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

Aim: The aim of the study is to identify and map what is known about workplace violence involving midwives in Australia and New Zealand. Background: Research from the United Kingdom demonstrates that workplace violence within maternity services is a pervasive issue with significant and wide‐ranging clinical, individual and organisational consequences. To date, little is known about this issue within Australian and New Zealand maternity services. Evaluation: A scoping review, guided by Arksey and O′Malley's framework, was conducted. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews checklist. Just one identified study aimed to explore midwives' experiences of workplace violence. A further nine arrived at related results or themes. Key issues: Workplace violence is present in a variety of forms across maternity services in Australia and New Zealand. Its prevalence is, however, yet to be understood. Workplace violence causes physical and mental health issues for midwives, premature workforce attrition, and jeopardizes the quality and safety of maternity care. Conclusions: Workplace violence has been acknowledged as one of the key contributing factors towards premature attrition from the midwifery profession, with new graduate midwives most likely to leave. With the midwifery workforce ageing and evidence of serious clinical implications emerging, workplace violence needs urgent research and organisational attention. Implications for nursing management: Workplace violence is a key contributing factor towards recruitment and retention challenges for managers. To help tackle this, managers have a key role to play in identifying and effectively addressing workplace violence by acting as positive role models, taking a zero‐tolerance approach and fostering collegial relationships. Managers, holding key clinical leadership positions, are pivotal to ensuring all complaints raised are handled with transparency and consistency regardless of one's position within the clinical hierarchy and organisational structure. [ABSTRACT FROM AUTHOR]

Ageing does not reduce people's need to connect with family members, friends, and acquaintances, and neither does migration. For those older migrants living in a foreign land, connectedness with others plays a particularly important role in achieving a sense of belonging and sustaining their health and well‐being. This paper explores the issues of social isolation and loneliness among older Asian migrants in New Zealand. Data were collected from in‐depth semi‐structured interviews with Chinese‐ or Korean‐speaking migrants aged between 75 and 84 years (n = 10: all females), and from three focus groups consisting of Chinese‐ and Korean‐speaking migrants (n = 10: 7 females, 3 males) and Chinese professionals (n = 5: 3 females, 2 males) between June 2016 and December 2016. The qualitative data obtained were analysed applying a thematic analysis approach using NVivo software for group analysis by a multidisciplinary research team. The findings from the study show that older Asian migrants experienced high levels of isolation and loneliness at least at some points in their migrant lives. Most participants in this study were living alone or with only their spouse, and this living arrangement was likely to provide fertile ground for isolation and loneliness to grow in the context of later‐life migration. It was also observed that their lonely ageing ironically resulted from their efforts to preserve family relationships through avoiding being a burden, while allowing them a sort of space to maintain now barely connected lives. The participants revealed multiple ways of coping with lonely and isolated experiences in their limited social network, and these individual strategies allow us to make suggestions about how best to reduce older migrants' social isolation and loneliness in the New Zealand context and beyond. [ABSTRACT FROM AUTHOR]

The needs of refugees and the struggles on the part of service providers to address this diverse population have received limited attention within the academic literature. This paper profiles Hauora o Puketapapa/Roskill Union and Community Health Centre (HoP), which is a non-profit, community owned and operated health clinic designed to deliver accessible, affordable and appropriate primary health care services to low-income groups in the Mt Roskill area of Auckland, New Zealand. The clinic's locality has undergone considerable demographic change over recent years with the arrival of refugees from diverse backgrounds. This situation has resulted in new sets of health needs and expectations which need to be addressed. The study took place in 2002–2003 and employed qualitative methods. In-depth interviews with community representatives, clinic users and health service staff members revealed that refugees face considerable barriers in accessing and utilising health services. Similarly, we found that health practitioners face the daunting task of endeavouring to meet these needs in an effective and culturally appropriate manner within a limited funding environment. We conclude that, despite these challenges, HoP has successfully established itself as a well-regarded place of primary health care. In so doing, it has strengthened the capacity of the local community to respond to the changing policy environment. However, long-term sustainability issues remain unless resourcing issues are adequately addressed. [ABSTRACT FROM AUTHOR]

