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Background: The existing literature on sexuality and intimacy in residential care tends to focus on either the question of rights, or the value of autonomy. Where the literature does reference values other than autonomy, such values are considered in the context of being a guide to whether or not a resident is autonomous, rather than being important values in their own right. Objective: This paper draws on qualitative data gathered as part of a larger study in order to inform practice on how care workers respond to intimacy issues that arise with residents with dementia and to inform a general ethics of sex and sexuality, demonstrating that an approach which permits value pluralism can be appropriate in certain contexts. Research Design: The qualitative data referred to in this paper was gathered from semi-structured interviews undertaken as part of a larger mixed-method research project. The interview text was analysed using Thorne's methodological approach, interpretive description. Participants and research context: The qualitative arm of the project consisted of semi-structured interviews conducted between October 2018 and October 2019 with participants (staff, residents and family members) recruited from 35 residential care homes in Aotearoa New Zealand. Ethical Considerations: Participation was informed, voluntary and written consent was gained before interviews. The project was approved by the Massey University Human Ethics Committee (Northern), number NOR 18/25. Findings: Analysis of the scenarios presented in this paper shows that decision-making around sexual intimacy involving people with dementia in a residential care setting is complex and requires recognizing and weighing the different values that may be a in play. Conclusion: A focus on safety and consent to the exclusion of other values which matter morally in this context is a mistake which prevents care workers from providing appropriately person-centred care to residents, as policies which focus on the goal of care allow space for critical examination of issues which are likely to be highly context-sensitive. [ABSTRACT FROM AUTHOR]

This article presents a description of a specific Indigenous research methodology, Kaupapa Māori Research (KMR), followed by a discussion of the potential contribution that KMR and other Indigenous frameworks make toward understanding and addressing widespread mental health inequities affecting the world's Indigenous peoples. The contribution of existing qualitative KMR to the fields of health and mental health in New Zealand is discussed, and innovative approaches employed within these studies will be outlined. This paper describes the utility of KMR methodology which informed the development of qualitative interviews and the adaptation of an analytic framework used to explore the impact of systems on the experiences of Māori (the Indigenous peoples of New Zealand) with bipolar disorder (BD). This paper adds to others published in this journal that describe the value, inherent innovation, and transformative potential of KMR methodologies to inform future qualitative research with Indigenous peoples and to enact systemic change. Transformation is achieved by privileging the voices of Māori describing their experiences of mental health systems; presenting their expert critique to those responsible for the design and delivery of mental health services; and ensuring equal weight is given to exploring the clinical, structural and organizational changes required to achieve health equity. It is proposed that this approach to research praxis is required to ensure that studies do not perpetuate institutional racism, which requires close adherence to Indigenous research priorities and partnership with Indigenous peoples in all steps of the research process. [ABSTRACT FROM AUTHOR]

Dementia-related sleep changes can lead to disruptions among families living with dementia which can jeopardise carers' wellbeing and ability to provide support. This research explores and represents the sleep of family caregivers across the trajectory of caring, before, during, and after the key period of their care recipient moving into residential care. The focus of this paper is viewing dementia caregiving as a trajectory, characterised by care needs which change over time. Semi-structured interviews were conducted with 20 carers whose family member with dementia had transitioned into residential care within the prior 2 years. Themes constructed from these interviews indicated that sleep was linked to earlier life course patterns as well as to significant moments of transition in the caregiving journey. As dementia progressed, carers' sleep progressively worsened in relation to the less predictable nature of dementia-symptoms, difficulty maintaining routines, and constant responsibilities creating a state of high alert. Carers attempted to facilitate better sleep and wellbeing for their family member, often sacrificing their own self-care. Around the care transition period, some cares reported not realising how sleep deprived they were; for others the busy momentum continued. After the transition, many carers acknowledged that they were exhausted, although many had not realised this while providing home-based care. Post-transition, many carers reported ongoing sleep disruptions associated with poor sleep habits established whilst caring, insomnia or nightmares and grief. Carers were optimistic that their sleep would improve with time and many were enjoying sleeping according to their own preferences. The sleep experience of family carers is unique and includes tensions between their essential need for sleep and the experience of care as self-sacrifice. Findings have implications for timely support and interventions for families living with dementia. [ABSTRACT FROM AUTHOR]

Introduction: Cerebral visual impairment (CVI) typically affects children's overall functioning in visually cluttered environments. This study aims to consider whether the removal of classroom clutter ameliorates visual problems and the associated behavioral difficulties for these children. Methods: Two classrooms at a special school were de-cluttered. Changes included: covering glass panels with thick black paper; hanging sheets over open shelving; creating areas of blank wall in front of the student to focus attention on work; removing unnecessary equipment and furniture; and taking down information on windows and walls, and that hanging from ceilings. Teachers, paraeducators, and students worked in these classrooms for two weeks, following typical daily routines. Observations by teachers and paraeducators of students' behavior and learning experiences before and after de-cluttering were sought through interviews. Findings: The perspectives of the teachers and paraeducators were that de-cluttering had a positive effect on the students' learning experiences and behavior and also on their own functioning. They also considered the fact that creation of learning spaces lined with black paper resulted in greater attention and focus, but that students continued to be distracted by the noise and movement of others. Discussion: The potential link between cluttered classrooms and students' functioning and behavior indicates that visual clutter may amplify the visual difficulties associated with CVI and distract the students from learning activities, and is in line with current literature. Changes to classroom layouts that include specific areas for different learning activities, including "black hubs," may therefore benefit students with CVI. Implications for practitioners: This pilot study suggests that the elimination of classroom clutter and the creation of black hub learning spaces enhances functioning and merits further investigation. A study that compares specific behaviors and performances, before and after implementation of de-cluttering strategies, might also determine whether the positive effects described by the teachers can be further corroborated. [ABSTRACT FROM AUTHOR]

