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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]

Purpose: Little is known about the barriers and facilitators to pregnancy, birth and motherhood for disabled women within the New Zealand context. Our study explored this deficit with the aim of improving health care interventions and support for disabled mothers. Methods: This paper reports on the third phase of a mixed-methods study. The first two phases used semi-structured individual and focus group interviews with disabled women, and health professionals, involved in maternity and postnatal care and has been reported elsewhere. Phase 3 utilised a modified Delphi technique with both groups of participants to seek consensus on the prioritisation of recommendations from the study. This article focuses on the disabled women's recommendations. Results: In all, 20 disabled women took part in the Delphi phase of the study (28% of the cohort from Phase 1). In total, 11 key recommendations were identified by the disabled women, with the top seven discussed in detail here. Conclusions: Health professionals and health systems could, and arguably should, utilise a matrix of these recommendations to facilitate a review of service responsiveness to disabled women. [ABSTRACT FROM AUTHOR]

Previous studies into alcohol and recreational aquatic activity amongst youth have found that alcohol is widely used in association with recreational aquatic activities in New Zealand (NZ), and young people accept alcohol consumption as an embedded practice. In NZ, certain youth actions in, near or on water, could be defined within a ‘kiwi youth culture’ context, given that these voluntary risk-taking practices are quite wide spread and entrenched, and thus have an element of being culturally defined in that they link to a national proclivity to participate in sometimes high-risk fun. Early in 2011 we undertook a small research project that sought to build on other studies' findings that, for young people, mixing alcohol and aquatics is not uncommon and can put young people in danger. Focus group interviews with 17–24-year olds sought to gain insight into young people's attitudes towards and experiences of alcohol consumption in and around water, and their perceptions of risk levels associated with consuming alcohol during recreational aquatic activities. This paper reports themes to emerge from the focus group interviews, and that support findings from previous research. [ABSTRACT FROM PUBLISHER]

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]

Exposure to clinical practice experiences ensures undergraduate physiotherapy students meet the clinical competencies required to graduate as autonomous practitioners. Much of the research literature has investigated the clinical experiences of medical students. While recent studies have explored physiotherapy students' experiences with simulation, few have explored their perspectives of a clinical placement in a hospital setting at the early learning stage of a four-year programme. To explore the perspectives of novice undergraduate physiotherapy students on a clinical placement in a real hospital setting. Fifteen Year 3 undergraduate physiotherapy students participated in semi-structured interviews midway through a three-week tertiary care clinical placement. Interviews were transcribed, coded and analyzed using thematic analysis. Three main themes emerged: 1) student attributes affecting placement experience; 2) impact of the educator on student experience; and 3) effects of the clinical environment on student experiences. The real clinical environment promotes a rich learning experience for students, while the clinical educator is pivotal to guiding student learning through provision of resources and feedback. Provision of early orientation and timely clarification of expectations is important to alleviate anxiety and allow students to prepare themselves. [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]

Transracial adoptees continually navigate the paradoxes of adoption, which arise in bio-normative and racialized contexts. "Being-adopted-and-Māori" was explored with 15 Māori adult adoptees. Hermeneutic phenomenological analysis revealed experiences of adoptive and racial "differentness," centered around four key paradoxes: "as if born to"; the lived experience of transracial adoption; post-reunion biological kinship; and whaka-papa. Examining these paradoxes elucidated the discursive basis of lived and felt contradictions and ambivalence, as well as otherness and exclusion. Māori adoptee identities are considered paradoxical precisely because they disobey hegemonic discourses. Their experiences tell us how dominant discourses of adoption and identity need to change. [ABSTRACT FROM AUTHOR]

Patient values, preferences, and circumstances are critical to decision-making in both patient-centred and evidence-based practice models of healthcare. Despite the established importance of integrating these patient attributes, the ways they are elicited in rehabilitation remain unclear. This study aimed to explore how health professionals elicit and share patients' 'values', 'preferences', and 'circumstances', and what they understand by the terms. This exploratory qualitative descriptive study used interviews with 13 clinicians from interprofessional teams in inpatient neurological rehabilitation. Data were analysed using a general inductive approach. Participants understood 'values' to mean what is important and meaningful; 'preferences' as likes/dislikes and choices; and 'circumstances' as the social, physical, and environmental context surrounding the person. Formal and informal strategies were used to gather information directly from patients or indirectly from other sources. The processes of eliciting and communicating this information were influenced by relationships and relied on contributions from many people. Elicitation involved a flexible approach tailored to the individual and considering each unique context. The strategies used and the approach used to implement these strategies were both essential to eliciting patient values, preferences, and circumstances in neurological rehabilitation. These findings offer insights into the practices of interprofessional rehabilitation clinicians. Eliciting patient values, preferences, and circumstances involves a combination of strategies and approaches that are applied gradually throughout the continuum of rehabilitation. These processes are flexible, and strategies should be tailored to individual patients/families and phases of rehabilitation. Clinicians should be attentive to informal opportunities to gather valuable information throughout rehabilitation. Establishing positive relationships and using effective communication is foundational to these processes. [ABSTRACT FROM AUTHOR]

