’s community nursing ........................................................................................... 6 Definition of children’s community nursing .................................................................. 6 Plunket nursing .............................................................................................................. 8 Public health nursing ...................................................................................................... 8 Home care nursing ....................................................................................................... 10 Research Focus ............................................................................................................ 11 Presentation style ......................................................................................................... 11 Structure of thesis ......................................................................................................... 11 Chapter 2: From methodology to method ................................................................... 13 Introduction .................................................................................................................. 13 Philosophy .................................................................................................................... 13 Summary ...................................................................................................................... 24 Method ............................................................................................................................. 24 Data Analysis process: reading, coding analysis ......................................................... 28 Assessment of Trustworthiness .................................................................................... 29 Summary ...................................................................................................................... 33 Chapter 3: Literature review: Children rights ........................................................... 34 Introduction .................................................................................................................. 34 The child ........................................................................................................................... 35 Genealogy of childhood ............................................................................................... 35 Genealogy of the children’s rights in the 20th century ................................................ 35 Definition of childhood ................................................................................................ 37 The State ........................................................................................................................... 38 Governmentality ........................................................................................................... 38 Children’s rights to health and neoliberalism .............................................................. 40 Children’s Rights and the law ...................................................................................... 43 ii UNCROC ..................................................................................................................... 44 Child Abuse ...................................................................................................................... 49 The Children Young Person and Their Families Act 1989 .......................................... 50 The Children’s Commissioner Act 2003 ..................................................................... 51 Children’s rights to health and medicine ......................................................................... 52 Epidemiology ............................................................................................................... 52 Cultural differences in child health .............................................................................. 53 Access to health care .................................................................................................... 55 Summary ...................................................................................................................... 57 Chapter 4: Children’s community nursing ................................................................. 58 Introduction .................................................................................................................. 58 History and genealogy ................................................................................................. 58 Ethical Dimension of nursing ...................................................................................... 62 Surveillance in nursing ................................................................................................. 63 Family Centred Care discourse .................................................................................... 65 Needs and Risk ............................................................................................................. 66 “At Risk” families ........................................................................................................ 70 Communication: the therapeutic use of self ................................................................. 74 The spatial relevance of the home ................................................................................ 74 Health promotion ......................................................................................................... 75 Children’s community nursing: New Zealand nursing journals .................................. 77 Discourse from New Zealand nurses research ............................................................. 80 Summary ...................................................................................................................... 83 Chapter 5: Analysis: It takes a village to raise a child ............................................... 84 Introduction .................................................................................................................. 84 The “entitled child” ...................................................................................................... 84 The suffering child and the nurse witness .................................................................... 87 Family centred care discourse versus child centred discourse ..................................... 91 Nurse as mother’s ally .................................................................................................. 92 The nurse as educator ................................................................................................... 94 Nurse as a resource and networker .............................................................................. 98 The Resistant alternative parent ................................................................................