In 2014, New Zealand enacted the Fisheries (Foreign Charter Vessels and Other Matters) Amendment Act in response to ongoing labour abuses on board South Korean vessels in New Zealand's foreign charter vessel sector. Importantly, the legislation expresses the universality of the International Labour Organization's Decent Work Agenda: all member countries must pursue policies based on the strategic objectives of equality, dignity, safe working conditions and that workers are protected from exploitation. The Act was in response to the identification of widespread labour abuses in this sector. In June 2011, the extent of the abuses came to light when 32 Indonesian crewmen of the Oyang 75 walked off their vessel. In this paper, we explore how a range of stakeholders worked organically to bring about change. We do this qualitatively by combining semi-structured interview (with over 160 Indonesian migrant crewmen between 2011 and 2017), observation and document analysis. We analyse our data through the lens of participatory action research which provides a framework to document the processes of who was involved, the cycles of change, what was achieved in each cycle, and importantly the platform for change. Specifically, we look at how stakeholders – the crew themselves, their advocates, academics, non-governmental organisations, journalists, activists, among others – all played a part in achieving legislated protections. [ABSTRACT FROM AUTHOR]

In many countries, an increasing proportion of deaths occur in residential aged care (RAC) (nursing homes) meaning that these have become both a place to live - a home- and a place to die. This paper reports on death practices and rituals in 49 RAC facilities in Aotearoa/New Zealand narrated in semi-structured interviews with staff. Themes coalesced around 'good death'. Dying alone was not seen as a good death and the demands of trying to prevent this caused tension for staff. Meeting family wishes, post death decision-making, after death practices and rituals, including communicating and remembrance of the death, were explored as part of good death. Overall, death rituals in RAC were limited. Balancing the needs of the living, the dying and the dead created tension. The rituals and practices facilities are currently enacting in death/post-death require attention, since more people will die in RAC with increasingly diverse needs. [ABSTRACT FROM AUTHOR]

This paper presents results from a study in Aotearoa New Zealand 1 which explored the ideas of social work practitioners on public perceptions of social work and how to improve them. This qualitative research was part of a Master's project for two of the authors and followed on from two previous quantitative studies on this topic in Aotearoa. In-depth, semi-structured interviews were conducted with 15 social work practitioners. Thematic analysis was used to create themes concerning what the perceived public perception was, what contributed to it, and how to improve it. The findings have implications for being better able to understand factors that contribute to the public perception of social work so that it may be improved, for increasing the public's understanding of social work, and for recruitment of students into the profession. [ABSTRACT FROM AUTHOR]

The Repeat Question Diary method involves research participants audio-recording many answers to a single question. This article investigates some of the features of the method that are relevant to the study of mobile practices. Particularly, the method encourages participant reflection and the paper argues that this can facilitate the study of mobile practices through enabling participants to notice and analyse previously taken-for-granted, pre-conscious, or corporeal aspects of their practices. The paper also explores the use of audio-recording in diary research and argues that audio-diaries can facilitate participant expression, particularly of emotions, and can avoid the stifling effects of self-editing in written diaries. [ABSTRACT FROM AUTHOR]

An increasing number of countries have, or are moving towards, reforming cannabis policies. New Zealand is also moving in this direction and the government will hold a referendum on the legalization of recreational cannabis in September 2020. To inform imminent public and political discussions it is important to understand how current cannabis use is controlled. Research suggests that cannabis law has been ineffective in NZ. Internationally, informal controls, rather than the law, have been found to shape cannabis use by creating a threshold for normalization, but the attitudes shaping this threshold are unknown. This study aimed to examine drug acceptability attitudes, specifically students' attitudes towards the illegal use of cannabis and their attitudes towards peers who abstain, sometimes use, or are heavy users of cannabis, to identify the factors that control cannabis use. Using a mixed methods approach, university students recruited their peers (N = 535) to complete a pen and paper survey investigating perceptions towards 3 cannabis user prototypes (abstainers, moderate users, heavy users), concern for legality of cannabis use, and the integration of cannabis into the student culture (perceptions of peers' use, ease of acquisition, and availability). Perceptions of peers' lifetime and regular use were 82% and 38.5%, respectively. Participants rated cannabis as easy to acquire and likely to be available at a typical student social occasion. The majority stated that the law does not deter use (92.7%); participants perceived the law to be soft and that they are unlikely to get caught. Participants' descriptions of the 3 cannabis user prototypes revealed a threshold for normalization. For instance, abstaining was perceived to be associated with positive attributes (such as being studious), linked to being less sociable, and linked to being less likely to be judged. Moderate use of cannabis was perceived to be normal and sociable. Heavy use was perceived to be associated with having negative attributes, such as being addicted, unhealthy, and an underachiever, and negative drug labels. Our findings revealed that cannabis use is not controlled by the law, but by informal thresholds of control. Moderate cannabis use is accepted whereas heavy cannabis use is not. We extended research by identifying the attitudes shaping these thresholds, in particular that negative outcomes associated with heavy use deters the normalization of this behavior. We argue that policy must be informed by, and build on, these informal controls. The negative perceptions associated with heavy use also raise concerns regarding the well-being of heavy users, and coupled with the ineffectiveness of cannabis law, lend support towards a health model for regulating cannabis. Furthermore, insights into the negative perceptions associated with heavy use could inform health interventions on the types of concerns that will resonate with users. [ABSTRACT FROM AUTHOR]