To uncover the factors that influence inter-rater agreement when extracting stroke interventions from patient records and linking them to the relevant categories in the Extended International Classification of Functioning, Disability and Health Core Set for Stroke. Using 10 patient files, two linkers independently extracted interventions and linked the target of the intervention to relevant functions in the ICF. The percentage agreement of extracted interventions and the ICF codes was calculated. Non-matching interventions and codes were further analysed to determine the reasons for poor agreement. A total of 518 interventions were extracted, with 44.01% agreement between the two linkers. Of the non-agree codes and interventions, 43.79% were due to mismatched ICF codes and 56.20% were due to mismatched interventions. Differences were due to linkers (a) extracting interventions from different parts of the patient note (b) differences in interpreting the target of the intervention, and (c) choosing a different code with similar meaning. Greater reliability when linking interventions to ICF codes can be achieved by; health services using a consistent progress note that uses ICF language, recording the intervention aim, linkers knowing the aims of each discipline's interventions and using multiple reliability checks and analysis to inform the linking method. Linking intervention targets to the ICF and to the ICHI is an emerging research field. Development of trustworthy inter-rater reliability methods is needed to achieve its potential to demonstrate the equity, quality and effectiveness of interventions. Independent linking of patient notes to the ICF can identify factors that impact inter-rater reliability. When writing patient notes, health professionals should use a consistent format that identifies the functional target of the intervention using ICF terms. [ABSTRACT FROM AUTHOR]

Issues of equity, such as service user and student participation, are reinforced in global and national standards of social work education, along with themes of Indigeneity, culture, accessibility, gender, and sexuality. Although standards influence and guide practices in social work education the range and degree to which democratising practices are operationalised at the local level depends upon the actual program delivery within higher education. Semistructured interviews were undertaken with social work education leaders in Aotearoa New Zealand to explore how democratising practices were demonstrated within their programs. Leaders of social work education have a vital role to play in the operationalising of democratising practices within social work programs. Leadership was identified as key to supporting student representation and diversity, recruiting and sustaining a diverse workforce, advancing expressions of activism, and working through internal and external challenges that are paramount to leading an equity-focused social work program. IMPLICATIONS The pursuit of equity is a fundamental professional value in social work education programs that is achieved through democratising practices. Leaders have a key role in operationalising this equity focus, which can be reinforced through standards and regulatory frameworks. An equity-focused program is demonstrated through supporting student representation and diversity, developing a curriculum and a pedagogy that advances equity, and recruiting and sustaining a diverse workforce. [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]

To enhance understanding of access to rehabilitation services in Australian and New Zealand acute care facilities for older adults living with dementia and/or living in residential aged care facilities (RACFs) following a hip fracture. Information on hip fracture rehabilitation was obtained from an online survey of 40 health professionals who were members of the Australian and New Zealand Hip Fracture Registry Network. This information was supplemented with key informant interviews with five geriatricians and five rehabilitation physicians. Availability of hip fracture rehabilitation services differed by region and country. Around one in 10 respondents indicated that their facility had specific rehabilitation protocols for people living in RACFs or who were living with dementia. Barriers to providing hip fracture rehabilitation were commonly related to availability of resources. Rehabilitation pathways were determined according to individual patient characteristics and perceived potential benefit. Decision making was mainly informed by the patient's pre-fracture morbidity and residence. Three key themes and nine sub-themes emerged from the interviews. The development of consistent decision criteria and pathways for access to hip fracture rehabilitation could provide a standard approach to access to rehabilitation, particularly for patients with cognitive impairment and/or who reside in RACFs. Need to establish evidence-based criteria for patients who will benefit from hip fracture rehabilitation. Consistent decision criteria for access to hip fracture rehabilitation will assist in guiding a standard approach to providing rehabilitation, particularly for patients with cognitive impairment and/or who reside in RACFs. There is a need to ensure the availability of physiotherapy services in RACFs to assist with rehabilitation provision. Rehabilitation provided to patients with cognitive impairment and/or who are living in RACFs should be tailored to their physical and mental ability. [ABSTRACT FROM AUTHOR]