Aim The Late Career Nurse project examined views and characteristics of nurses working in New Zealand who were born before 1960. This paper focuses on the experiences of such nurses who undertake shift work. Background The mean age of registered nurses in New Zealand has been rising steadily, and 40% are now aged 50 years or over. While there is substantial literature on the phenomenon and consequences of the ageing nursing workforce, little is known of the particular experiences of nurses aged over 50 years who work shifts. Method An anonymous online survey was emailed to eligible nurse New Zealand Nurses Organisation members aged over 50 years in February 2012. Quantitative and qualitative analyses of the 3273 responses received were undertaken. Result Over 45% of respondents worked shifts or flexible hours. While shift work suited many, others noted deleterious effects on family and social relationships, physical and mental health (notably sleep patterns and fatigue), and decreasing tolerance for shift work as they age. Poor scheduling practices were particularly detrimental. Conclusion and implications for nursing management Worldwide, workforce ageing means strategies are required to retain older nurses in the workforce. Improved scheduling practices including increasing access to flexible and part time work hours, and development of resources on coping with shift work are recommended. [ABSTRACT FROM AUTHOR]

The present paper investigates what keeps doctors ‘in place’ in New Zealand rural communities and what prompts their departure from practice. The study is based on in-depth interviews conducted with nine overseas-trained medical practitioners within rural areas in New Zealand during 2004. A thematic analysis was undertaken. The resulting narratives reveal the unintended circumstances under which respondents often arrived in their rural communities, as well as some of the ‘pull’ factors which a more relaxed rural lifestyle offers. Recurring themes relating to the attractiveness of place include community loyalty and the enjoyment of ‘fully practicing medicine’. Themes which corroded the attractiveness of place included ‘entrapment’, lack of choice in secondary schooling, restricted spousal employment opportunities, the lack of cultural and entertainment activities, and difficulties accessing continuing medical education. The authors conclude that addressing the question of what makes ‘place’ attractive to overseas-trained general practitioners in rural New Zealand requires an understanding of place as context rather than mere location. [ABSTRACT FROM AUTHOR]

Abstract The present paper examines the relationship between deprivation and changing patterns of public hospital admissions in Christchurch, New Zealand, between 1992 and 1997, during a time of economic restructuring and rapid change in the health sector. The total set of admissions into Christchurch Hospital was geocoded according to the meshblock domicile of each patient. Domiciles were classified into 10 decile categories using the NZDep91 and NZDep96 measures of deprivation. Regression analysis was used to measure changes in the relationship between deprivation and different types of admissions. Differences between admission rates for people living in the most and least deprived areas increased over time, especially following the implementation of the 1993 health reforms. This was most marked for younger adults (ages = 25–44 years), day patients, and especially, acute day patients, ambulatory-care-sensitive admissions and re-admissions. The average length of stay also varied by deprivation and appeared to be an important cause of the increasingly high rate of re-admissions. On average, patients from more affluent areas are hospitalised longer than low-income patients, although the differences narrow over time. The results suggest that the widening social gap in hospitalisation rates is a result of the effects of poverty and problems of access to primary care. However, more research on different admission pathways and causes of admissions for different patients from different parts of the city is needed to confirm these observations. [ABSTRACT FROM AUTHOR]

This paper examines the issue of targeting primary health-care benefits in favour of low-income recipients and other high users of health care. Specifically we examine the New Zealand case where, despite the introduction of such benefits in 1992, financial barriers appear to remain a significant determinant of utilization. We address this issue through a case study conducted in the city of Christchurch. Through a survey-based research design, we seek to determine the extent to which price barriers remain important by comparing patient utilization of a free community health clinic (n = 202) with a low-income control sample of patients who continue to use conventional (for New Zealand) fee-for-service providers (n = 148). We found that a large proportion of respondents delayed seeking care because of cost. Further, for respondents using the fee-for-service providers, levels of use were not related to need, whereas at the free clinic there was an inverse relationship between income and consultation rates. We conclude that if a universality of benefits is not possible, then there is a need for better targeting of primary care benefits. We believe there is a danger in such initiatives being evaluated primarily in terms of their validity as funding mechanisms, rather than in terms of their success in meeting the health-care needs of the disdavantaged. [ABSTRACT FROM AUTHOR]