Objective: Research designed to increase knowledge about Māori with bipolar disorder is required to understand how health services support wellbeing and respond to identified levels of community need. This paper synthesises the expert critique of Māori patients with bipolar disorder and their whānau regarding the nuances of cultural competence and safety in clinical encounters with the health system. Methods: A qualitative Kaupapa Māori Research methodology was used. A total of 24 semi-structured interviews were completed with Māori patients with bipolar disorder and members of their whānau. Structural, descriptive and pattern coding was completed using an adapted cultural competence framework to organise and analyse the data. Results: Three themes were evident from participants' critique of clinical components of the health system. Theme 1 established that the efficacy of clinical care for bipolar disorder was dependent on Māori patients and whānau having clear pathways through care, and being able to access timely, consistent care from clinically and culturally competent staff. Theme 2 identified the influence of clinical culture in bipolar disorder services, embedded into care settings, expressed by staff, affecting the safety of clinical care for Māori. Theme 3 focused on the need for bipolar disorder services to prioritise clinical work with whānau, equip staff with skills to facilitate engagement and tailor care with resources to enhance whānau as well as patient wellbeing. Conclusion: The standard of clinical care for Māori with bipolar disorder in New Zealand does not align with practice guidelines, Māori models of health or clinical frameworks designed to inform treatment and address systemic barriers to equity. Research also needs to explore the role of structural and organisational features of the health system on Māori patient and whānau experiences of care. [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]

Sexual violence prevention has shifted from centering around a message of ‘no means no’ toward a message of ‘get consent.’ This paper explores how young adults conceptualise consent in relation to how they talked about expressing a willingness to participate in sex. The analysis here argues that understandings of consent are disconnected from how young people understand communication about sex. Consent is viewed as a formal minimum requirement for ‘ok’ sex. At the same time, young people were more sophisticated when discussing how they understand and communicate a willingness to have sex. Implications for sexual violence prevention education and research on sexual consent are discussed. [ABSTRACT FROM PUBLISHER]

This paper describes and contrasts the implementation of Lean Thinking – a quality methodology that emphasises waste reduction and performing at higher levels of productivity with the same or less resources – into New Zealand’s healthcare system. As the field is relatively new, three literature-based exemplar cases were developed to provide an analysis framework to analyse the three New Zealand research sites, which had activities, teamwork, leadership and sustainability as its core themes. Each research site’s case was developed from primary data gathered through interviews, augmented by secondary data from project reports, District Health Board websites and media stories. The results highlight the benefits of a supportive quality-focussed organisational culture, executive management involvement and cross-functional teams as enablers. Further, work intensification and workplace resistance were also evident in varying levels within the sites. The study, while reiterating the problems of introducing quality methods from other domains into healthcare, presents the New Zealand context and reinforces that organisational preparedness as a significant factor which contributes to implementation success. This study goes beyond investigations of the use of Lean tools, changing improvement metrics and descriptive statistics to identify the contexts and variables which surround quality and process improvement implementations. [ABSTRACT FROM PUBLISHER]

In this paper, we document and theorise ‘ownership’ practices in young people’s intimate relationships and discuss the parallels with domestic violence. Ten young New Zealand women engaged in focus group discussions about their heterosexual partner’s ‘ownership’ practices or jealous, possessive and controlling behaviours. Using discourse analysis informed by feminist poststructuralism and critical realism, we identified three proprietary ‘ownership’ practices experienced by these young women: ‘ownership’ entitlement, surveillance and identity ‘ownership’. We discuss the parallels between these practices and those experienced by women subjected to men’s domestic violence, the possibility that such practices may be precursors to the development of domestic violence and the implications for prevention. [ABSTRACT FROM PUBLISHER]

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]

Background: People living with borderline personality disorder (BPD) face high levels of prejudice and discrimination from both the community and medical professionals, but no measure of prejudice toward people living with BPD exists. Aims: The current study aimed to adapt an existing Prejudice toward People with Mental Illness (PPMI) scale and investigate the structure and nomological network of prejudice toward people with BPD. Methods: The original 28-item PPMI scale was adapted to create the Prejudice toward People with Borderline Personality Disorder (PPBPD) scale. The scale and related measures were completed by three samples: 217 medical or clinical psychology students, 303 psychology undergraduate students, and 314 adults from the general population. Results: The original four-factor structure of the PPMI was supported in the PPBPD scale. Reported prejudice toward people with BPD was more negative than prejudice toward people with mental illness in general. The association of the PPBPD scale with antecedents and consequences was assessed, including social dominance orientation, right-wing authoritarianism, ethnocentrism, personality traits, empathy, prior contact, and feelings toward other stigmatized groups and mental illnesses. Conclusions: This study provided evidence for the validity and psychometric properties of the PPBPD scale across three samples and investigated anticipated relationships with theoretically related antecedents and consequences. This research will help improve understanding of the expressions underlying prejudice toward people with BPD. [ABSTRACT FROM AUTHOR]

Background: Despite the reported importance of rapport, there are knowledge gaps in the ways rapport is developed and experienced by health professionals during telehealth calls in palliative care. Aim: To gain an understanding about developing rapport during telehealth calls by exploring the experiences of health professionals in community palliative care. Design: A qualitative Interpretive Description study was conducted with semi-structured interviews and focus groups between November 2020 and May 2021. Data was audio recorded, transcribed, and analysed using Reflexive thematic analysis. A COREQ checklist was completed. Setting/Participants: Thirty-one palliative care professionals who had participated in telehealth calls were recruited from four hospice locations in Aotearoa, New Zealand. Results: There were two themes identified: (1) 'Getting on together', which included how rapport shows up in telehealth, with examples of calls with rapport and without rapport, and (2) 'Rapport is a soft skill', which identified health professionals using body language and listening in specific ways in telehealth, while being aware of the privacy of calls, and lack of training concerns. Conclusion: Based on health professionals experiences of rapport it was determined that rapport is vitally important in telehealth calls, as it is in-person interactions. Rapport is a soft skill that can potentially be learned, practiced and mastery developed, although rapport in each interaction is not guaranteed. Patient and family experiences of rapport in the palliative telehealth area warrants further research and there is some urgency for health professional training in telehealth interpersonal skills. [ABSTRACT FROM AUTHOR]

