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Introduction. Pacific peoples experience inequity in accessing hearing health care and are disproportionately exposed to the underlying determinants impacting ear and hearing health in Aotearoa New Zealand. Understanding community members’ worldviews, including perspectives, beliefs and values, is essential in developing appropriate and responsive hearing healthcare services to meet the needs of Pacific peoples. Aim. The purpose of this paper is to understand the worldviews, knowledge and beliefs held by Pacific peoples regarding hearing health in Aotearoa New Zealand. Methods. A mixed-methods approach was used. Twelve semistructured face-to-face interviews were conducted with Pacific community members. Twentyfive participants completed an online questionnaire. A simultaneous, integrated mixed-methods approach was used to analyse the qualitative and quantitative data. Results. Five main themes were established, which were: The Meaning of Hearing; Causes of hearing loss; Consequences of hearing loss and Disability; and Improving health care for ear disease and hearing loss. Discussion. Pacific peoples value hearing health to communicate and connect with their families and communities. Participants highlighted the importance of hearing health across the life course. Although the study findings revealed there is potentially less stigma and shame around hearing loss in New Zealand, denial and fatalistic attitudes towards hearing loss may delay some people from seeking healthcare services. Participants expressed key ways in which the health system can be more responsive to the hearing health needs of Pacific peoples in Aotearoa New Zealand. [ABSTRACT FROM AUTHOR]

Racism is a key modifiable determinant of health that contributes to health inequities in Aotearoa and elsewhere. Experiences of racism occur within the health sector for workers, patients and their whānau (extended family) every day. This paper uses stories of racism from nurses – reworked into vignettes – to examine the dynamics of racism to generate possible micro, meso and macro anti‐racism interventions. A critical qualitative design was utilised, informed by kaupapa Māori approaches. The five vignettes in this paper were sourced from a pair of caucused focus groups with nine senior Māori (Indigenous peoples of Aotearoa) and Tauiwi (non‐Māori) nurses held in Auckland Aotearoa in 2019. The vignettes were lightly edited and then critically analysed by both authors to identify sites of racism and generate ideas for anti‐racism interventions. The vignettes illustrate five key themes in relation to racism. These include (i) mono‐cultural practice, (ii) everyday micro‐aggressions; (iii) complexity and the costs of racism, (iv) Pākehā (white settler) privilege and (v) employment discrimination. From analysing these themes, a range of evidence‐based micro, meso and macro‐level anti‐racism interventions were derived. These ranged from engaging in reflective practice, education initiatives, monitoring, through to collective advocacy. Vignettes are a novel way to reveal sites of racism to create teachable moments and spark reflective practice and more active engagement in anti‐racism interventions. When systematically analysed vignettes can be utilised to inform and refine anti‐racist interventions. Being able to identify racism is essential to being able to effectively counter racism. [ABSTRACT FROM AUTHOR]

This paper synthesises critique from Māori patients with Bipolar Disorder (BD) and their whānau to identify barriers and propose changes to improve the structure and function of the New Zealand mental health system. A qualitative Kaupapa Māori Research methodology was used. Twenty-four semi-structured interviews were completed with Māori patients with BD and members of their whānau. Structural, descriptive and pattern coding was completed using an adapted cultural competence framework to organise and analyse the data. Three key themes identified the impact of structural features of the New Zealand mental health system on health equity for Māori with BD. Themes involved the accessibility, delivery and scope of the current health system, and described how structural features influenced the quality, utility and availability of BD services for Māori patients and whānau. Structural barriers in the existing design, and potential changes to improve the accessibility, delivery and scope of BD services for Māori, were proposed including a redesign of operational, environmental, staffing, and navigation points (information, transition, fatigue) to better meet the needs of Māori with BD. A commitment to equity when implementing structural change is needed, including ongoing evaluation and refinement. This paper provides specific recommendations that should be considered in health service redesign to ensure the New Zealand mental health system meets the needs of Māori patients with BD and their whānau. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known about the subject?: While therapeutic relationships remain core to mental health nursing practice and patient recovery, increased managerialism and focus on risk has impacted nurses' therapeutic practice with patients. While there is anecdotal evidence of the impact there has been little research that demonstrates nurses experience of therapeutic engagement within the current context. What the paper adds to existing knowledge?: The paper reports on qualitative research that highlights nurses' strong attempts to create the space for therapeutic engagement with clients.This research provides evidence of the constraints on practice imposed by new managerial processes and suggests potential means of responding to them. What are the implications for practice?: Mental health nurses are committed to working therapeutically but struggle to balance this against new managerial demands imposed across many OECD countries. The New Zealand government has recently reported on positive changes to mental health provision but does not suggest changes to the structures that impede good practice. This research indicates that structural change is essential to therapeutic engagement. Introduction: Increasing managerialism, driven in part by notions of risk, compromises the mental health nurses therapeutic engagement with clients potentially impacting their recovery. While the importance of therapeutic relationships in mental health recovery is acknowledged, there is little evidence about how managerial processes encroach on this relationship. Aim: To explore mental health nurses experience of engaging in therapeutic relationships within the current practice environment. Method: This paper utilized an interpretive phenomenological approach, using interviews with mental health nurses. Results: Managerial processes significantly impacted the practice of nurses who struggled to make space for therapeutic relationships within a chaotic milieu. The chaos is associated with increasing austerity within the health system; this has resulted in high staff turnover and staff shortages. Discussion: Managerial demands dominate the practice field at the expense of therapeutic engagement between nurses and clients ultimately affecting client recovery. While nurses' integrity means they desperately try to make space for the therapeutic work, they often become burnt out and disheartened. Implications for practice: While nurses are often blamed for failures in the system, the structures that disable nurses in their attempts to practice therapeutically require urgent responses, strengthening professional organizations and engaging in democratic partnerships with consumer groups. [ABSTRACT FROM AUTHOR]

Studies on domestic violence in ethnic minority communities highlight that social norms, family structures and cultural practices are among the key triggers of violence against women. Not surprisingly, most antiviolence interventions in these communities aim to redeem women from the oppressive features of these cultures. More recently, however, emergent scholarship advocates mobilising, rather than erasing, culture within existing anti-violence strategies. This paper explores the nature of culturally informed interventions used by front-line workers. It presents the findings of a small-scale qualitative study in Aotearoa/New Zealand, where around 13% of the population are currently deemed to be from minority ethnic communities. Interviews and one focus group were conducted with nine practitioners - including social workers, counsellors and the police - in Hamilton, Aotearoa in 2013-2014. Based on thematic analysis, the paper identifies two core strands: (a) the distinctive profile of ethnic violence and (b) the strategies that mobilise culture in antiviolence interventions. Specifically within the former strand, it was found that violence in the ethnic community was distinctive for the following reasons: the heightened sense of stigma surrounding disclosure and the consequent silence by women who suffer from it; the lack of trust in authority; and the fear of conventional safety plans necessitating longer time periods for rapport-building. Among the strategies that mobilise culture, the study found that practitioners used a family approach; engaged men in their interventions, at times reinforcing gendered roles; utilised micro-interventions; and deployed cultural tropes, especially around spirituality, as a strategy. The conclusion points to the gap between interventions that challenge and mobilise cultures. While anecdotally, the latter are perceived to be relevant and effective in antiviolence interventions, there is need for a fuller assessment and better codification of these strategies within the training of practitioners who work in these communities. [ABSTRACT FROM AUTHOR]

Accessible Summary What is known on the subject? Loneliness in older adults has been identified as an important public health issue in many countries., Widowhood is a time when many older people experience loneliness., What this paper adds to existing knowledge? Little is known about strategies that are effective in mitigating experiences of loneliness and this paper explores this with older people who have been through the process., The narratives of the older people in this study described a trajectory in which loneliness was experienced as both a loss of spouse and a loss of routines that enabled them to maintain connections with others., This trajectory moved onto the establishment of new routines that enabled connections to be developed., What are the implications for practice? Loneliness is strongly associated with depression and anxiety in the elderly and mental health nurses should be encouraged to screen for loneliness when undertaking assessments., Interventions that facilitate the development of meaningful routines could be integrated into mental health nursing care of older people., Abstract Background Loneliness in older people is a public health concern in many Western countries. While not necessarily a symptom of mental disorder, it is often associated with depression and anxiety. Widowhood is a transition period during which many older people experience acute loneliness but over time develops strategies to manage it. Little is known about effective strategies that older people have used to manage the experience. The strategies older people used to manage this was the focus of this paper. Aim The aim was to examine older widows' experiences of loneliness. Design The design of this study was a qualitative narrative analysis with thematic analysis and the participants were 40 older widow/widowers aged between 70 and 97 years. Findings The study found that the participants negotiated the experience of loneliness following widowhood from an acute phase of experiencing an absence and the associated loss of routine connection to the establishment of new routines that provided new connections and a new sense of identity as an individual rather than a couple. Conclusions It is important for mental health nurses to screen for loneliness and be able to facilitate interventions that may alleviate the experience of loneliness. [ABSTRACT FROM AUTHOR]