Purpose: Our objective was to explore the intersection between mild traumatic brain injury (MTBI) recovery experiences and injury understandings, using both quantitative and qualitative methods. Materials and Methods: The quantitative component was a descriptive case–control study comparing participants (n = 76) who had recovered or not recovered after an MTBI, across demographic and psychological variables. A subset of participants (n = 10) participated in a semi-structured interview to explore experiences of recovery in more detail. We followed threads across the datasets to integrate findings from component methods. Results: The quantitative analyses revealed differences between the two groups in terms of injury recovery understandings and expectations. The qualitative analyses suggested that achieving consistency across information sources was important. By tracing threads back and forth between the component datasets, we identified a super-ordinate meta-theme that captured participants' experiences of wrestling with uncertainty about their recovery and the impacts in terms of heightened anxiety, confusion, and feelings of invalidation. Conclusion: The effectiveness of psychoeducation and reassurance after MTBI may be optimized when content is tailored to the individual. Clinicians are urged to attend both to the subjective interpretations patients make of information gained from formal and informal, internal and external sources, and where information across these sources conflicts and creates uncertainty. Effectiveness of psychoeducation and reassurance after injury may be optimized when content is tailored to the individual rather than being generic. Effectiveness of such interventions may also be optimized by understanding the subjective interpretations individuals make of injury knowledge gleaned from formal and informal, internal and external sources. Conflicting information from such multiple sources may create uncertainty with associated increased distress as an individual negotiates their recovery from injury. Attending to this uncertainty may be a helpful target for treatment. [ABSTRACT FROM AUTHOR]

In a qualitative study of the experiences of 1.5 generation Korean New Zealanders as parents, a notable finding was the significant part the participants' identity-related experiences as migrants played in shaping their parenting practices. Interviews were conducted with 18 Korean "Kiwis" (New Zealanders), colloquially referred to as "Kowis," who had arrived in New Zealand before 2002 as children or adolescents with their parents and were now married with children. Reflecting on the challenges of their migration and identity journeys enabled them to recognise their vulnerabilities and their advantages, and the multiple ways in which identity-related cultural conflicts and confusion influenced their parenting of their children. The implications are identified for further research and for counselling practice. [ABSTRACT FROM AUTHOR]

The provision of community-based child welfare services (CCW) in a managerialist climate in Aotearoa New Zealand (ANZ) necessitates constantly renegotiated contractual partnerships, service targeting and measured outcomes. Reflective supervision is essential to counter the perceived negative impacts of managerialism on CCW work. Within this environment, there is a struggle to ensure supervision provides reflective spaces for social workers to develop in their work with service users despite the demands of meeting organisational imperatives. This article reports on a qualitative study which critically analyses the espoused theory and theories-in-use [Argyris, C., & Schön, D. (1974). Theory in practice: Increasing professional effectiveness. San Francisco, CA: Jossey Bass.] about reflective supervision held by social workers practising in the demanding environment of CCW. In the first phase of the research reported here, nine key informants who had both considerable experience in CCW and academic experience in ANZ were interviewed about the nature of reflective supervision in CCW social work. Findings indicate that social workers working in CCW settings are influenced by factors associated with self-awareness, relationships, organisational and professional obligations within a changing and risk-averse managerial environment. Key informants assert that social workers from CCW backgrounds need reflective supervision to engage in self-reflection, consider wider socio-cultural factors and to critically develop social-justice-informed practice with service users. [ABSTRACT FROM AUTHOR]