The burden of health inequities borne by Indigenous peoples can be overwhelming, especially when mothers and newborns' lives are at stake and health services seem slow to invest in responsiveness. In Aotearoa (New Zealand), urgent action is required to eliminate persistent systemic inequities for Māori (Indigenous) whānau (family collectives that extend beyond the household). This Kaupapa Māori (by Māori, for Māori) qualitative study aimed to explore the views of health practitioners identified as champions by whānau of preterm Māori infants. Ten health practitioners were interviewed and asked about their involvement with the whānau, their role in explanations and communication, and their thoughts on whānau coping. Interview data were analysed using interpretative phenomenological analysis. Three superordinate themes were identified: working together in partnership, a problem shared is a problem halved, and sacred space. Collaboration between health practitioners and with whānau was important to the champions and central to their goal of enabling whānau autonomy. This was built on a foundation of connectivity, relationships, and a full appreciation that childbirth is a sacred time that is potentially disrupted when an infant is born prematurely. The values- and relationship-based practices of these champions protected and uplifted whānau. They showed that health practitioners have important roles in both the elimination of inequities and the sustaining of Māori self-determination. This championship is an exemplar of what culturally safe care looks like in day-to-day practice with Māori and is a standard that other health practitioners should be held to. [ABSTRACT FROM AUTHOR]

Objectives: Anorexia nervosa is a severe psychiatric disorder with high mortality rates. While its aetiology is poorly understood, there is evidence of a significant genetic component. The Anorexia Nervosa Genetics Initiative is an international collaboration which aims to understand the genetic basis of the disorder. This paper describes the recruitment and characteristics of the Australasian Anorexia Nervosa Genetics Initiative sample, the largest sample of individuals with anorexia nervosa ever assembled across Australia and New Zealand. Methods: Participants completed an online questionnaire based on the Structured Clinical Interview Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) eating disorders section. Participants who met specified case criteria for lifetime anorexia nervosa were requested to provide a DNA sample for genetic analysis. Results: Overall, the study recruited 3414 Australians and 543 New Zealanders meeting the lifetime anorexia nervosa case criteria by using a variety of conventional and social media recruitment methods. At the time of questionnaire completion, 28% had a body mass index ⩽ 18.5 kg/m2. Fasting and exercise were the most commonly employed methods of weight control, and were associated with the youngest reported ages of onset. At the time of the study, 32% of participants meeting lifetime anorexia nervosa case criteria were under the care of a medical practitioner; those with current body mass index < 18.5 kg/m2 were more likely to be currently receiving medical care (56%) than those with current body mass index ⩾ 18.5 kg/m2 (23%). Professional treatment for eating disorders was most likely to have been received from general practitioners (45% of study participants), dietitians (42%) and outpatient programmes (42%). Conclusions: This study was effective in assembling the largest community sample of people with lifetime anorexia nervosa in Australia and New Zealand to date. The proportion of people with anorexia nervosa currently receiving medical care, and the most common sources of treatment accessed, indicates the importance of training for general practitioners and dietitians in treating anorexia nervosa. [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]

Background: Family caregivers provide the majority of palliative care. The impact of family caregiving on employment and finances has received little research attention in the field of palliative care. Aim: The aim of this study was to explore perspectives and experiences of combining paid employment with palliative care family caregiving, and to assess the availability and suitability of employment support across three countries – the United Kingdom (UK), Aotearoa New Zealand and Canada. Design: A qualitative descriptive study design was used. Semi-structured interviews were held with 30 key informants with professional or personal experience in palliative care from the UK (n = 15), Aotearoa New Zealand (n = 6) and Canada (n = 9). Interviews were recorded, transcribed and analysed using the principles of thematic analysis. Results: Four main themes were identified: (1) significant changes to working practices are required to enable end of life family carers to remain in work; (2) the negative consequences of combining caregiving and employment are significant, for both patient and carer; (3) employer support for working end of life caregivers is crucial but variable and; (4) national, federal and government benefits for working end of life family carers are necessary. Conclusion: Supporting carers to retain employment whilst providing care has potential benefits for the patient at end of life, the caregiver, and the wider economy and labour market. Employers, policymakers and governments have a role to play in developing and implementing policies to support working carers to remain in employment. [ABSTRACT FROM AUTHOR]

Objectives: Forensic mental health services (FMHS) have higher rates, duration and frequency of restrictive practices (seclusion, physical restraint and mechanical restraint). Data generated by services can be used to set targets (benchmarks) with like services to reduce or eliminate restrictive practices. The aim of this study was to develop restrictive practice benchmarks for Australian and New Zealand FMHS. Method: A participatory action research methodology was used by conducting a Delphi study. FMHS experts provided de-identified service-specific restrictive practice data, which was used to stimulate reflection towards the development of restrictive practice benchmarks. Results: Consensus decision-making was reached on benchmarks for the rate, duration and frequency of seclusion and physical restraint. Mechanical restraint was found to be a rare event, requiring event specific review in each service. Conclusions: Benchmarking with FMHS may assist in working to reduce restrictive practices and encourage the scrutiny of service practice. Establishment of a FMHS network might assist to embed the proposed benchmarks. [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]