Introduction: Across Aotearoa (New Zealand), there are chronic shortages of qualified Māori (Indigenous peoples of Aotearoa) health practitioners and systemic ethnic health inequities. This study, focussing on the discipline of occupational therapy, explores Māori graduates' recollections of the institutional barriers that impacted on their study in this field over a 25‐year period. Methods: This qualitative study interviewed seven Māori occupational therapy graduates using pūrākau—an innovative Māori narrative inquiry method. Pūrākau (stories) were collected in 2018 via kanohi ki te kanohi (face to face) semi‐structured interviews. They were analysed using the kaupapa Māori (Māori philosophical) framework of Pū‐Rā‐Ka‐Ū which draws on traditional Māori mātauranga (knowledge). Findings: The institutional barriers identified were (1) cultural dissonance, (2) cultural (in)competency and (3) the limitations of (Western) pastoral care. Conclusion: This study highlighted how racism is embedded within the Western tertiary education system. To create a safe learning environment for Māori students, tertiary education institutions require a planned approach to address racism within policy, procedures, the curriculum, teaching and professional staff. [ABSTRACT FROM AUTHOR]

Worldwide, a growing burden of health and social issues now affect young people. Interagency collaboration and the "integration" of health and social care services are advocated to address the increasingly complex needs of at‐risk youth and to reduce barriers to accessing care. In New Zealand, Youth‐One‐Stop‐Shops (YOSSs) provide integrated health and social care to young people with complex needs. Little is known about how YOSSs facilitate collaborative care. This study explored the collaboration between YOSSs and external agencies between 2015 and 2017 using a multiple case study method. This paper reports qualitative focus group and individual interview data from two of four case sites including six YOSS staff and 14 external agency staff. Results showed participants regarded collaboration as critical to the successful care of high needs young people and were positive about working together. They believed YOSSs provided effective wraparound collaborative care and actively facilitated communication between diverse agencies on behalf of young people. The main challenges participants faced when working together related to the different "world views" and cultures of agencies which can run contrary to collaborative practice. Despite this, some highly collaborative relationships were apparent and staff in the different agencies perceived YOSSs had a lead role in co‐ordinating collaborative care and were genuinely valued and trusted. However without the YOSS involvement, collaboration between agencies in relation to young people was less frequent and rarely went beyond limited information exchange. Establishing and maintaining trusting interpersonal relationships with individual staff was key to successfully negotiating agency differences. The study confirms that collaboration when caring for young people with high needs is complex and challenging, yet agencies from diverse sectors value collaboration and see the YOSS integrated wraparound approach as an important model of care. [ABSTRACT FROM AUTHOR]

It is well documented that Health care assistants (HCAs) provide the most hands‐on care to residents in aged care facilities, and play a critical role in the provision of care to dementia residents. Over the last 25 years, a philosophy of person‐centred care has become the preferred approach to care and this has meant that HCAs are encouraged to get to know the resident very well. This paper reports the experiences of HCAs in caring for people at end‐of‐life, identifies the skills required for their work and examines the education provided against these skills. Semi‐structured interviews were conducted in 49 facilities (n = 34) across New Zealand and data analysed thematically, with the aim of critically examining the adequacy of education for health care assistants which meets their needs within a person‐centred environment. The results confirm that the skills include traditional tasks of care (showering, feeding, toileting, and dressing) but the increasingly important communication and de‐escalation skills, both verbal and non‐verbal, have become central to their care skills. Education provided has not sufficiently shifted focus to include these more complex skills. Provision of educations that acknowledges the increased complexities of their role needs to be provided. As well, facilities need to be challenged to reconsider the HCA's position in the facility care tem. [ABSTRACT FROM AUTHOR]

Access to economic resources influences the material conditions of life for older people, as well as the freedoms and capacities of older people to achieve the kind of lives they value. Security is one aspect of later life valued by older people. Ontological security provides a sense of order and continuity and needs to be understood in terms of the situated life experiences and circumstances of older people. The study reported in this paper analysed 145 qualitative interviews with New Zealanders aged 63–93 in order to explore how participants understand ontological security. Varying levels of access to economic resources were associated with differing abilities of participants to manage the unpredictability of everyday life. Among the wealthy, security was strongly connected to the freedoms provided by ample financial resources. Contrary to what might be expected, those with the lowest levels of economic resources did not express higher levels of insecurity, but instead drew upon life experiences of managing and making do to construct a trajectory of security. Those with mid-range levels of economic resources expressed most insecurity, including anxiety over changing economic conditions and concerns over their ability to manage reductions in economic resources. In discussing the implications of this, the paper highlights the need to recognise ways in which access to economic resources intersect with life circumstances, past experiences and future social expectations to provide opportunities for all older people to pursue security as they strive to age well. [ABSTRACT FROM PUBLISHER]

This paper describes psychiatric mental health nurses' (PMHN) experiences of patient assaults within mental healthcare settings using a thematic analytical approach. The aim of the study was to explore and describe psychiatric mental health nurses' experiences of patient assaults. The major findings of the study related to the nature and impact of assaults and supportive strategies associated with violence perpetrated by patients against psychiatric mental health nurses. Perpetrator risk factors for patients include mental health disorders, alcohol and drug use and the inability to deal with situational crises. The injuries sustained by nurses in the context of the study include lacerations, head injuries, dislocations and bruises. Psychological harm has also occurred, including quite severe mental health problems, such as post-traumatic stress disorder. Protective strategies for combating negative consequences of workplace violence include practice of self-defence, social support and a supportive and consultative workplace culture with access to counselling services and assistance in all aspects, including finances. The paper concludes that while healthcare employers need to provide better support services to the healthcare professionals who are assaulted, the legal system also needs to acknowledge that assaults against nurses are a violation of human rights and violence should not to be tolerated as part of working in mental healthcare settings. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known of the subject: Consumer participation in mental health services is an expectation articulated through mental health policy.Consumers as researchers could contribute significantly to mental health services. Barriers to participation are significant and limit consumer involvement. What the paper adds to existing knowledge: Enhanced understandings of collaborative relationships between consumer and nonconsumer researchers.Researchers from the health disciplines find value in consumer involvement in mental health research.These researchers can support and facilitate consumer research by being allies to consumer researchers. What are the implications for practice: Understanding the role of allies is necessary to strengthen their capacity to support consumer researchers.Involving consumers in mental health research is likely to lead to improved practice. Introduction: Australia and New Zealand mental health policy requires consumer participation in all aspects of mental health services. Systemic participation informs and improves the quality of mental health services. Collaboration with consumer researchers should be similarly required. Enhanced understandings of collaborations are needed. Aim: To enhance understanding of the perspectives and experiences of nonconsumer researchers in working collaboratively with consumers as researchers. Method: This qualitative exploratory study involved interviews with nonconsumer mental health researchers who have worked collaboratively with consumers in research. Interviews were conducted with participants from Australia and New Zealand. Results: "Allyship" emerged as a major theme. This describes nonconsumer researchers playing an actively supportive role to facilitate opportunities for the development and growth of consumer research roles and activities. Seven subthemes were identified: establishing and supporting roles, corralling resources, guiding navigation of university systems, advocacy at multiple levels, aspiring to coproduction and consumer‐led research, extending connections and partnerships, and desire to do better. Discussion: Allyship may have an important role to play in the broader consumer research agenda and requires further consideration. Implications for practice: Embedding meaningful consumer participation within mental health services requires active consumer involvement in research. Allies can play an important facilitative role. [ABSTRACT FROM AUTHOR]