Food addiction is increasingly being recognised as a contributory factor in overweight and obesity. Management of eating compulsivity, a key component of food addiction, may assist greatly in the successful treatment of obesity. Measurement of food addiction and its core characteristic of eating compulsivity is fundamental to increasing understandings of the concept of food addiction, its prevalence among people with and without obesity and its utility within a treatment context. The current study describes the development and initial validation of a brief measure of eating compulsivity that can be used within clinical and research settings to establish a person's level of eating compulsivity. Sixty five participants with a BMI ≥30 (mean BMI 38.1) were recruited from a general population sample within Christchurch, New Zealand. Participants completed the test version of the Measure of Eating Compulsivity (MEC) and the Yale Food Addiction Scale (YFAS) as well as providing self-reported measures of height and weight. The 10-item MEC was developed. This measure was shown to have excellent internal consistency (Cronbach's alpha =.946), based on a single factor accounting for 67.4% of the variance and excellent test-retest reliability (r =.923). MEC10 score was strongly predictive of being categorised as having food addiction based on the YFAS, although not associated with BMI. This brief tool is likely to have high utility in clinical and research settings and requires further validation with a range of populations including those with and without obesity, binge eating disorder and other eating disorders. [ABSTRACT FROM PUBLISHER]

Variable decisions are a persistent problem in child welfare decision-making. This article reports on the findings of a study of variability drivers in Aotearoa New Zealand. Using a mixed methods ecological approach, it compares ‘risk-averse’ and ‘risk friendly’ practitioners (n = 67 child welfare social workers). The study found the risk-averse group contained more non-governmental child welfare workers, but there were no other demographic differences. Risk-averse respondents were more certain of their conclusions even when little information was provided, and rated the children’s safety lower. The risk-averse group estimated more harm to children over time, if there was no intervention. Both groups described risk and safety factors similarly, but despite this shared knowledge base, risk and safety level perceptions still differed. When explaining problem causes the risk-averse group focused on the past trauma histories of parents, whereas the risk-friendly group focused more on issues in the present. This pattern suggests practitioners conceptualise the meaning and weighting of risk factors differently, with some having a ‘developmental lifespan- futurist’ orientation as opposed to a ‘welfare/needs-presentist’ orientation. Implications for practice are discussed. [ABSTRACT FROM PUBLISHER]

Purpose:Qualitative research examining experiences of recovering from mild traumatic brain injury (MTBI) is limited. Findings from quantitative studies regarding predictors of persisting symptoms are inconsistent with limited attention directed to capturing broad perspectives and priorities of the wider stakeholders. More flexible research approaches may help advance the field. We used a mixed method design to generate patient perspectives of MTBI recovery, integrating these with quantitative investigation to isolate factors that might contribute to divergent MTBI outcomes. Methods:The qualitative component reported here involved semi-structured interviews with selected participants (n = 10) from the quantitative study cohort, sampling both recovered and non-recovered adult MTBI participants. Interviews focused on participants’ general description and understandings of their recovery and perceptions of what helped or hindered this. Data were analyzed using general thematic analysis. Results and conclusion:Participants regardless of recovery status identified the importance of having a coherent understanding of their injury and recovery. Factors facilitating coherence included social support, validation, reassurance, accessing credible evidence-based information and having a pathway to wellness. Findings suggested that coherence could be a helpful umbrella construct worthy of examination in future MTBI research. This construct appears broad and able to cope with the complexity of individual experiences after injury.Implications for rehabilitationSense of coherence may be a helpful umbrella construct that can facilitate resilience and positive recovery beliefs and expectations after mild traumatic brain injury.Reassurance, validation, and social support appear important and may facilitate injury recovery.Focus on the experiences of people recovering from mild traumatic brain injury may help to refine recovery models and understandings and thus provide more effective intervention targets. [ABSTRACT FROM AUTHOR]

We aimed to evaluate a strength and balance program delivered in the community. There is little evidence of implementation of evidence-based exercise in practice. The program was a step-down model, designed to encourage long-term exercise in community classes. The program consisted of a fully funded referral only evidence-based 12-week strength and balance (Community Otago) class, followed by an evidence-based continuous open-access community strength and balance class (Active Always). The program was offered to patients: 1) after formal falls rehabilitation (falls and fracture service); 2) after falls rehabilitation in intermediate care; and 3) referred by a GP who were not eligible for rehabilitation (preventative measure). Outcome evaluation used descriptive statistics to report changes in function, confidence in balance, hospital attendance/admission for falls/fractures and transition to community classes. Focus groups established participant experience/satisfaction. Seventy-nine participants were included, aged 56–96, and 53 (67%) were women. About 63.3% of patients transitioned to Active Always classes, demonstrating improvement in maintenance. Follow-up scores from baseline attendance at falls and fracture service to 12-weeks follow-up (24 weeks) in Community Otago showed the majority of patients improved their function (Timed up and Go), confidence (ConfBal) and lowered their falls risk (Tinetti). Follow-up of participants from Community Otago baseline to the end of 12-weeks showed improvement in function and confidence, but only a third of participants lowered their falls risk. Focus groups data suggest that continuity of delivery, the role of the instructor, health professional, and social and physical outcomes were essential for maintenance. A supportive environment can be created which encourages older adults’ continued participation in group-based strength and balance, helping the delivery of evidence-based practice. [ABSTRACT FROM PUBLISHER]