In New Zealand, a store-and-forward telemedicine programme is implemented in schools to address common health conditions. This study aimed to investigate perceptions of the non-clinical school staff involved on this telemedicine model of care. Interviews and analysis were framed by sociotechnical theory under constructs of identities, affiliations, interactions and environments. Findings show that telemedicine aligned with identities of staff as carers. Affiliations via close relationships with children and community support enabled the programme. Delivering telemedicine enhanced interactions with children. Environments related to practices and physical characteristics of the school were viewed as constrainers and enablers for delivery. School-based telemedicine delivered by school staff is perceived as an acceptable model of care. Benefits include empowerment, school cohesion and potential improvement in health literacy, with no major issues perceived. Telemedicine may be effective for treating common health conditions in school children, with potential for community members to be involved in health care. [ABSTRACT FROM AUTHOR]

Objective: To review rates of suicide and 'hidden suicide' in New Zealand (NZ), Australia, Ireland and Spain.Method: Using estimated population figures and online cause-of-death data from four countries, rates of suicide and 'hidden suicide' in 2014-2016 were calculated and compared.Results: Age patterns and rates of suicide and 'hidden suicide' differ between these countries. The male suicide rate progressively rises across the age range in Spain but becomes lower in late life in Ireland. The male patterns in NZ and Australia are bimodal; male and female rates decrease in late life, with NZ lower than Australia. Māori age patterns are downward-sloping. Suicide rates of young Māori considerably exceed those of young non-Māori in NZ.Conclusions: The NZ youth suicide peaks are attributable to high rates of Māori youth suicide. Rates of 'hidden suicide' are relatively low in the four countries. [ABSTRACT FROM AUTHOR]

Introduction: Cognitive stimulation therapy is an evidence-based group intervention for promoting cognition and quality of life in people with dementia. This New Zealand study aimed to describe and measure the 'switch-on' effect, a recently reported benefit involving enhanced participation. Method: A convergent parallel mixed methods design was implemented. Interviews guided by qualitative descriptive methodology were conducted with four community-dwelling men with mild dementia and their wives, before, during and after cognitive stimulation therapy. Concomitantly, participants with dementia were scored on the Volitional Questionnaire following a single-subject A–B design. Qualitative and quantitative data were analysed using NVivo-assisted thematic analysis and descriptive statistics respectively and conjointly. Findings: 'Switch-on' was found to be multi-dimensional in nature, with increased engagement and expanded scope in Doing, Feeling, Relating, and Thinking and Reflecting. 'Switch-on' occurred with a noticeable onset within 3 weeks, which was sustained and consolidated towards completion of cognitive stimulation therapy in both group and home environments. Three men showed concurrent improvements on the achievement sub-scale of the Volitional Questionnaire. However, the measure did not effectively capture 'switch-on' due to its ceiling effect. Conclusion: Findings about 'switch-on' suggest broader, under-researched benefits of cognitive stimulation therapy that merit further exploration from an occupational therapy perspective. [ABSTRACT FROM AUTHOR]

Introduction: Evaluating how therapeutic horse riding improves health for children experiencing disability is made complex by a lack of clarity around mechanisms of treatment effect. This research develops an explanatory theory outlining how health outcomes may be optimised, by exploring what works for which riders, under what conditions and how. Method: Within a realist research framework, we undertook three phases of study using a mix of qualitative and quantitative data collection and analysis approaches. Findings were then integrated into an overall evaluative account. Results: Riders with a range of impairments (n = 32; aged 5 to 17 years), caregivers (n = 29) and therapeutic horse riding providers (n = 16) participated. Three key mechanisms of intervention effect are proposed: (1) therapeutic horse riding facilitates development of a rider's self-concept through opportunities for accessible, meaningful participation; (2) the context in which therapeutic horse riding is provided promotes a focus on riders' capacities and strengths and (3) therapeutic horse riding provides opportunities for a broad range of learning experiences. Conclusion: Therapeutic horse riding provides opportunities for meaningful occupational participation for children experiencing disability. Ensuring that the physical and ideological context in which therapeutic horse riding is provided focuses on a rider's capacities and strengths will enhance self-concept development and participation outcomes. [ABSTRACT FROM AUTHOR]

Background: Family caregivers of people at the end of life can face significant financial burden. While appropriate financial support can reduce the burden for family caregivers, little is known about the range and adequacy of financial support, welfare and benefits for family caregivers across countries with similarly developed health care systems. Aim: The aim is o identify and compare sources of financial support for family caregivers of people approaching the end of life, across six countries with similarly performing health care systems (Australia, Canada, Ireland, New Zealand, the United Kingdom and the United States). Design: A survey of financial support, welfare and benefits for end of life family caregivers was completed by 99 palliative care experts from the six countries. Grey literature searches and academic database searches were also conducted. Comparative analyses of all data sources documented financial support within and between each country. Results: Some form of financial support for family caregivers is available in all six countries; however the type, extent and reach of support vary. Financial support is administered by multiple agencies, eligibility criteria for receiving support are numerous and complex, and there is considerable inequity in the provision of support. Conclusion: Numerous barriers exist to the receipt of financial support, welfare and benefits. We identified several areas of concern, including a lack of clarity around eligibility, inconsistent implementation, complexity in process and limited support for working carers. Nonetheless, there is significant potential for policymakers to learn from other countries' experiences, particularly with regard to the scope and operationalisation of financial support. [ABSTRACT FROM AUTHOR]