Introduction. From a coronavirus disease (COVID-19) pandemic perspective, Aotearoa New Zealand (NZ) rural residents formed an at-risk population, and disparities between rural and urban COVID-19 vaccination coverage have been found. Aim. To gain insight into factors contributing to the urban-rural COVID-19 vaccination disparity by exploring NZ rural health providers' experiences of the vaccine rollout and pandemic response in rural Māori and Pasifika communities. Methods. Rural health providers at four sites participated in individual or focus group semi-structured interviews exploring their views of the COVID-19 vaccine rollout. Thematic analysis was undertaken using a framework-guided rapid analysis method. Results. Twenty interviews with 42 participants were conducted. Five themes were identified: Pre COVID-19 rural situation, fragile yet resilient; Centrally imposed structures, policies and solutions - urban-centric and Pakehā focused; Multiple logistical challenges - poor/no consideration of rural context in planning stages resulting in wasted resource and time; Taking ownership - rural providers found geographically tailored, culturally anchored and locally driven solutions; Future directions - sustained investment in rural health services, including funding long-term integrated (rather than 'by activity') health services, would ensure success in future vaccine rollouts and other health initiatives for rural communities. Discussion. In providing rural health provider perspectives from rural areas serving Māori and Pasifika communities during the NZ COVID-19 vaccine rollout, the importance of the rural context is highlighted. Findings provide a platform on which to build further research regarding models of rural health care to ensure services are designed for rural NZ contexts and capable of meeting the needs of diverse rural communities. [ABSTRACT FROM AUTHOR]

INTRODUCTION: During the coronavirus disease 2019 (COVID-19) pandemic lockdown in New Zealand in March 2020, there was a rapid shift to virtual consultations in primary care. This change was supported by system adjustments to enable electronic transmission of prescriptions without a handwritten signature if they met certain security criteria. International research suggests potential for unintended consequences with such changes, so it is important to understand the effect on professional practice in New Zealand general practice and community pharmacy. AIM: The purpose of this study was to undertake a preliminary exploration of the experiences of New Zealand general practitioners and community pharmacists when prescriptions are transmitted electronically directly from prescriber to pharmacy. METHODS: Semi-structured interviews with a purposive sample of four pharmacists and four general practitioners gathered qualitative data about their experiences of the shift to electronic transmission of prescriptions. Participants' perceptions of effect on professional workflow, interprofessional interactions between general practitioners and pharmacists, and interactions with patients were explored. Interviews were audio-recorded, and the data analysed thematically using an inductive approach. RESULTS: Four themes were identified: workflow transformation; mixed impact on interactions with patients; juggling timing and expectations; and new avenues for interprofessional communication (with some cul-de-sacs). DISCUSSION: Both general practitioners and pharmacists experienced transformational changes to workflow. This was positive for general practitioners due to saved time and increased work flexibility. Pharmacists noted potential benefits but also some challenges. To fully reap teamwork benefits, more work is needed on managing the timing issues and patient expectations, and to refine the new modes of communication between health-care practitioners. [ABSTRACT FROM AUTHOR]

Family members continue to be used as interpreters in medical consultations despite the well-known risks. This paper examines participant perceptions of this practice in three New Zealand clinics chosen for their frequent use of interpreters and their skill in using them. It is based on a detailed study of 17 video-recorded interpreted consultations and 48 post-consultation interviews with participants (5 doctors, 16 patients and 12 interpreters, including 6 family members). All participants expressed satisfaction with the communication. Analysis of the interviews explored what participants liked or valued about family member interpreters (FMIs). Key themes were the FMIs' personal relationship and knowledge, patient comfort, trust, cultural norms, time efficiency and continued help outside the consultation. General practitioners (GPs) expressed awareness of potential risks and how to manage them, in contrast to patients and FMIs. Although the use of professional interpreters needs to be strongly promoted, a well-informed decision to use a family member is appropriate in some situations. GPs need to be well trained in how to assess and manage the risks. Rather than striving for 'best practice' (i.e. universal use of professional interpreters), it is better to aim for 'good practice' where a considered judgement is made about each situation on an individual basis. [ABSTRACT FROM AUTHOR]

Aims: Investigated the experiences of Māori (the Indigenous peoples of Aotearoa, New Zealand) patients and whānau (extended family network) engaging with acute hospital inpatient services and their priorities for a Māori-centred model of relational care. Design: A qualitative Māori-centred research design using a Thought Space Wānanga (learning through in-depth group discussion, deliberation and consideration) approach. Methods: Two wānanga were conducted between May 2022 and June 2022, with 13 Māori patients who had been acutely hospitalized within the past 12 months and their whānau members. The first wānanga utilized storytelling and journey mapping to collect data. The second wānanga refined the initial themes. Wānanga were audiorecorded and then inductively coded and developed into themes. Results: Thirteen patients and whānau attended the first wānanga, while 10 patients and whānau participated in the second wānanga). Four themes were developed: (1) Whakawhanaungatanga (establishing connections and relationships), (2) Whakamana (uplifting the status and esteem of Māori), (3) Whakawhitiwhiti kōrero (the importance of communicating, discussing and deliberating) and (4) Kotahitanga (working together with purpose) all provide insights into the importance of effectively engaging and connecting with Māori patients and whānau when acutely hospitalized. Conclusions: The experiences and priorities of Māori patients and whānau affirm the international literature, suggesting that Indigenous relational concepts are critical to building relationships, connections and trust. Despite existing healthcare models for working with Indigenous peoples, their poor application contributes to sub-optimal healthcare experiences at all points of their healthcare journey. A relational mode of practice focused on engagement and forming connections better meets the needs of Indigenous peoples engaging with inpatient health services. Implications for the profession and/or patient care: Despite the existence of Indigenous models of care, Indigenous peoples consistently report a lack of engagement and connection when accessing inpatient health services. Without establishing relationships, applying models of care is challenging. Impact (Addressing): • What problem did the study address? Internationally, healthcare systems are consistently ill-equipped to deliver culturally safe care for Indigenous and marginalized peoples, evident in ongoing health inequities. Like other reports of Indigenous experiences of health services, Māori express dissatisfaction with care delivery in an acute inpatient setting. This study investigated Māori patients and whānau experiences engaging with acute hospital inpatient services and their priorities for a Māori-centred model of relational care. • What were the main findings? Māori patients and whānau recounted negative experiences with healthcare professionals lacking effective relationships and trust. Satisfaction occurred when engagement with health care professionals resembled Indigenous cultural rituals of encounter that considered their holistic, collective and dynamic worldviews. Previous models of relational care, while helpful, are not Indigenous and so do not address their needs, such as engagement as a mode of practice (how) to achieve this. • Where and on whom will the research have an impact? This research impacts Indigenous peoples' health outcomes, particularly Māori, and nurses and clinicians working and interacting within acute inpatient and other hospital settings. Indigenous research methods support co-constructing knowledge for translation into practical outcomes through transformational practices, policies and theory development. Reporting method: We used the Consolidated Criteria for Strengthening the Reporting of Health Research Involving Indigenous Peoples (CONSIDER) statement (see File S2—CONSIDER Checklist) and the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (see File S3—COREQ Checklist). [ABSTRACT FROM AUTHOR]

Introduction: The Department of General Practice and Primary Health Care at the University of Auckland is considering developing a Master of Primary Health Care (MPHC) programme. Masters level study entails considerable investment of both university and student time and money. Aim: To explore the views of potential students and possible employers of future graduates to discover whether there is a market for such a programme and to inform the development of the programme. Methods: Semi-structured interviews were conducted with 30 primary health care stakeholders. Interviews were digitally recorded, transcribed and analysed using a general inductive approach to identify themes. Findings: Primary care practitioners might embark on MPHC studies to develop health management and leadership skills, to develop and/or enhance clinical skills, to enhance teaching and research skills, or for reasons of personal interest. Barriers to MPHC study were identified as cost and a lack of funding, time constraints and clinical workload. Study participants favoured inter-professional learning and a flexible delivery format. Pre-existing courses may already satisfy the post-graduate educational needs of primary care practitioners. Masters level study may be superfluous to the needs of the primary care workforce. Conclusions: Any successful MPHC programme would need to provide value for PHC practitioner students and be unique. The postgraduate educational needs of New Zealand primary care practitioners may be already catered for. The international market for a MPHC programme is yet to be explored. [ABSTRACT FROM AUTHOR]

