Kath Melia - Academia.edu (original) (raw)
Papers by Kath Melia
Context and Method in Qualitative Research
Athens Journal of Health, 2018
By discussing the lessons learned from Chinese nurses leaving nursing practice, this paper report... more By discussing the lessons learned from Chinese nurses leaving nursing practice, this paper reports on the currently neglected issue of nursing wastage in the nursing shortage in China. The nursing shortage needs to be understood locally and resolved globally. However, a lack of understanding of the root causes and consequences of nurses leaving nursing practice in their home countries has impeded the implementation of effective strategies in resolving nursing shortage nationally and worldwide. This qualitative study draws on a grounded theory approach. In-depth interviews with 19 nurses who had left nursing practice were theoretically sampled from one provincial capital city in China. Managerial and organizational support from the current Chinese nursing workforce management to retain qualified nurses is lacking. While hospital managers claim that nurses' voluntary leaving is an individuals' problem rather than an institutional problem, participants view their leaving nursing practice as the way to pursue personal freedom and value in response to their dissatisfaction and stress in nursing. The lessons from Chinese nursing perspective indicate that nursing wastage may not only occur when nurses choose voluntary leaving, but also happen when they resort to passive staying. The wastage of nursing human resources in Chinese Grade Three hospitals is arguably the most pressing nursing crisis in regards to the nursing shortage nationwide. The study suggests that nursing wastage may be avoided if nurses have greater autonomy to achieve more reasonable career prospects, thereby ensuring nurses' professional value and contribution to be properly rewarded with managerial and organizational support.
Sociology of Health and Illness, 1984
Student nurses' construction of occupational socialisation bstract This paper examines the occup... more Student nurses' construction of occupational socialisation bstract This paper examines the occupational socialisation of British nurses. It uses Bucher and Strauss's notion of segmentation and considers two major segments within nursing: the education segment wiiich, through the colleges of nursing, promotes a 'professional' version of nursing, and the service segment which is concerned with getting nursing work done. Students' accounts of their training were obtained by means of 40 informal interviews. On the basis of these accounts it is argued that the students leam neither the education nor the service segment's version of nursing, rather they leam to recognise when one version is appropriate and the other not and 'fit in' accordingly. ITie organisation of nurse training is based on a compromise between the two segments whereby the students move between clinical placements and the college of nursing; in this way both versions of nursing are enforceable on the students. The paper argues that nursing as an occupation, by its organisation and compromise solution to the training of its recruits, supports a transient approach to nursing work itself and so implicitly supports a lack of commitment to nursing as an occupation.
Social Science & Medicine, 2001
This paper draws upon an empirical study and combines moral philosophical insights and sociologic... more This paper draws upon an empirical study and combines moral philosophical insights and sociological analysis to shed light on the ethical issues in intensive care. It is argued that moral philosophical debate often leaves aside the social context in which ethical decisions are taken and carried through. In order to gain an understanding of how intensive care is accomplished and specifically how ethical issues are handled, the study focused primarily on nurses' accounts of and views on the practices which form the everyday work of intensive care. A qualitative approach was adopted involving theoretical sampling and the constant comparative method of analysis. The paper argues that the most difficult ethical issue in intensive care, namely the withholding or withdrawal of treatment, is an area in which nursing and medical perspectives are often at odds. However, when the social context of clinical practice is taken into account, this paper argues, there is common ground between the two professions. It was found that the period during which the decision to withdraw treatment is being made, the members of the intensive care team closest to the bedside, nursing and medical staff, become impatient for some resolution of the situation. The differences of opinion which arise over the decision to withdraw are not simply to do with the way in which the situation is experienced by each professional group, proximity to the patient had a part to play in shaping their views rather than, as it is sometimes presumed, a simple rift between medicine and nursing. The data suggest that intensive care has to be a team effort. Even though there is no legal requirement for nurses to agree with the ICU decisions, there seems to be a strong desire within the intensive care team that moral consensus should be achieved in the interests of good patient care. Intensive care relies on the integrity of the team and the unfailing functioning of teamwork. Consequently, achieving this, it seems, is more important than other temporary lapses in interprofessional relations and disagreements over treatment in individual cases. Consensus is important and its achievement is a central, day to day working arrangement for ensuring the solidarity of the team.
Qualitative Health Research, 1996
This article seeks to shed some light on the difference of opinion that has developed between the... more This article seeks to shed some light on the difference of opinion that has developed between the cooriginators of the grounded theory approach to qualitative data analysis. The author has worked with grounded theory and has followed the developments in the methods books written independently by Glaser and Strauss since the publication of The Discovery of Grounded Theory in 1967. What had to date appeared to be an ongoing process of refinement of the strategies for the handling of data and the development of theory has developed into nothing short of a head on clash between Glaser and Strauss.