Social workers in New Zealand other schools work with other school professionals to respond to potential child maltreatment in the school setting, but little is reported about their experience of interprofessional collaboration. An exploratory qualitative study focused on school professionals' process when responding to child maltreatment. The author conducted 20 semi-structured telephone interviews with social workers to explore their interprofessional work with teaching professionals. Many challenges were reported including power imbalances; resource issues, especially inadequate time given their placement in multiple schools; marginalisation, and teachers' inconsistent understanding of the social work role. Social workers reported relationship-based strategies to manage these challenges, and a sense of pride and identity was apparent in these accounts. Patient relationship building was a key strategy to build respect and understanding of social work knowledge and skills. A reading of Bourdieu's discussion of social distinction suggests social work is often perceived as a profession lacking the confidence of the "distinguished possessor" of capital and more of the uncertainty of the "pretentious challenger". A professional capital framework, that positions school-based social workers as 'guests' in a host setting, is useful in understanding these dynamics and how social workers choose to respond. This study suggests that preparation for school social work might usefully focus on interprofessional working and in particular support the development of conscious, principled yet pragmatic relationship-building skills to bridge the gap between the teaching and social work professions and improve the welfare of children. [ABSTRACT FROM AUTHOR]

Just as ageing is part of life, so is death. Death does not end people's desire to connect with deceased family members and, arguably, the connection between the dead and the living plays an important role in people's lives and relationships. This article explores the matter of ancestor worship, as a form of filial piety, and highlights the importance of considering an "expanded" connection between past and current generations, beyond death. Data were collected from two qualitative studies with Korean residents from Australia, New Zealand and Korea, and analysed using an altered mode of thematic analysis in a Korean and English bilingual context. The findings from the studies show that connectedness with ancestors is an important part of the participants' physical and mental worlds. The discussion in this article includes the meaning of ancestral engagement, ancestral veneration, and mutual connections between ascendants and descendants. The term "memorial piety" is used to define what people practise in relation to remembering and commemorating ancestors or other late loved ones – not necessarily worshipping them in contemporary times. This article addresses a need to broaden the scope and quality of social work for both people who have died and their surviving families, and highlights the potential role of social workers in promoting a meaningful relatedness between past and living generations. [ABSTRACT FROM AUTHOR]

Background. Adaptive equipment (AE) is frequently provided during stroke rehabilitation by occupational therapists. Purpose. This study aimed to identify the AE that people typically use after a stroke and the outcomes achieved as a result, and to explore people's experiences obtaining and using AE, to inform both practice and policy in this field. Method. A mixed-methods study, involving a postal questionnaire and interviews, used descriptive statistics and grounded theory to analyze the quantitative and qualitative data, respectively. Findings. Questionnaire data (n = 258) revealed mobility AE was issued most frequently, with increased safety as the primary reported outcome. Interview data (n = 15) indicated relationships with health professionals and the hospital environment shaped early AE selection and use. Once home, making sense of AE and community participation were more influential. Implications. Therapeutic relationships and reflection time are critical to maximize AE use after stroke. Policy and related funding for AE need to prioritize community participation. [ABSTRACT FROM AUTHOR]

Background: A key challenge in meeting the palliative care needs of people in advanced age is the multiple healthcare and social service agencies typically involved in their care. The 'patient navigator' model, originally developed in cancer care, is the professional solution most often recommended to address this challenge. However, little attention has been paid, or is known, about the role that family carers play in enabling their dying relatives to negotiate service gaps. Aim: To explore the role family caregivers play in helping people dying in advanced old age navigate health services at the end of life. Design: Qualitative study using semi-structured interviews and analysed via thematic analysis. Setting/participants: A total of 58 interviews were conducted in New Zealand with the family caregivers of 52 deceased older relatives who had been participants in Life and Living in Advanced Age: a Cohort Study in New Zealand. Results: Fragmentation of services was the key concern, causing distress both for the older person and their family caregivers. Carers identified and engaged with appropriate services in order to facilitate care and treatment. Their involvement was not always met by healthcare professionals with respect or regard to their knowledge of the older person's needs. Conclusion: Family caregivers are trying to help their older relatives overcome the limitations of fragmented health systems at the end of life. They are doing so at times by stepping in to perform patient navigator tasks usually conceptualised as a role for statutory services to carry out. Programmes and services need to be implemented that will better support family carers who are acting as care navigators. [ABSTRACT FROM AUTHOR]

The influence of variables that might affect the accuracy of pulse oximetry (SpO2) recordings in critically ill patients is not well established. We sought to describe the relationship between paired SpO2/SaO2 (oxygen saturation via arterial blood gas analysis) in adult intensive care unit (ICU) patients and to describe the diagnostic performance of SpO2 in detecting low SaO2 and PaO2. A paired SpO2/SaO2 measurement was obtained from 404 adults in ICU. Measurements were used to calculate bias, precision, and limits of agreement. Associations between bias and variables including vasopressor and inotrope use, capillary refill time, hand temperature, pulse pressure, body temperature, oximeter model, and skin colour were estimated. There was no overall statistically significant bias in paired SpO2/SaO2 measurements; observed limits of agreement were +/-4.4%. However, body temperature, oximeter model, and skin colour, were statistically significantly associated with the degree of bias. SpO2 <89% had a sensitivity of 3/7 (42.9%; 95% confidence intervals, CI, 9.9% to 81.6%) and a specificity of 344/384 (89.6%; 95% CI 86.1% to 92.5%) for detecting SaO2 <89%. The absence of statistically significant bias in paired SpO2/SaO2 in adult ICU patients provides support for the use of pulse oximetry to titrate oxygen therapy. However, SpO2 recordings alone should be used cautiously when SaO2 recordings of 4.4% higher or lower than the observed SpO2 would be of concern. A range of variables relevant to the critically ill had little or no effect on bias. [ABSTRACT FROM AUTHOR]