Aim The objective of this paper was to explore how present-day filial piety is understood among Koreans in geographically different settings. Methods Data were collected from qualitative interviews with 61 Korean participants in Australia, New Zealand and Korea and then thematically analysed and evaluated. Results The findings from this study show that filial piety for Koreans consists of family care and support, along with respect for parents. The norm of filial piety is regarded as an important aspect of intergenerational family relationships in current Korean culture, while its practice is perceived as increasingly eroded within a context of major socio-cultural and economic changes, including migration. Conclusion The results show that the tension between the social and economic aspects of filial piety often creates a 'bystander' attitude toward parents and provides fertile ground for the seeds of family conflict. [ABSTRACT FROM AUTHOR]

Accessible summary What is known about the subject? Citizenship is an important yet largely overlooked concept within psychiatric and mental health nursing practice, Many service users are subject to legally mandated restrictions that place conditions on their rights and responsibilities as citizens., What this paper adds to existing knowledge? Even though service users have legal status as citizens, they continue to experience many conditions on their rights and responsibilities., Concerns about services users' trustworthiness and doubts about their levels of insight impact on their status as full citizens., What are the implications for practice? Nurses' understandings of the conditions placed on the citizenship rights and responsibilities of service users will ensure inclusive and less restrictive care and treatment, Integration of the principles of therapeutic reciprocity and procedural justice within practice will help nurses balance both the rights of services users and legal restrictions on their liberty and autonomy, Abstract Introduction Service users have long been lobbying for equal participation as citizens, yet citizenship is an important and largely overlooked concept within nursing education and practice. Aims The study explored service users' understandings of their rights and responsibilities of citizenship and the conditions placed on these. Methods A total of 17 service users participated in semi-structured interviews. Isin's theory of the content of citizenship was used to analyze the data using a framework approach. Results Service users experience conditional citizenship that includes barriers to their participation and their rights and responsibilities that others in society enjoy. Discussion When the world of the service user is constructed through the language of the biomedical model, nurses may unwittingly reinforce psychiatric labels and thus perpetuate the stereotype that service users lack the competence to fully enact their rights and responsibilities. Implications for practice When providing care, nurses should incorporate the notion of therapeutic jurisprudence and the principles of reciprocity, procedural justice and the implementation of advanced directives to reduce conditions on service users' status as citizens. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapists can improve the quality of life of people receiving palliative care through the management of communication and swallowing difficulties (dysphagia). However, their role in this domain is poorly defined and little is understood about the current international professional practice in this field. Aims: To examine how speech and language therapists perceive their role in the delivery of palliative care to clients, to discover current international speech and language therapist practices and to explore the similarities and differences in speech and language therapists’ practice in palliative care internationally. This will inform professional clinical guidelines and practice in this area.Design:Anonymous, non-experimental, cross-sectional survey design.Participants:Speech and language therapists working with adult and paediatric palliative care populations in Republic of Ireland, United Kingdom, United States, Canada, Australia and New Zealand where the speech and language therapist profession is well established. Method: Purposive and snowball sampling were used to recruit participants internationally using gatekeepers. An online survey was disseminated using Survey Monkey (http://www.surveymonkey.com). Results: A total of 322 speech and language therapists responded to the survey. Speech and language therapist practices in palliative care were similar across continents. Current speech and language therapist practices along with barriers and facilitators to practice were identified. The need for a speech and language therapist professional position paper on this topic was emphasised by respondents. Conclusion: Internationally, speech and language therapists believe they have a role in palliative care. The speech and language therapist respondents highlighted that this area of practice is under-resourced, under-acknowledged and poorly developed. They highlighted the need for additional research as well as specialist training and education for speech and language therapists and other multidisciplinary team members in the area of palliative care. [ABSTRACT FROM AUTHOR]

This article presents a qualitative study of New Zealand social work practitioners’ experiences as supervisees. This study was part of a wider mixed-methods study of social work supervision. The aims of the paper were to explore how social work practitioners developed their understanding, participation, and use of supervision, and how their histories influenced their development and behaviour as supervisees. Sixteen participants were interviewed regarding their supervision histories. These histories were thematically analysed. Results showed that practitioners developed their understanding, participation in, and use of supervision over time. In addition, their supervision histories influenced their development and behaviour as supervisees both positively and negatively. These findings provide a starting point for further research into theorising about supervision from the supervisee's perspective and encouraging practitioners and supervisors to consider the influence that supervision histories have within their supervision. [ABSTRACT FROM AUTHOR]

Spirituality is increasingly understood to be important in healthcare provision, as seen in policy, guidelines and practice across many Western healthcare systems. Definitions of spirituality remain controversial, despite their importance for consistency in research and practice. This paper reports on the definition findings of a nation-wide New Zealand (NZ) study (2006–2008) that examined understandings, experiences and ways to improve spiritual care, primarily focused in hospices. A mixed methods approach included 52 semi-structured interviews and a survey of 642 patients, family members and staff from 25 (78%) of NZ's hospices. A generic qualitative design and analysis was used to capture the experiences and understandings of participants' spirituality and spiritual care and a cross-sectional survey gave sample-based information about the study's questions. Across both studies the majority view held that spirituality is a useful, important, inclusive and broadly defined concept. NZ is a secular country, yet there is clear evidence that spirituality is important at the end of life. These findings add weight to the international trend for spirituality to be further investigated and attended to in healthcare. [ABSTRACT FROM AUTHOR]

Purpose: Across Australia and New Zealand, speech-language pathologists (SLPs) routinely assess and treat adults with cognitive-communication disorders following traumatic brain injury (TBI). Despite their regular involvement, little is known about how clinicians provide management to this client group, particularly in community-based contexts. Therefore the aim of this study is to explore the clinical practices of SLPs who have experience working in community-based rehabilitation services with adults with cognitive-communication disorders following TBI. Method: A qualitative descriptive study using one-on-one semi-structured interviews was conducted as part of an explanatory sequential mixed-methods design. Fourteen SLPs with experience working with individuals with TBI completed an interview with content analysis used to explore the data. Result: The overarching theme identified was that a "Client-centred and inclusive approach to community-based rehabilitation services" is required. The three subthemes to emerge from the data included the importance of utilising a (1) "flexible service delivery approach", with (2) "meaningful therapy focus", and (3) "collaboration" with multidisciplinary team members and significant others when managing this client group. Conclusion: SLPs play a crucial role in client-centred inclusive rehabilitation for community-dwelling adults with cognitive-communication disorders following TBI. The complexity of working with this population requires current and future models of care to incorporate an interdisciplinary approach that is flexible in its delivery and meaningful in focus. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to explore the perceptions of intensive care unit staff deployed to other clinical areas. It also aimed to identify challenges that the staff face during their redeployment. Design: A mixed method study. Method: 40 participants (nurses and healthcare assistants) completed an anonymous online questionnaire, and five participants (nurses) participated in one-to-one semi-structured interviews. Participants were recruited through purposive sampling from the selected ICU/HDU. Results: Content analysis of the data revealed three major themes: "Negative feelings of redeployment", "Positive feelings of redeployment" and "Visible and Structured leadership interventions". Results indicate that ICU nursing management needs to make some additional efforts and implement the study recommendations to improve the overall perception and experience of ICU/HDU staff redeployment. Public Contribution: This research will create insight into the redeployment of intensive care unit staff to other clinical areas. Furthermore, it will add value to patient safety and improve institutional healthcare policies. [ABSTRACT FROM AUTHOR]

Introduction. Maternal vaccination against influenza and pertussis protects mothers and babies from severe disease and is recommended and funded in Aotearoa New Zealand. Despite this, maternal vaccination uptake is low, varies by region and is inequitable, with Māori and Pacific māmā (mothers) less likely to receive vaccination. Aim. To determine what interventions currently exist to support and encourage maternal vaccination against influenza and pertussis and what changes and interventions could be implemented to improve coverage, with a focus on Māori and Pacific hapū māmā (pregnant mothers). Methods. Interviews with six participants with diverse roles in the vaccination workforce were conducted. Participants were involved in education, certification and supporting vaccinators, high-level strategising, and vaccination. Interviews aimed to determine what interventions currently exist for hapū māmā, what changes need to be made to improve coverage and how Māori and Pacific people have been specifically engaged. Qualitative data analysis was used to determine themes. Results. Participants identified that interventions must focus on prioritising and emphasising the importance of maternal vaccination, promoting collaboration and innovation, making interventions accessible, and empowering Māori- and Pacific-driven avenues to vaccination. To create positive foundations, participants identified the importance of building and maintaining trust and affording mothers’ time and autonomy in vaccination. Discussion. Healthcare professionals need to proactively engage hapū māmā about vaccination and collaborate in service delivery. Interventions must be suitably accessible and allow for the autonomy of hapū māmā over vaccination decisions. Equity should be considered at the foundation of vaccine interventions to improve the accessibility of vaccines to all communities. [ABSTRACT FROM AUTHOR]