The Lancet, 1993
When a Christian who has walked with God and knows the things of the Spirit decides willfully, to... more When a Christian who has walked with God and knows the things of the Spirit decides willfully, to step back into the worldintentionally or unintentionally-this is a very Serious matter to God. Most have no idea that this action has consequences. It doesn't matter how long you have served God in the past, or how dedicated you may have been, when someone steps back into the world and begins to act, and talk as the world does, the result is extremely serious. A Serious Matter: When I say serious, I'm talking about a situation so grave that it eventually causes God to take an aggressive and antagonistic stance toward that believer! This is why James 4:4 says: "...A friend of the world is the enemy of God." Notice that James refers to believers who have become a 'friend' of the world. The word 'friend' is from the Greek word 'phileo', a word that has many different facets, including the ideas of 'fondness, friendship, or love'. This is the Greek word someone would use if he wanted to express' affection' or even 'romance'. And when used to depict friends, this word is the picture of very 'close friends' who are 'fond of' and 'familiar with each other'.
Journal of Medical Ethics, 1994
This paper raises the questions: 'What do we expect from nursing ethics?' and 'Is the literature ... more This paper raises the questions: 'What do we expect from nursing ethics?' and 'Is the literature of nursing ethics any different from that of medical ethics?' It is suggested that rather than develop nursing ethics as a separate field writers in nursing ethics should take a lead in making the patient the centralfocus of health care ethics. The case is made for empirical work in health care ethics and it is suggested that a good way of setting about this is to ask practising nurses about the real ethical problems they encounter. to go away.
Journal of Advanced Nursing, 1982
Drawing on student nurses' accounts of their training, "Learning and Working" is a ... more Drawing on student nurses' accounts of their training, "Learning and Working" is a study of the tensions created in modern nursing between service needs and education.
American Journal of Hospice and Palliative Medicine®, 2013
We explored caregivers’ experiences and needs when providing hospice home care to their terminall... more We explored caregivers’ experiences and needs when providing hospice home care to their terminally ill elderly patients with cancer in Taiwan for 1 year. A total of 44 caregivers were interviewed using a semistructured interview once monthly during hospice home care visits until the patients’ deaths. Content analysis of the interviews revealed 5 themes, hoping for a cure, experiencing fluctuating emotions, accepting the patient’s dying, regarding the patient’s death as a good death, and needing emotional support and information. Caregivers in hospice home care who experienced difficulties tended to seek emotional support and information throughout the entire caregiving process. With a greater understanding of caregivers’ experiences and needs, nurses can alleviate caregivers’ negative emotional reactions by actively attending to their needs during this process.
Health Expectations, 2006
I wanted to know much more about the characters, who were too puppet-like for me, serving the int... more I wanted to know much more about the characters, who were too puppet-like for me, serving the interests of the author who, it seemed, wanted to portray lines of argument accurately more than the characters. The consequence was that the debates themselves were unrealistic than they could have been. The only time I felt the author was really letting the character and the plot carry her writing rather than something more artificial was during the interrogation scenes at the police station. Even the cover of the book is disappointing, saying quite clearly that the book is going to educate its reader. This book represents a new genre of writing and it is a very good, page-turning, first attempt. However, the scaffolding of ethical argument is too obvious. Let the book be a proper novel: develop the plot and show the characters fully, and let the ethical debates take care of themselves within that. In this way, the book can become a helpful contribution to contemporary ethical discourse, precisely because it is so realistic.
Journal of Medical Ethics, 1990
This is a comparative study of management accounting in intensive care units in the UK and Finlan... more This is a comparative study of management accounting in intensive care units in the UK and Finland. The management accounting problems of health care in many countries are well documented in the literature (difficulties of budgetary implementation: non-integration of health care professionals into the financial management process). This study examines these issues in the situation of intensive care, where there are difficult ethical decisions to be made by health care professionals in a climate of rapid medical advance where financial constraints may lead to rationing of health care. This paper reveals commonalities between these two countries in terms of intensive care problems, but there are differences, too, which can be attributed to contrasts in management accounting practices in the two countries.
Work, Employment and Society, 2001
Page 1. book reviews Nurses and Doctors at Work Rethinking Professional Boundaries Deidre Wicks B... more Page 1. book reviews Nurses and Doctors at Work Rethinking Professional Boundaries Deidre Wicks Buckingham: Open University Press, 1998 paper xvii+202 pp. This, the author says, is an edited and largely re-written version of her doctoral thesis. ...
Journal of Medical Ethics, 1994
This is an extremely useful work. It centres upon the findings of a postal survey concerned with ... more This is an extremely useful work. It centres upon the findings of a postal survey concerned with the teaching of nursing ethics undertaken by the Royal College of Nursing and the Institute of Medical Ethics. The sur-vey was used as the basis of the work of a multidisciplinary ...