In New Zealand, embryo donation (ED) is “open,” allowing offspring to access genetic information. Donors and recipients meet prior to donation. Drawing on interviews with 15 recipients, 22 donors, and nine counselors, this article discusses how ED may be constructed as a form of gifting. This discourse may evoke expectations that recipients will express gratitude for the gift, including through honoring contact agreements. Donation becomes a relational practice of obligations and counter-obligations. However, the gift discourse may not adequately capture the emotional sacrifice experienced by donors. Donors describe significant attachment to their embryos, ambiguity about relinquishment, and interest in offsprings’ welfare. Furthermore, embryos may be constructed as inalienable bodily gifts resulting in children with whom the donors share immutable social ties. A discourse of ED as mutual exchange, collaboration, and extended family building may be more useful to donors and recipients in managing ED. [ABSTRACT FROM AUTHOR]

Background: Increasing importance is being placed on the coordination of services at the end of life. Aim: To describe decision-making processes that influence transitions in care when approaching the end of life. Design: Qualitative study using field observations and longitudinal semi-structured interviews. Setting/participants: Field observations were undertaken in three sites: a residential care home, a medical assessment unit and a general medical unit in New Zealand. The Supportive and Palliative Care Indicators Tool was used to identify participants with advanced and progressive illness. Patients and family members were interviewed on recruitment and 3–4 months later. Four weeks of fieldwork were conducted in each site. A total of 40 interviews were conducted: 29 initial interviews and 11 follow-up interviews. Thematic analysis was undertaken. Findings: Managing risk was an important factor that influenced transitions in care. Patients and health care staff held different perspectives on how such risks were managed. At home, patients tolerated increasing risk and used specific support measures to manage often escalating health and social problems. In contrast, decisions about discharge in hospital were driven by hospital staff who were risk-adverse. Availability of community and carer services supported risk management while a perceived need for early discharge decision making in hospital and making ‘safe’ discharge options informed hospital discharge decisions. Conclusion: While managing risk is an important factor during care transitions, patients should be able to make choices on how to live with risk at the end of life. This requires reconsideration of transitional care and current discharge planning processes at the end of life. [ABSTRACT FROM AUTHOR]

Background: Research indicates that women are the primary family caregivers for others at life’s end and, because of ageing populations, will keep fulfilling this role as they age. Yet, little is known about how the gendered nature of caregiving contributes to older women’s understandings of providing care. Aim: To explore how gender norms constructed older women’s views about the appropriate roles of women and men in providing palliative and end-of-life care for family members. Design: Six focus groups were conducted with 39 community dwelling older adults (36 women and 3 men) using two vignettes to prompt discussion about experience of end of life caring and attitudes towards Advance Care Planning. This article reports on data gathered from female participants’ reactions to Vignette 1 which prompted significant discussion regarding the intersection of gender and older women’s caregiving experience. Setting/participants: A total of 36 women in the age ranges of ‘50–59 years’ through to ‘90–99 years’ from New Zealand. Results: Three themes regarding gender and caregiving were identified: the expectation women will care, women’s duty to care and women’s construction of men in relation to caregiving and illness. The women adhered to stereotypical gender norms that regard women as primary caregivers. There was little connection between the burden they associated with caregiving and this gender construction. Conclusion: The expectation that older women will provide end-of-life care even when experiencing considerable burden is an unacknowledged outcome of gender norms that construct women as caregivers. [ABSTRACT FROM AUTHOR]

Social work practice with sex workers in New Zealand occurs within a context of decriminalization since the passing of the Prostitution Reform Act (PRA) in 2003. This article presents the findings of a qualitative study focused on social workers’ perceptions of sex work/ers, the PRA, and its influence on practice with individuals in the sex industry. The findings suggest that social workers hold nuanced perspectives on sex work. While decriminalization creates opportunities that support social work practice with sex workers, challenges to antioppressive, critical social work remain, even within the context of decriminalization. [ABSTRACT FROM AUTHOR]

Background: The acute hospital plays a significant role in caring for people with a life-limiting illness. Most research to date has focused exclusively upon the negative aspects of hospitalisation. Currently, there is little known about the benefits of hospital admissions for patients with palliative care needs. Aim: The aim of this study was to explore the benefits of hospital admissions, from the perspectives of patients with palliative care needs. Design: A qualitative study design was adopted. Longitudinal, semi-structured, face-to-face interviews were used to elicit the views of patients admitted to hospital in one large urban acute hospital in New Zealand. Setting/participants: The study sample comprised 14 patients admitted to Auckland City Hospital between July 2013 and March 2014 who met one of the Gold Standard Framework Prognostic Indicators for palliative care need. Results: Through a process of thematic analysis, four themes were identified from the data: being cared for and feeling safe, receiving care to manage at home, relief for family and ‘feeling better and/or getting better’. The benefits of being in hospital were reported to extend beyond treatments received. Most participants reported their preference was to come to hospital even if they had been able to access the care they received in hospital at home. Conclusion: This research contributes to a greater understanding of the benefits associated with hospitalisation for patients with palliative care needs. The findings suggest that such benefits extend beyond the treatment patients receive and challenge current assumptions regarding the role of the acute hospital in palliative care. [ABSTRACT FROM AUTHOR]

The article presents information on the economic costs of health service provision for people with palliative care needs. Topics discussed include direct and indirect costs incurred by caregiving, increase of costs in palliative care, and influence of costs of caring on wider family and network. Also being discussed is the inadequate cost and care-support systems.