Purpose: Vocational rehabilitation (VR) involves complex skills, and often inter-disciplinary teams need to work effectively to meet the needs of stakeholders. Research highlights important influences on effective teamwork, including funding systems, team structure, policies and procedures, and effects of professional hierarchies. This qualitative study aimed to explore these issues in-depth including how factors interact to produce problems and solutions. We focused on identifying challenges and opportunities for VR teams working in the Aotearoa-New Zealand context which may also be transferrable to other settings. Methods: Qualitative descriptive instrumental case study involving focus groups and interviews with two VR teams (n = 14). Teams worked in musculoskeletal injury and were geographically diverse. Reflexive thematic analysis was used to analyse the data. Results: Analysis constructed three overarching themes: Having the Power, Being Human, and VR is Not for Everyone. Achieving trusting relationships within the team was paramount. This was achieved through seeing everyone as equal, and as human. Equality within the team was particularly important for professionals that occupied different positions of power in a wider professional hierarchy. VR specialist skills (experience and postgraduate qualifications) were often under-recognised, leading them to have little power in VR decision making processes. VR professionals also experienced competing demands between client needs and business drivers. Conclusion: Findings offer detail of processes teams engage in to create effective team relationships and manage systemic factors to facilitate positive outcomes. Additionally, findings highlight opportunities in decision-making processes for VR medical certification that may increase job satisfaction and better utilize skills and expertise. [ABSTRACT FROM AUTHOR]

Purpose: To understand adolescents' and their parents' perspectives on 'being active', this study explored the experience of participation in physical activity (PA), the role of long-term participation in PA, and the importance of remaining active for life. Methods: Eight ambulant adolescents with CP (aged 11–16 years, seven male) participated in a high-level mobility programme twice per week for 12 weeks. Guided using interpretive description, adolescents and 12 of their parents were interviewed before, after and nine months following the programme. Thirty-eight interviews were coded, analysed, and interpreted, informed by audit information, reflective journaling, and team discussions. Results: Adolescents and their parents highly value being active now and into adulthood. Sustainable participation in PA requires adolescents and families to navigate complex environments (interpersonal, organisational, community, and policy). Core themes were: 'Just Doing it', 'Getting the Mix Right' (right people, right place, right time), 'Balancing the Continua' and 'Navigating the Systems'. The continua involved balancing intra-personal attributes: 'I will try anything' through to 'I will do it if I want to' and 'It's OK to be different' through to 'It sucks being disabled'. Conclusions: The journey to sustainable participation was complex and dynamic. Experiences of successful journeys are needed to help adolescents with CP "stay on track" to sustainable participation. [ABSTRACT FROM AUTHOR]

In 2020, a government-funded healthy school lunch program was introduced in a quarter of New Zealand schools, selected due to high levels of socio-economic barriers. This study assesses the impact of the introduction of the school lunch program from family (whānau), student and school principal perspectives. Across four schools, we conducted five focus groups (two with secondary students and three with family members) and four school principal interviews. Participating schools represented a range of contexts: primary and secondary, schools with cooks in on-site kitchens and schools receiving meals delivered by external caterers. Thematic analysis was used to develop themes describing the health, wellbeing and nutritional impact of the program. Family participants were 82% Indigenous Māori and self-identified as having 'borderline' (73.5%) or no financial security (8.8%). Seven positive impact themes were identified: improved food security, enhanced equity, increased appreciation of healthy foods for students, enhanced mana (wellbeing) for all, reduced financial hardship/stress for families, opportunities for nutritional learning and recognition that appreciation and uptake happen over time. Four negative impact themes were identified: low uptake that created food waste, perception that healthy food is not palatable for students, lack of knowledge of the program and loss of agency for students. This is the largest intervention in nutrition and food security for children implemented in New Zealand since the 1930's. The first 2 years have offered wellbeing and financial benefits for students and families, particularly when school environments promote uptake. More involvement of students and family members in the program planning is essential. [ABSTRACT FROM AUTHOR]

Introduction: Delivery of end-of-life care for severe chronic obstructive pulmonary disease (COPD) has been hampered by an unpredictable disease trajectory and poor integration of health care and social services. Objective: To critically explore the perspectives, values, and experiences of stakeholders in COPD end-of-life healthcare services in a large district in Aotearoa New Zealand. Design: Focus groups analysed utilising critical theory and Actor-Network Theory. Methods: Stakeholders in end-of-life COPD healthcare services were purposively sampled from a large healthcare network in Canterbury, Aotearoa New Zealand to participate in seven focus groups (bereaved carers, community-based health professionals, non-Māori, non-Pacific patients, and support people (two groups), Māori patients, supporters and health professionals, Pacific patients, support people and health professionals, and hospital-based health professionals). Participants discussed end-of-life care services for people with COPD. Transcripts were coded utilising descriptive and structural coding to develop themes related to provision of quality care. Participants were positioned as experts. We considered how the themes arising supported and disrupted the healthcare network for end-of-life COPD. Results: Five themes related to quality of care for end-of-life COPD were identified: compassion, competence, community, commitment, and collaboration. The absence of any of these five themes required for quality care led to power imbalances within healthcare systems. Power inequities created disconnection among stakeholders which then disrupted commitment, community, and collaboration. A dysfunctional healthcare network impeded compassion between stakeholders and did not support their competence, leading to lower quality care. All five themes were identified as essential to delivery of high-quality end-of-life care in COPD. Conclusion: Stakeholders' perspectives of end-of-life care for COPD identified of core features of a health system network that enabled or impeded the actions of stakeholders and allocation of resources to provide quality care. [ABSTRACT FROM AUTHOR]

Aim and Objectives: This study aimed to explore inpatient healthcare delivery experiences of Māori (New Zealand's Indigenous people) patients and their whānau (extended family network) at a large tertiary hospital in New Zealand to (a) determine why Māori are less satisfied with the relational and psychosocial aspects of fundamental care delivery compared to other ethnic groups; (b) identify what aspects of care delivery are most important to them; and (c) contribute to the refinement of the Fundamentals of Care framework to have a deeper application of Indigenous concepts that support health and well‐being. Background: Bi‐annual Fundamentals of Care audits at the study site have shown that Māori are more dissatisfied with aspects of fundamental care delivery than other ethnic groups. Design: Retrospective analysis of narrative feedback from survey data using an exploratory descriptive qualitative approach. Methods: Three hundred and fifty‐four questionnaires containing narrative patient experience feedback were collected from the study site's patient experience survey reporting system. Content analysis was used to analyse the data in relation to the Fundamentals of Care framework and Māori concepts of health and well‐being. The research complies with the SRQR guidelines for reporting qualitative research. Results: Four themes were identified: being treated with kindness and respect; communication and partnership; family is the fundamental support structure; and inclusion of culture in the delivery of care. Conclusion: The current iteration of the Fundamentals of Care framework does not reflect in depth how indigenous groups view health and healthcare delivery. The inclusion of an Indigenous paradigm in the framework could improve healthcare delivery experiences of Indigenous peoples. Relevance to clinical practice: Research around the application and relevance of the Fundamentals of Care framework to Indigenous groups provides an opportunity to refine the framework to improve health equity, and healthcare delivery for Indigenous people. [ABSTRACT FROM AUTHOR]