Context and Method in Qualitative Research
Athens Journal of Health, 2018
By discussing the lessons learned from Chinese nurses leaving nursing practice, this paper report... more By discussing the lessons learned from Chinese nurses leaving nursing practice, this paper reports on the currently neglected issue of nursing wastage in the nursing shortage in China. The nursing shortage needs to be understood locally and resolved globally. However, a lack of understanding of the root causes and consequences of nurses leaving nursing practice in their home countries has impeded the implementation of effective strategies in resolving nursing shortage nationally and worldwide. This qualitative study draws on a grounded theory approach. In-depth interviews with 19 nurses who had left nursing practice were theoretically sampled from one provincial capital city in China. Managerial and organizational support from the current Chinese nursing workforce management to retain qualified nurses is lacking. While hospital managers claim that nurses' voluntary leaving is an individuals' problem rather than an institutional problem, participants view their leaving nursing practice as the way to pursue personal freedom and value in response to their dissatisfaction and stress in nursing. The lessons from Chinese nursing perspective indicate that nursing wastage may not only occur when nurses choose voluntary leaving, but also happen when they resort to passive staying. The wastage of nursing human resources in Chinese Grade Three hospitals is arguably the most pressing nursing crisis in regards to the nursing shortage nationwide. The study suggests that nursing wastage may be avoided if nurses have greater autonomy to achieve more reasonable career prospects, thereby ensuring nurses' professional value and contribution to be properly rewarded with managerial and organizational support.
Sociology of Health and Illness, 1984
Student nurses' construction of occupational socialisation bstract This paper examines the occup... more Student nurses' construction of occupational socialisation bstract This paper examines the occupational socialisation of British nurses. It uses Bucher and Strauss's notion of segmentation and considers two major segments within nursing: the education segment wiiich, through the colleges of nursing, promotes a 'professional' version of nursing, and the service segment which is concerned with getting nursing work done. Students' accounts of their training were obtained by means of 40 informal interviews. On the basis of these accounts it is argued that the students leam neither the education nor the service segment's version of nursing, rather they leam to recognise when one version is appropriate and the other not and 'fit in' accordingly. ITie organisation of nurse training is based on a compromise between the two segments whereby the students move between clinical placements and the college of nursing; in this way both versions of nursing are enforceable on the students. The paper argues that nursing as an occupation, by its organisation and compromise solution to the training of its recruits, supports a transient approach to nursing work itself and so implicitly supports a lack of commitment to nursing as an occupation.
Social Science & Medicine, 2001
This paper draws upon an empirical study and combines moral philosophical insights and sociologic... more This paper draws upon an empirical study and combines moral philosophical insights and sociological analysis to shed light on the ethical issues in intensive care. It is argued that moral philosophical debate often leaves aside the social context in which ethical decisions are taken and carried through. In order to gain an understanding of how intensive care is accomplished and specifically how ethical issues are handled, the study focused primarily on nurses' accounts of and views on the practices which form the everyday work of intensive care. A qualitative approach was adopted involving theoretical sampling and the constant comparative method of analysis. The paper argues that the most difficult ethical issue in intensive care, namely the withholding or withdrawal of treatment, is an area in which nursing and medical perspectives are often at odds. However, when the social context of clinical practice is taken into account, this paper argues, there is common ground between the two professions. It was found that the period during which the decision to withdraw treatment is being made, the members of the intensive care team closest to the bedside, nursing and medical staff, become impatient for some resolution of the situation. The differences of opinion which arise over the decision to withdraw are not simply to do with the way in which the situation is experienced by each professional group, proximity to the patient had a part to play in shaping their views rather than, as it is sometimes presumed, a simple rift between medicine and nursing. The data suggest that intensive care has to be a team effort. Even though there is no legal requirement for nurses to agree with the ICU decisions, there seems to be a strong desire within the intensive care team that moral consensus should be achieved in the interests of good patient care. Intensive care relies on the integrity of the team and the unfailing functioning of teamwork. Consequently, achieving this, it seems, is more important than other temporary lapses in interprofessional relations and disagreements over treatment in individual cases. Consensus is important and its achievement is a central, day to day working arrangement for ensuring the solidarity of the team.
Qualitative Health Research, 1996
This article seeks to shed some light on the difference of opinion that has developed between the... more This article seeks to shed some light on the difference of opinion that has developed between the cooriginators of the grounded theory approach to qualitative data analysis. The author has worked with grounded theory and has followed the developments in the methods books written independently by Glaser and Strauss since the publication of The Discovery of Grounded Theory in 1967. What had to date appeared to be an ongoing process of refinement of the strategies for the handling of data and the development of theory has developed into nothing short of a head on clash between Glaser and Strauss.