Objectives: To describe implementation of an innovative gerontology nurse specialist role within one primary health organisation in Auckland, New Zealand. Quantitative outcomes of the screening tool as well as the nurse specialist assessment will be presented.Method: The intervention involved use of the Brief Risk Identification for Geriatric Health Tool (BRIGHT) to identify high-needs older people with subsequent comprehensive geriatric assessment (CGA) performed by the gerontology nurse specialist.Results: A total 384 of the 416 BRIGHTs were completed (92% response rate) and 15% of these were identified as high risk (n= 57). The BRIGHTs for high-risk older people revealed the highest scoring question was ‘needing help with housework’ (26%). The most frequent intervention by the gerontology nurse specialist was education (30%).Conclusions: The primary health care gerontology nurse specialist model delivers a proactive case finding and specialist gerontology intervention for older people at high risk of functional or health decline. [ABSTRACT FROM PUBLISHER]

Background:Engaging and inspiring the next generation of physician-scientists at an early stage is recognised as key to ensure the future of medical research. However, little is known about medical student perceptions of research. Objectives:We attempted to ascertain perceptions of research and research-orientated careers from medical students studying in different countries. Methods:An online questionnaire was developed, piloted, and promoted to medical students in various countries. Results:1625 responses were collected from 38 countries. Analysis was restricted to data collected from countries with >100 responses (n = 890). Less than half the respondents felt their medical school provided adequate research training. Key perceived barriers to research participation as a student included lack of time and difficulty finding mentors or projects. A significant gender disparity existed in research ambitions of students with females desiring less research involvement. The importance of barriers and satisfaction with research training differed significantly between countries. Conclusions:Students perceive a number of key barriers to research involvement and pursuit of research-orientated careers. Programmes designed to engage students with research should focus on overcoming identified barriers. Greater effort is needed to engage female students who report more significant barriers and less desire to follow research-orientated careers. [ABSTRACT FROM PUBLISHER]

Primary objective: There have been few reports of the approaches taken by speech-language pathologists (SLPs) when assessing cognitive communication (CC) during post-traumatic amnesia (PTA) after TBI. This study sought to understand SLPs’ rationales for CC assessment during PTA and to examine their perspectives on assessment methods during the early recovery period. Methods and procedures: In this qualitative study, 10 SLPs participated in semi-structured face-to-face or telephone interviews about their rationales and methods for CC assessment during PTA and early recovery. Content analysis was conducted using NVivo software to identify key categories. Main outcome and results: SLPs reported their reasons for CC assessment as including: (1) Documenting changes and monitoring progress, (2) Feedback to team, family and patient, (3) Diagnosis of communication disorder, (4) Planning and (5) Prognosis. They described conducting ongoing, informal assessment and monitoring of CC, using a combination of standardized and non-standardized measures during PTA, and commenced formal testing after PTA resolution to formulate a baseline level of communication function. Conclusions: The current study highlighted the importance that SLPs placed on an individualized approach in CC assessment. Findings provided insight into the process of assessment of CC during PTA and the early stage of recovery after TBI. [ABSTRACT FROM PUBLISHER]

Purpose: People with stroke or Parkinson’s disease (PD) live with reduced mood, social participation and quality of life (QOL). Communication difficulties affect 90% of people with PD (dysarthria) and over 33% of people with stroke (aphasia). These consequences are disabling in many ways. However, as singing is typically still possible, its therapeutic use is of increasing interest. This article explores the experiences of and factors influencing participation in choral singing therapy (CST) by people with stroke or PD and their significant others.Method: Participants (eight people with stroke, six with PD) were recruited from a community music therapy choir running CST. Significant others (seven for stroke, two for PD) were also recruited. Supported communication methods were used as needed to undertake semi-structured interviews (totalN = 23).Results: Thematic analysis indicated participants had many unmet needs associated with their condition, which motivated them to explore self-management options. CST participation was described as an enjoyable social activity, and participation was perceived as improving mood, language, breathing and voice.Conclusions: Choral singing was perceived by people with stroke and PD to help them self-manage some of the consequences of their condition, including social isolation, low mood and communication difficulties.Implications for RehabilitationChoral singing therapy (CST) is sought out by people with stroke and PD to help self-manage symptoms of their condition.Participation is perceived as an enjoyable activity which improves mood, voice and language symptoms.CST may enable access to specialist music therapy and speech language therapy protocols within community frameworks. [ABSTRACT FROM AUTHOR]