Within the context of an ageing population and the added challenges posed by COVID‐19, the need to optimise palliative care management in the community – the setting where a significant proportion of people prefer to die – cannot be underestimated. To date, there has been a dearth of research exploring community palliative care delivery during the pandemic. This study aimed to explore the impact of and response to COVID‐19 for hospice community services in Aotearoa/New Zealand. Eighteen structured interviews were conducted (10 February–18 August 2021) with healthcare professionals from sixteen purposively sampled community hospices from New Zealand regions according to the number of COVID‐19‐positive patients per 100,000 inhabitants (low, medium and high) with oversampling of high prevalence areas. Two overarching themes emerged 'challenges' and 'adaptations'. Each theme had several subthemes related to service delivery in communication, visiting, allied health team collaboration and volunteer services. Adaptations involved adjusting official health advice to the local context, increased use of telehealth, reducing infection risk during in‐home visits through triaging of cases, division of the workforce into teams and repurposing volunteers' services. Despite these adaptations, challenges remained, including increased workload pressures for staff and an absence of the human touch for patients and families. Implications for hospice practice and recommendations for future research are discussed. Governments must acknowledge the essential contribution of hospice to the COVID‐19 pandemic and ensure that these services are incorporated into the healthcare system response. [ABSTRACT FROM AUTHOR]

The aim of this paper is to share findings from an evaluation of a community- based, nurse-run intravenous (IV) therapy clinic, established in Christchurch, New Zealand, with a focus on feedback from consumers, referrers and nurses. Nurse Maude's district nursing services have provided IV therapy in the home for many years. Following the 2011 Canterbury earthquakes, when many homes were in a poor or unsanitary condition, an IV therapy centre was established in the Nurse Maude community specialty nursing clinic, as an alternative venue. In 2014, the New Zealand Institute of Community Health Care was asked to evaluate the service, to inform decision-making on its future. A mixed-methods approach was used for the evaluation, including analysis of financial and service activity data; qualitative feedback was sought from consumers, referrers and staff, to gauge the impact of the services from their perspective. The evaluation was also to provide recommendations about continuation of the service. Findings from the evaluation of this seven-day-a-week service indicated it was a safe and popular choice for clients, as well as an efficient and cost-effective way of delivering the service for both consumers and staff. The overall 20 percent increase in referrals to the service over the first 18 months was seen as showing that referrers and consumers had confidence in the service. This service broadened the IV therapy options available in the community, enabling consumers to avoid the need to visit the hospital for more complex IV therapies. With a trend towards community-based health care provision for those with complex treatment needs, alternative ways of providing traditional services in these settings need to be explored. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Rural women face many challenges with regards to maternity services. Many rural primary birthing facilities in New Zealand have closed. The Lead Maternity Carer (LMC) model of maternity care, introduced in 1990, has moved provision of rural maternity care from doctors to independent midwifery services. Shortages of rural midwives in the Midland region led to rural maternity care being seen as a vulnerable service. AIM: To understand the views and experiences of rural women concerning maternity care, to inform the future design and provision of rural maternity services. METHODS: Participants were drawn from areas purposively selected to represent the five District Health Boards comprising the Midland health region. A demographic questionnaire, focus groups and individual interviews explored rural women's perspectives of antenatal care provision. These were analysed thematically. RESULTS: Sixty-two women were recruited. Key themes emerging from focus groups and interviews included: access to services, the importance of safety and quality of care, the need for appropriate information at different stages, and the role of partners, family and friends in the birthing journey. While most women were happy with access to services, quality of care, provision of information, and the role of family in their care, for some women, this experience could be enhanced. CONCLUSION: Midwives are the frontline service for women seeking antenatal services. Support for rural midwives and for local birthing units is needed to ensure rural women receive services equal to that of their urban counterparts. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The study aimed to explore the perspectives of adult children about late‐life living and care arrangements for their ageing immigrant parents living in New Zealand. Background: Older immigrants' well‐being is closely associated with filial relations and is often reliant on families as a main source of social, financial and emotional support. Research among migrant Asian adults has reported mixed findings regarding intergenerational perspectives of filial practices. Design: Qualitative design using focused ethnographic lens. Methods: Semi‐structured individual interviews were undertaken with 45 adult children of older immigrants living in New Zealand to explore their views about filial piety. The CoREQ checklist was used in reporting methods and findings. Results: Two major themes were identified in this study of adult children's view of filial piety and late‐life care for their ageing parents. The first theme, 'holding on—reconfiguring values', referred to a process described by the participants as upholding the core values and cultural familial expectations, looking after their ageing parents, yet modifying the ways in which they provide care. The second major theme 'letting go—reconfigured expectations', described participants' views of aged care for themselves, which meant they no longer held traditional values that needed to be enacted by their children. Conclusions: Adult children from immigrant families were positioned as intermediaries of these shifting values of their own and within younger generations. The adult children's shift of thinking and acceptance of reconfigured expression of filial duties impact care and living arrangements of older people from immigrant and culturally diverse backgrounds, which also influences health and well‐being in later life. Relevance to clinical practice: Healthcare professionals including nurses working in the ageing and aged care sector need to accommodate the changing generational perspectives about filial piety to cater to the unique late‐life care requirements and health needs of older people and their families. [ABSTRACT FROM AUTHOR]

Background: In the context of a sudden or unexpected event, people with a life-limiting illness and their family caregivers may be dependent on emergency ambulance services Aim: To explore bereaved family members' experiences of emergency ambulance care at the end of life. Design: A qualitative study using reflexive thematic analysis of data collected from semi-structured phone interviews. Setting/Participants: A purposive sample of 38 family caregivers identified from a database of deaths in Aotearoa, New Zealand. Results: Emergency ambulance personnel assist, inform and reassure patients and family caregivers managing distressing symptoms, falls, infections, unexpected events and death itself. Family members and patients are aware of the pressure on emergency services and sometimes hesitate to call an ambulance. Associating ambulances with unwanted transport to hospital is also a source of reluctance. Conclusions: The generalist palliative care provided by emergency ambulance personnel is a vital service for patients in the last year of life, and their caregivers. This must be acknowledged in palliative care policy and supported with training, specialist consultation and adequate resources. [ABSTRACT FROM AUTHOR]

This article presents New Zealand school counsellors' narratives of counselling adolescents from a strength-based perspective. Strength-based counselling encompasses several counselling modalities including positive psychology, narrative and solution-focused brief counselling and promotes adolescents' strengths to enhance wellbeing. Using semi-structured interviews, eight secondary school counsellors with a strength-based practice focus were interviewed. Narrative analysis drawing on a categorical-content mode of reading across participants' narrative data showed that the school context plays a significant role in shaping counsellors' practice. Metanarratives of both strength and deficit, and metanarratives of the school context were identified as having an impact on counsellors' strength-based practices. Dominant deficit metanarratives were juxtaposed with metanarratives of strength. Implications of how counsellors negotiate counselling in a school context are discussed. [ABSTRACT FROM AUTHOR]

The study aimed to explore perceptions and experiences about how engaging in daily activities and occupations influenced recovery in the first eight weeks after surgical treatment of a distal radius fracture. Twenty-one adults completed an online activity and exercise log then participated in a semi-structured interview between weeks 6 and 8 postoperatively. Interviews were transcribed and analysed using reflexive thematic analysis. Daily activities and occupations were highly influential in facilitating recovery of movement and function of the operated limb. Five themes provided an understanding of how occupation operated to promote recovery. Occupation was (i) a primary driver of the rehabilitative process, providing an impetus for recovery, (ii) offered ready-to-hand challenges for opportunistic, automatic movement, (iii) invited intentional use of the affected wrist, (iv) habituated the wrist to movement through repetition and confidence-building, and (iv) drew on psychosocial resources to enable reengagement with life activities and roles. Incorporating the performance of graded, modified activities during the early weeks of rehabilitation creates opportunities for wrist movement, enhances wellbeing, and assists in the habituation of wrist movement. Activities and occupations can be used as a therapeutic strategy to promote recovery from surgical treatment of a distal radius fracture. Rehabilitation after surgical repair of distal radius fractures has traditionally focused on exercise routines. Daily activities and occupations can also be used to promote wrist movement and function during the early weeks of rehabilitation. Occupation is a naturally occurring source of wrist movement, motivation, and wellbeing that can be harnessed for therapeutic advantage after surgical repair of distal radius fractures. Therapists can collaborate with patients to select and modify daily activities and occupations to incorporate into early postoperative therapy programmes. [ABSTRACT FROM AUTHOR]