Background: Direct impacts with the head (linear acceleration or pressure) and inertial loading of the head (rotational acceleration or strain) have been postulated as the 2 major mechanisms of head-related injuries such as concussion. Although data are accumulating for soccer and American football, there are no published data for nonhelmeted collision sports such as rugby union. Purpose: To quantify head impacts via instrumented mouthguard acceleration analyses for rugby union players over a season of matches. Study Design: Descriptive epidemiology study. Methods: Data on impact magnitude and frequency were collected with molded instrumented mouthguards worn by 38 premier amateur senior rugby players participating in the 2013 domestic season of matches. Results: A total of 20,687 impacts >10g (range, 10.0-164.9g) were recorded over the duration of the study. The mean ± SD number of impacts per player over the duration of the season of matches was 564 ± 618, resulting in a mean ± SD of 95 ± 133 impacts to the head per player, per match over the duration of the season of matches. The impact magnitudes for linear accelerations were skewed to the lower values (Sp = 3.7 ± 0.02; P<.001), with a mean linear acceleration of 22.2 ± 16.2g. Rotational accelerations were also skewed to the lower values (Sp = 2.0 ± 0.02; P < .001), with a mean rotational acceleration of 3902.9 ± 3948.8 rad/s2. Conclusion: The acceleration magnitudes and number of head impacts in amateur rugby union players over a season of matches, measured via instrumented mouthguard accelerations, were higher than for most sports previously reported. Mean linear acceleration measured over a season of matches was similar to the mean linear accelerations previously reported for youth, high school, and collegiate American football players but lower than that for female youth soccer players. Mean rotational acceleration measured over a season of matches was similar to mean rotational accelerations for youth, high school, and collegiate American football players but less than those for female youth soccer players, concussed American collegiate players, collegiate American football players, and professional American football players. [ABSTRACT FROM AUTHOR]

How and if public hospital leaders in a national health system use an annual Serious and Sentinel Events (SSE) report, an aim of which is to stimulate improvements in health care quality and patient safety, is an important question that is underresearched. This exploratory qualitative study in New Zealand using semi-structured interviews was undertaken in response. Interviewees included 29 representatives in patient safety leadership roles from 20 hospital districts, each of whom were recommended by their Chief Executives. Four themes describing factors contributing to the use of the SSE report were identified: response to the report itself; perceived use of and value of the report as a quality improvement tool; collaboration amongst hospitals around the findings; and, the priority given to improving quality within respondents' healthcare organisations. This article provides examples of these themes and how they relate to the use of the SSE report as a quality improvement tool. The article concludes that an annual SSE report has the potential to be a very useful tool for health care leaders in addressing SSEs. However, it also suggests that the report is underutilised and consequently some of this potential is lost. This may be explained by hospital capacity to absorb information from, and respond to, the SSE report. [ABSTRACT FROM AUTHOR]

The article discusses a study to examine the preferences and concerns of New Zealand patients waiting for kidney transplantation. Topics discussed include the positive attitudes towards living donor kidney transplantation, the importance for patients to understand risks and benefits of various renal replacement therapy options to themselves and the need to integrate a range of initiatives in practice and policy for an effective strategy to increase rates of living donor transplantation.

Introduction: The purpose of this research was to explore whether New Zealand occupational therapists’ recommendations for chronic low back pain are predicted by their fear avoidance beliefs. Method: In an online survey, 63 therapists rated the strength of recommendation on a four-point Likert scale (for each of: home help, equipment provision, and environmental modification) for a case study of low back pain, and completed two questionnaires about fear avoidance beliefs. The strength of recommendation (definitely not, not likely, likely, definitely yes) was analysed as an ordinal scale response variable, with important predictors each of the Fear Avoidance Beliefs Tool and the Health Care Providers Pain and Impairment Relationship Scale. Potential confounding variables were: age, years in practice or pain practice, and receipt of extra pain education. The main response variable was the probability of recommending home help. Analysis was by proportional odds regression. Findings: 54/63 (85.7%) of the surveys had complete data. The adjusted odds ratio, per point higher on the fear avoidance belief scales, for therapists who were more likely to recommend home help was 1.19 (95% CI 1.06 to 1.35), p = 0.005 for the Fear Avoidance Belief Tool and 1.16 (95% CI 1.04 to 1.29), p = 0.006 for Health Care Providers Pain and Impairment Relationship Scale. This is consistent with those with greater fear avoidance beliefs being more likely to recommend home help. Conclusion: Occupational therapists’ fear avoidance beliefs are associated with treatment recommendations that lessen activity or movement demands. These beliefs are potentially unhelpful and may reinforce avoidance behaviour in patients with chronic low back pain. [ABSTRACT FROM AUTHOR]

The article presents a study which illustrates the role of values in decision making process of occupational therapists in their practice. It cites a case study using the Values Exchange web-based values transparency software. The study concluded that several aspect of decision making such as degrees of divergence, concern for dignity and risk, and values-based reasoning were value based.

The article presents a study which explores the reasons some healthy older New Zealanders oppose physician-assisted dying to inform existing debate. It says that the recorded interviews were analysed and transcribed by the authors after some edits had been made by respondents. Results showed that the thinking of some older people about physician-assisted dying was influenced by their past experiences of death and dying.

The decrease in physical activity time in and out of school increases the need for active commuting. School travel plan programs have been used internationally to increase active commuting in elementary school children. However, little research has been conducted in the reliability and validity of travel survey instruments. The purpose of this study was to evaluate the test–retest reliability and validity of the Hands-Up survey to assess active commuting to school from a random sample of children within the Auckland region, New Zealand. Test–retest reliability and criterion validity of travel modes were determined in 118 elementary school children in the Auckland region. The survey tool consisted of one question on commuting to school. Test–retest reliability and validity were evaluated using kappa coefficients. The level of agreement between the children’s responses (κ = .96, 95% confidence interval = 0.92-1.00) and between children’s and parents’ (κ = .91, 95% confidence interval = 0.85-0.98) were almost perfect. The Hands-Up survey is a valid and reliable tool to determine travel mode to school among elementary school children. [ABSTRACT FROM PUBLISHER]