The Lancet, 1993
When a Christian who has walked with God and knows the things of the Spirit decides willfully, to... more When a Christian who has walked with God and knows the things of the Spirit decides willfully, to step back into the worldintentionally or unintentionally-this is a very Serious matter to God. Most have no idea that this action has consequences. It doesn't matter how long you have served God in the past, or how dedicated you may have been, when someone steps back into the world and begins to act, and talk as the world does, the result is extremely serious. A Serious Matter: When I say serious, I'm talking about a situation so grave that it eventually causes God to take an aggressive and antagonistic stance toward that believer! This is why James 4:4 says: "...A friend of the world is the enemy of God." Notice that James refers to believers who have become a 'friend' of the world. The word 'friend' is from the Greek word 'phileo', a word that has many different facets, including the ideas of 'fondness, friendship, or love'. This is the Greek word someone would use if he wanted to express' affection' or even 'romance'. And when used to depict friends, this word is the picture of very 'close friends' who are 'fond of' and 'familiar with each other'.
Journal of Medical Ethics, 1994
This paper raises the questions: 'What do we expect from nursing ethics?' and 'Is the literature ... more This paper raises the questions: 'What do we expect from nursing ethics?' and 'Is the literature of nursing ethics any different from that of medical ethics?' It is suggested that rather than develop nursing ethics as a separate field writers in nursing ethics should take a lead in making the patient the centralfocus of health care ethics. The case is made for empirical work in health care ethics and it is suggested that a good way of setting about this is to ask practising nurses about the real ethical problems they encounter. to go away.
Journal of Advanced Nursing, 1982
Drawing on student nurses' accounts of their training, "Learning and Working" is a ... more Drawing on student nurses' accounts of their training, "Learning and Working" is a study of the tensions created in modern nursing between service needs and education.
American Journal of Hospice and Palliative Medicine®, 2013
We explored caregivers’ experiences and needs when providing hospice home care to their terminall... more We explored caregivers’ experiences and needs when providing hospice home care to their terminally ill elderly patients with cancer in Taiwan for 1 year. A total of 44 caregivers were interviewed using a semistructured interview once monthly during hospice home care visits until the patients’ deaths. Content analysis of the interviews revealed 5 themes, hoping for a cure, experiencing fluctuating emotions, accepting the patient’s dying, regarding the patient’s death as a good death, and needing emotional support and information. Caregivers in hospice home care who experienced difficulties tended to seek emotional support and information throughout the entire caregiving process. With a greater understanding of caregivers’ experiences and needs, nurses can alleviate caregivers’ negative emotional reactions by actively attending to their needs during this process.
Health Expectations, 2006
I wanted to know much more about the characters, who were too puppet-like for me, serving the int... more I wanted to know much more about the characters, who were too puppet-like for me, serving the interests of the author who, it seemed, wanted to portray lines of argument accurately more than the characters. The consequence was that the debates themselves were unrealistic than they could have been. The only time I felt the author was really letting the character and the plot carry her writing rather than something more artificial was during the interrogation scenes at the police station. Even the cover of the book is disappointing, saying quite clearly that the book is going to educate its reader. This book represents a new genre of writing and it is a very good, page-turning, first attempt. However, the scaffolding of ethical argument is too obvious. Let the book be a proper novel: develop the plot and show the characters fully, and let the ethical debates take care of themselves within that. In this way, the book can become a helpful contribution to contemporary ethical discourse, precisely because it is so realistic.
Journal of Medical Ethics, 1990
This is a comparative study of management accounting in intensive care units in the UK and Finlan... more This is a comparative study of management accounting in intensive care units in the UK and Finland. The management accounting problems of health care in many countries are well documented in the literature (difficulties of budgetary implementation: non-integration of health care professionals into the financial management process). This study examines these issues in the situation of intensive care, where there are difficult ethical decisions to be made by health care professionals in a climate of rapid medical advance where financial constraints may lead to rationing of health care. This paper reveals commonalities between these two countries in terms of intensive care problems, but there are differences, too, which can be attributed to contrasts in management accounting practices in the two countries.
Work, Employment and Society, 2001
Page 1. book reviews Nurses and Doctors at Work Rethinking Professional Boundaries Deidre Wicks B... more Page 1. book reviews Nurses and Doctors at Work Rethinking Professional Boundaries Deidre Wicks Buckingham: Open University Press, 1998 paper xvii+202 pp. This, the author says, is an edited and largely re-written version of her doctoral thesis. ...
Journal of Medical Ethics, 1994
This is an extremely useful work. It centres upon the findings of a postal survey concerned with ... more This is an extremely useful work. It centres upon the findings of a postal survey concerned with the teaching of nursing ethics undertaken by the Royal College of Nursing and the Institute of Medical Ethics. The sur-vey was used as the basis of the work of a multidisciplinary ...