Background: Acupuncture is considered a clinically effective and cost-effective treatment option for chronic low back pain. However, few clinical trials have evaluated the dose dependence of acupuncture for chronic low back pain based on the number of sessions. Conclusions are conflicting and there is little high-quality evidence to support the cumulative effects of repeated interventions. A randomized controlled trial to investigate the optimal number of sessions of acupuncture in addition to usual care for adults with chronic low back pain is required; a feasibility study to test the rationale and method for the full-scale trial is the first step in that process. Design:A pragmatic parallel three-armed randomized, controlled feasibility study. Methods:Forty-five participants with chronic low back pain will be recruited locally and randomized on a 1:1:1 basis to receive usual care plus 4 (n = 15), 7 (n = 15) or 10 sessions (n = 15) of semi-standardized acupuncture. Primary outcomes are acceptability of and adherence to different numbers of sessions of acupuncture, as well as the feasibility of the recruitment approach and completion of the specific outcome measures. Secondary outcomes include pain intensity and patient satisfaction. Follow-up questionnaires will be collected at discharge, 6, and 12 weeks after randomization. Discussion:Outcomes will inform the decision to conduct a full-scale trial to definitively test the dose dependence of acupuncture. Findings will add to the limited evidence available regarding the optimal number of sessions of acupuncture in the management of chronic low back pain, as well as being clinically relevant to clinicians, researchers and policy makers. [ABSTRACT FROM AUTHOR]

The purpose of this study was to obtain evidence regarding the validity and reliability of an instrument to measure the self-reported competencies of interprofessional care in interprofessional education programs. Five hundred and eighty-four students and clinicians in Canada and New Zealand who were registered in 15 interprofessional education undergraduate, postgraduate, and continuing professional development programs completed the Interprofessional Collaborative Competency Attainment Survey (ICCAS) using a retrospective pre-test/post-test design. Factor analyses showed the presence of two factors in the pre-program items and one factor in the post-program items. Tests conducted provided evidence in support of the validity and reliability of the ICCAS as a self-assessment instrument for interprofessional collaborative practice. Internal consistency was high for items loading on factor 1 ( α = 0 .96) and factor 2 ( α = 0 .94) in the pre-program assessment and for the items in the post-program assessment ( α = 0 .98). The transition from a two factor solution to a single factor structure suggests interventions influence learners' understanding of interprofessional care by promoting the recognition of the high degree of interrelation among interprofessional care competencies. Scores on the ICCAS are reliable and predict meaningful outcomes with regard to attitudes toward interprofessional competency attainment. [ABSTRACT FROM AUTHOR]

Sleep deprivation is an often hidden problem in working adults. In this study, we evaluated self-regulation processes contributing to poor sleep patterns of full-time office employees. We investigated whether work-related demands and prioritizing sleep (in relation to other activities) predicted sleep behaviours over an 11-day period. Seventy-three adults in New Zealand completed online measures, including the Copenhagen Psychosocial Questionnaire, a measure of sleep prioritization, and the Pittsburgh Sleep Quality Index. Mixed-model analyses of daily data revealed that higher sleep prioritization and positive work-related emotions during a workday predicted better sleep quality that night. Cognitive demands on a workday predicted a later bedtime that night, whereas emotional demands predicted an earlier bedtime (but also an earlier waking time). Regression analyses revealed that when controlling for baseline levels of each dependent measure, pre-sleep arousal predicted fewer hours of sleep and greater sleep difficulty whereas sleep prioritization predicted a faster time getting to sleep, longer sleep and less sleep difficulty. High priority for sleep and positive emotions at work may promote sleep quality, whereas cognitive and emotional demands, or pre-sleep arousal may disrupt sleep patterns. These findings point to sleep prioritization and cognitive-emotional self-regulation skills as potential targets for work-based interventions aimed at promoting sleep. [ABSTRACT FROM PUBLISHER]