Objectives: To explore Chinese late-life immigrants' perceptions of loneliness and social isolation. Methods: A qualitative descriptive methodology underpinned this study. In-depth individual interviews were conducted in Mandarin with purposively recruited participants. The twenty-three participants in the study had all emigrated from China, were 65–80 years old on arrival and had lived in New Zealand for between 2.5 and 16 years. An inductive thematic analytic process was undertaken. The COREQ checklist was followed to ensure study rigour. Results: Three themes, ‘high value placed on meeting family obligations’, ‘feeling a deep sense of imbalanced intergenerational reciprocity’ and ‘moving away from filial expectations’, were identified. Confucianist values of ‘women's domestic duty of caring for grandchildren’, ‘filial piety’, and ‘saving face’ to be accepted and respected by others negatively attributed to participants' understandings and experiences of loneliness. To plan for increasing frailty and to avoid family conflict while ameliorating potential loneliness, some participants reluctantly discarded prior customary filial piety expectations in favour of formal aged care options. Conclusions: Participants' profound sense of loneliness was seen to be attributed to their deeply rooted cultural values and backgrounds from having lived for a significant period of time in China. Loneliness occurred as a result of the resettlement process in later life. These experiences highlight the importance of using cultural framing that takes into account beliefs and adaptations to host societies anticipated during the process of late-life immigration. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The rate of sexually transmitted infections (STIs) amongst midlife and older heterosexual women in New Zealand is rising. Popular culture celebrates a heightened sexuality for this population group. However, depictions of sexually savvy 'cougars' are at odds with reality for many women. International literature highlights that these women are often ill-equipped to negotiate safer sex and condom use, instead focusing on pleasing men and attributing their silence to spontaneity. The study aimed to explore barriers to safer heterosexual sex as perceived by midlife and older New Zealand women who are re-partnering or in casual relationships. METHODS: This qualitative study utilised Interpretive Phenomenology Analysis, supported by the theory of gender and power, to examine the gender-normative assumptions and behaviours in women's accounts of unprotected sex. Eight single women aged 40-69 participated in individual, in-depth interviews. This exploration included eliciting women's accounts of potential information resources, such as clinical consultations. FINDINGS: Analysis indicated that these women held misconceptions about STI transmission but had not sought educational material, nor discussed their sexual health with health professionals. Results highlighted women's ambivalence about prioritising safer sex, preferring to comply with partners' wishes, particularly when under the influence of alcohol. Women described valuing their own pleasure and their distaste for condom use, but data emphasised that women predominantly aligned their choices with men's preferences. CONCLUSION: This study highlights that the women were both ill-informed and vulnerable with regards to sexual health. General practitioners are well placed to provide education and sexual health advice. [ABSTRACT FROM AUTHOR]

Background: Death and dying are inevitable life encounters, but a nurse’s first experience with patient death may pose considerable cognitive, emotional and clinical challenges. This paper reports the findings of the second phase of a study; the first has been reported elsewhere. This phase explored the earliest memorable patient death experiences of New Zealand registered nurses. Method: A purposeful, self-selected sub-sample of a larger study of New Zealand registered nurses, took part in individual face-to-face semi-structured interviews. Interpretative phenomenological analysis was utilised to seek to understand participants’ experiences. Thematic analysis was undertaken to identify emerging themes, with participants’ own words used as theme headings, where their phrases provided succinct or powerful descriptors. Results: A diverse participant group of twenty, currently practising, New Zealand registered nurses provided rich and detailed descriptions of their earliest memorable experience with patient death. Participants from a variety of training backgrounds described patient deaths, which occurred in a range of settings – some only a few months prior, others – more than thirty years ago. Seven emergent themes, and features of more positive, or negative experiences were identified: Event Significance; Emotional Challenges; Sharing the Experience; Learning; Feeling Unprepared, Responses to Death and Finding Benefits. Conclusion: For participants in this study, there was considerable evidence that their earliest memorable patient death was a significant event. Furthermore, although most participants’ experiences were characterised by emphatic or poignant description, there was most often a balance of challenges and rewards. [ABSTRACT FROM AUTHOR]

Internationally there is limited research on the experiences of people with disabilities during and following a major disaster. The overall aim of this research was to explore how the Christchurch earthquakes impacted upon disabled people. This paper reports on findings from the research relating to emergency preparedness and perceptions of vulnerability among disabled people who were living in Christchurch over the extended period in which the earthquakes occurred. Qualitative inquiry was carried out, involving purposive sampling and face to face interviews with 23 disabled people and four agency representatives living in Christchurch during the earthquakes. The qualitative research was followed by a pilot quantitative survey involving 25 disabled people living in Christchurch during the earthquakes and 10 people who work in the disability sector. Qualitative interview material was analysed using thematic analysis while quantitative data was analysed using descriptive statistics. All findings are related to sections of the Hyogo Framework for Action. The research identified that prior to the September earthquake, disabled people were not prepared for an emergency. Following the earthquake most people took steps to ensure that they were better prepared. However, few disabled people were able to prepare for an emergency without support. Vulnerability was discussed by participants in relation to personal safety, communication, housing, transport and financial hardship. A lack of community preparedness alongside insufficient structures to assist disabled people in the disaster response or recovery phases increased exposure to risk. It was relevant to discuss findings with reference to the Hyogo Framework for Action's emphasis on vulnerable communities, given that this international document was under review at the time of writing. Our research suggests that disabled people are more likely to be impacted in a civil emergency and are less likely to be prepared. Emergency preparedness management needs to engage with disabled people in the community and have specific policies to assist disabled people prior to and in the event of a disaster. [ABSTRACT FROM AUTHOR]

Introduction New Zealand's Asian population is growing and diverse. Kidney failure is a major health burden and 10% of dialysis population is identified as Asian ethnicity. There is currently no information about their experience on haemodialysis. This study aimed to understand their perspectives in order to help improve dialysis experience. Methods Thirteen Asian haemodialysis patients were recruited and took part in semi-structured interviews in Counties Manukau Health. All interviews were recorded, transcribed and reviewed. Themes were developed based on common experiences. Findings Four key themes emerged from the data -- the impact of illness, how culture and language are integral to health, the importance of family, and personal relationships with health professionals. Some experiences were associated with being on dialysis and their overall health status and the major time commitment associated with dialysis visits. Others were related more specifically to cultural factors, including reliance on support from extended family, and access to familiar food. Language barriers were also an important factor, especially for the participants living in aged care facilities. All the participants highly valued the input from dietitians, doctors and staff from dialysis units. Discussion Asian dialysis patients face a range of challenges on dialysis. Particular challenges included language difficulties and accessing cultural support. Developing an increasingly culturally and linguistically diverse workforce could lead to improved care of this population. [ABSTRACT FROM AUTHOR]

Introduction. Prediabetes is the asymptomatic precursor to type two diabetes mellitus, a significant and growing public health problem in New Zealand (NZ). Little is known about how general practitioners (GPs) and nurses view prediabetes care, and similarly little is known about how people with prediabetes view their condition and care. Aim. This study aimed to investigate the views of NZ GPs and nurses, and people with prediabetes about prediabetes and its management. Methods. This was a mixed qualitative methods study that is part of a randomised control trial of a prediabetes intervention. Results. Three key themes emerged from the health professional data (GPs and nurses) and another three themes emerged from people with prediabetes data. GPs and nurses were uncertain about the progression of prediabetes; they felt prediabetes was not a priority and they were unsure about what to advise. People with prediabetes were uncertain about the diagnosis and information given to them; they were unsure about what to do about prediabetes and they found lifestyle change hard. Discussion. GPs, nurses and people with prediabetes, expressed much uncertainty, but also some certainty about prediabetes. All were certain that prediabetes is common and increasing and that sustained lifestyle change was very difficult. But uncertainty prevailed about whether, in reality, prediabetes could be stopped, who would be most likely to benefit from lifestyle interventions and how best to achieve these. Older Māori and Pacific women were keen to promote lifestyle change and this appeared best done through Māori and Pacific peoples' organisations by means of co-designed interventions. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Internationally, non-medical practitioners are increasingly involved in tasks traditionally undertaken by general practitioners (GPs), such as medication review and prescribing. This study aims to evaluate GPs' perceptions of pharmacists' contributions to those services. METHODS: Semi-structured interviews were carried out in two localities with GPs whose patients had and had not undergone a pharmacist-led adherence support Medication Use Review (MUR). GPs were asked their opinions of pharmacists' provision of MUR, clinical medication review and prescribing. Data were analysed thematically using NVivo 8 and grouped by strengths, weaknesses, opportunities and threats (SWOT) category. FINDINGS: Eighteen GPs were interviewed. GPs mentioned their own skills, training and knowledge of clinical conditions. These were considered GPs' major strengths. GPs' perceived weaknesses were their time constraints and heavy workloads. GPs thought pharmacists' strengths were their knowledge of pharmacology and having more time for in-depth medication review than GPs. Nevertheless, GPs felt pharmacist-led medication reviews might confuse patients, and increase GP workloads. GPs were concerned that pharmacist prescribing might include pharmacists making a diagnosis. This is not the proposed model for New Zealand. In general, GPs were more accepting of pharmacists providing medication reviews than of pharmacist prescribing, unless appropriate controls, close collaboration and co-location of services took place. CONCLUSION: GPs perceived their own skills were well suited to reviewing medication and prescribing, but thought pharmacists might also have strengths and skills in these areas. In future, GPs thought that working together with pharmacists in these services might be possible in a collaborative setting. [ABSTRACT FROM AUTHOR]