In New Zealand, support services have been developed in response to patient need but are variable. The benefits of psycho-social-spiritual care in reducing distress and enhancing quality of life for people with cancer and their families are well established yet unmet needs continue to feature. This project aimed to examine how health care professionals assessed for psycho-social-spiritual distress and unmet need, decisions on appropriate support, and identification of barriers in the referral process. A mixed-methods approach was used for this research. The qualitative phase entailed semistructured interviews with health care professionals working in cancer care. The quantitative phase was an online survey of oncologists and nurses. Thematic analysis was carried out by performing a side-by-side analysis of both sets of data. Nurses were most likely to assess for psycho-social-spiritual need and to refer to support services. Despite a clear mandate to provide regular psycho-social-spiritual assessment, there is no consistency of assessment and referral across New Zealand. There are clearly unmet psycho-social-spiritual needs among people affected by cancer in New Zealand, with health care professionals in this study noting structural impediments to adequate supportive care. There is a mismatch between the importance placed on such care and the capacity that is currently available. The results of this study provide evidence that can be used to argue for improvements in the infrastructure, funding allocation and policy that would allow for better psycho-social-spiritual care within the challenging context of increasing numbers of those affected by cancer. [ABSTRACT FROM PUBLISHER]

In New Zealand, the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003 provides diversion for persons with an intellectual disability who have been charged with, or convicted of, a criminal offence. This unique Act moves the responsibility for such ‘care recipients’ from the criminal justice system to a disability sector that values a social model of disability and philosophies of autonomy, choice and normalisation. This research identified dilemmas faced by care managers legally responsible for care recipients. Care managers experienced: tension between imperatives of risk management, rehabilitation and human rights; role ambiguity between ‘custodian’ or ‘therapist’; philosophical incongruity within their services; and ethical dilemmas over decisions to lengthen care orders. The changing care recipient population has intensified these dilemmas: services must now adapt to the needs of young, street-wise people with alcohol and drug problems and histories of criminal behaviour. The article makes recommendations about how these dilemmas can be addressed. [ABSTRACT FROM PUBLISHER]

The monitoring-blunting theory of coping suggests that when faced with a threatening situation, individuals can respond by either monitoring or avoiding (blunting) threatening information. The current study sought to validate a scale of children's preferences for monitoring or blunting in dental situations (the Monitoring Blunting Dental Scale or MBDS). The psychometric characteristics of the scale were assessed in a sample of 240 New Zealand children aged 11–13. Reliability was adequate for both monitoring (α = 0.74) and blunting (α = 0.76) subscale scores. Convergent validity was indicated by strong correlations (>0.6) between the measure's subscales and those of a related scale, although discriminant validity with respect to dental anxiety was problematic for the blunting subscale. Exploratory factor analysis supported a two-factor monitoring-blunting model, although confirmatory factor analysis indicated reasonable but imperfect fit for this model, SBχ2(251) = 510.7, p < 0.001, RMSEA = 0.066. We reflect on conceptual issues which may underlie the difficulties experienced here and elsewhere in developing psychometrically sound measures of Miller's blunting construct and suggest that the monitoring subscale of the study scale may be most useful to other researchers. [ABSTRACT FROM PUBLISHER]

Aim: The aim of this study was to explore what factors may enhance the teaching and preparation of undergraduate Bachelor of Nursing students to better prepare them for practice in older adult settings in a provincial region of New Zealand. Background: There are concerning shortages of nurses working in older adult settings in New Zealand. With an ageing nursing workforce, demand for nurses in this area will continue. Of ongoing concern is a lack of interest among undergraduate students to take up positions in older adult settings on completion of their studies. Method: This exploratory study utilised a qualitative approach to explore the perspectives of 12 participants (six faculty and six industry leaders) on how preparation of undergraduate students to take up nursing positions in the older adult sector can be enhanced. Data were collected over a 5-month period from February 2009 until June 2009. Findings: Ways to enhance undergraduate student preparation to work in the older adult sector included: making older adult content visible within an integrated curriculum; faculty development; identifi cation of key skills and implementing processes to teach these; reinvigorating clinical placements in older adult settings with a particular focus at each year of the programme; and actively developing collaborative partnerships between faculty and clinicians. Conclusion: The provision of appropriate older adult care content in undergraduate registered nursing programmes is an area warranting attention if faculty are to ensure student nurses are appropriately prepared to take up positions in the older adult sector. [ABSTRACT FROM AUTHOR]