ABSTRACT Concerns relating to the adequacy of nurses' preparation for the care of people with mental illness prompted significant revision of the mental health component in a Bachelor of Health Science nursing programme in New Zealand that prepares approximately 200 students per year. Working collaboratively with clinical providers, university staff developed and introduced three courses (equivalent to 450 hours of learning) specifically focused on mental health science, inpatient practice, and primary community mental health practice. This paper provides an overview of the new courses and reports the findings of an appreciative inquiry evaluation of this curriculum innovation. [ABSTRACT FROM AUTHOR]

Bronchiectasis is a chronic respiratory disease that impacts significantly on quality of life for those who have it. There is a paucity of literature exploring the perspectives of children and young people. The aim of this study was to examine the day-to-day life experience of a group of young people with bronchiectasis. A qualitative study using semi-structured interviews explored fifteen young people's perspectives of life with bronchiectasis. Key themes were identified using an inductive iterative approach through constant comparative analysis guided by Thorne's interpretive description. Life with bronchiectasis was conceptualized by participants as "Pretty Normal". This consisted of two co-existing life views which represented how young people balanced the ups and downs of adolescence while learning to accommodate the demands of living with bronchiectasis. Three key thematic elements "sore and tired", 'life interrupted and "looking after self", influenced and challenged these two views of life. Young people with bronchiectasis portray life as being the same as their peers. Despite this, they recognized that the symptoms, interruptions, and self-management responsibilities led them to find ways of coping and integrating their experience into a new and modified view of normal. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore the experiences of alcohol and other drug nurses transitioning to telehealth due to the COVID‐19 pandemic. Background: COVID‐19 has caused immense disruption to healthcare services, and to reduce viral transmission, many services moved to off‐site care delivery modalities such as telehealth. Design: We used a qualitative descriptive design for this study. Methods: Secondary analysis of semistructured interviews with alcohol and other drug nurses from Australia and New Zealand (n = 19) was conducted in July and August 2020. Data were analysed using thematic analysis and reported using COREQ guidelines. Results: Three were identified: '"All our face‐to‐face contact ceased with clients": Changing service delivery', '"How do I do my job when I can't see you?": An anxious shift in service delivery' and '"A lot of Indigenous people don't like the FaceTiming and all that": Challenges to delivery of services through telehealth'. Conclusion: Participants in our study reported challenges in transitioning to telehealth modalities. The perceived loss of therapeutic communication, difficulties in assessing risks to healthcare consumers such as domestic violence and challenges delivering telehealth care to a marginalized consumer cohort need to be overcome before telehealth is considered successful in alcohol and other drug treatment. However, telehealth was a successful adjunct to existing practices for nurses working with consumers in regional or remote areas or where consumers preferred this method of service delivery. Impact: Nurses in this study described substantial issues with the delivery of alcohol and other drug treatment via telehealth, including a perception that telehealth was a barrier to addressing risks to consumers who use alcohol and other drugs, and difficulties working in a therapeutically beneficial way via telehealth. Telehealth is a means to reduce viral transmission through a reduction in face‐to‐face contact, and although it may be useful for some service functions, it may be detrimental to the clinical services nurses provide. [ABSTRACT FROM AUTHOR]

Aims: To explore the experiences of strategic leads for nurse education as they sought to respond to the COVID‐19 pandemic. Design: We utilised a qualitative interpretative approach to explore education leaders' experiences of leading during the early months of the pandemic. Methods: Nineteen leaders with significant strategic responsibility for nurse education in Australia, Canada, New Zealand, Singapore and the United Kingdom were identified via purposive sampling and agreed to participate. Interviews were held between May and July 2020. Results: Four overarching themes arose from the analysis: (1) Crisis driven adaptability & flexibility; (2) Responsive, complex and changing communication; (3) Making decisions for student and staff safety; (4) Looking to the future; stronger partnerships. Conclusion: Internationally, while nursing education leaders faced different problems, they shared a common goal amidst the crisis to remain student‐centred. They demonstrated they were able to face major challenges, respond to large scale logistical problems and make decisions under significant and ongoing pressure. Impact: In responding to the pandemic, nurse leaders shared knowledge and offered mutual support. This bodes well for future collaboration. The move to online learning accelerated an existing trend and it seems likely that this will continue. Given the pressures they experienced over an extended period, the sector may wish to consider how it prepares and supports existing and future leaders. [ABSTRACT FROM AUTHOR]

Background: Increasingly, many patients believe that a combined approach of complementary and alternative medicine (CAM), including acupuncture, and conventional medicine is better than either on its own, and more patients now have the desire to discuss CAM with well-informed general practitioners (GPs). However, to our knowledge, the interaction and collaboration between GPs and acupuncturists specifically in relation to shared care have not been investigated. This research explored interprofessional communication between GPs and acupuncturists in New Zealand. This article specifically reports the GPs' viewpoints. Methods: This study was part of a larger mixed-methods research project. Semi-structured interviews of 14 purposively sampled GP participants were conducted and analysed using thematic analysis. Results: The data analysis identified both facilitators of and barriers to integrative health care. Facilitators included the willingness of GPs to engage in communication and a recognition of the importance of patient choice. Barriers included the limited opportunities for sharing information and the lack of current established pathways for communication or direct referrals. GPs also highlighted the confusion around scopes of practice in terms of the different styles of and approaches to acupuncture. Conclusion: This research contributes to the body of knowledge concerning interprofessional communication and collaboration between GPs and acupuncturists and suggests that while there are significant barriers to collaboration, there is also the potential to impact provider satisfaction and patient well-being. It provides context within a New Zealand health care setting and also provides additional insights regarding acupuncture, specifically through the disaggregation of specific CAM modalities. [ABSTRACT FROM AUTHOR]

Aim: This study determines whether the culture within an acute care hospital empowers 'all' nurses to be leaders by exploring intersectionality and nursing leadership in the context of the social environment. Background: Nurses practice leadership in their day‐to‐day activities as clinical leaders alongside traditional roles of management and leadership. However, some nurses do not acknowledge nursing work as leadership activity, nor is it seen so by others where hierarchical leadership approaches remain prevalent. Social constructs of gender and race are barriers to accessing formal leadership positions for some, while dominant power structures such as class diminish the value of bedside nursing work. Unexplored is the impact of the intersection of these and other social identities on nurses being leaders. Design: An embedded case study design. Methods: Thirty‐one participants participated in semi‐structured interviews. Four levels of analysis including inductive and deductive approaches were applied to the data. The research complied with COREQ guidelines for reporting qualitative research. Results: This study shows nurses do not identify themselves as leaders without an associated title and the pathway to leadership varies depending on intersecting social constructions. Conclusion: The impact of the organisational structures and the experience of navigating intersecting social constructions on nurses being leaders goes unseen, privileging some while disadvantaging others. Relevance to clinical practice: Health organisations need to be aware of intersectionality in the workplace and explore equity in their structures to be genuinely empowering. Nursing leadership must examine strategies that challenge and decolonise the nursing profession. Bedside nurses should be given more power and respected as leaders of the patient experience, achievable through a renewed emphasis on the fundamentals of care and resonant leadership, which can neutralise a culture of managerialism. Intersectionality can inform the development of new nursing leadership roles that enable nurses to remain clinically active, widening opportunities. [ABSTRACT FROM AUTHOR]