This paper provides a regional commentary on the progress of deinstitutionalization in an era of restructuring in New Zealand. The commentary focuses on the Waikato region, where the transition to community-based psychiatric care has been underway since the announcement of the closure of Tokanui Hospital in 1993. We use media reports to construct a narrative illuminating the distinctive threads of alternative discourse on the re-placing of people with mental health problems and sites of treatment ‘into the community’. Our interpretation of this local narrative is cast against a series of backdrops: firstly, we provide an abbreviated history of deinstitutionalization in New Zealand; secondly, we examine mental health care as a sector within a rapidly evolving health system; and, thirdly, we reflect on the implementation of community mental health care in a re-regulated civil society. We argue that the effective implementation of community care has been hampered by the lack of concerted policy in the mental health care sector, by a fiscal squeeze on the health care system and by the impingement of non-health care legislation (the Commerce Act, the Privacy Act and the Resource Management Act) on the local expression and management of community care. In the Waikato narrative, we also identify administrative practices that have recast people with mental health problems as criminals and re-established prisons as the site of treatment. We conclude that the media in New Zealand have a role that extends beyond simply reporting on events. Indeed, the media act as a reflexive conduit; journalists interpret issues and through their ‘stories’ help to shape the course of events. [ABSTRACT FROM AUTHOR]

There has been growing recognition of the harmful consequences of loneliness for health and well‐being, and the need for community intervention, particularly in times of global crisis such as the Covid‐19 pandemic with its imperatives of distancing, isolation, and quarantine. Social capital and a sense of social cohesion are known to have roles in buffering against the effects of adverse life circumstances. Our study sought to investigate the association of a range of social attitudes and activities – as proxies for social capital – with loneliness while taking into account socio‐demographic factors. We undertook a national survey on a stratified random sample of the New Zealand (NZ) adult population aged 18+ in 2017 (n = 1,358), data from which included the requisite variables. The prevalence of loneliness was highest in young adults (18–30), falling with age until a slight rise in older people (76+). Loneliness was associated with socio‐demographic factors, being more prevalent in the more disadvantaged groups: the deprived, Māori (the indigenous people of NZ), the non‐partnered, and the less educated. Controlling for these socio‐demographic factors, pro‐social attitudes (that is towards political efficacy, trust in others, not feeling exploited, or being committed to family) and participation in social activities (that is being employed or being involved in recreation groups) – were protective against loneliness. Our study supports asset‐based approaches to tackling loneliness – with implications for health and social care – that emphasise mobilising existing social resources, building social capital, and raising social cohesion in our communities. Such intervention on loneliness would help to prevent and ameliorate its detrimental consequences for public health. [ABSTRACT FROM AUTHOR]

Older adults living alone in the community with no immediate family network or support are referred in the literature as 'elder orphans'. The grey literature has a growing emphasis on the importance of supporting this vulnerable group, particularly with health and social care. However, there is a dearth of empirical research on 'elder orphans', and definitions remained semantically complicated and unknown to the public, healthcare professionals and those being referred as elder orphans. This research explored the views of older adults on the use of the terminology 'elder orphans', and the implications of using the terminology in health and social care systems. A descriptive qualitative approach through face‐to‐face interviews of 11 older adults was undertaken in Auckland, New Zealand in October 2018. Narratives were analysed using thematic analysis. Two themes were identified from the analysis of interview data. The first theme was 'realistic and practical term', which emphasised the participants' impression of the term 'elder orphan' resonating to themselves with great relevance to their current and future situations. The second theme is 'visibility and vulnerability', which highlighted participants' both positive and ambivalent views on the use of the terminology in healthcare settings. The participants viewed this terminology as beneficial to alerting care services, and in promoting awareness among healthcare providers. Older adults from the study, who are living alone without immediate family networks and support self‐identified themselves as 'elder orphans' through a gradual realisation of their current and anticipated social situations. The use of the term within healthcare was considered and preferred by the participants to be used contextually, and targeted towards appropriate health and social care services within and outside hospital‐care settings. [ABSTRACT FROM AUTHOR]

Practice nursing in New Zealand is not well described in the literature. One survey illustrated that most of the New Zealand practice nurses sampled did not know of the country's two premier evidence-based health websites. A recent review compared general practice in the UK, New Zealand and Australia and found that whereas there had been significant developments in empowering the practice nurse workforce to run nurse-led clinics in the UK, New Zealand and Australia lagged behind. The aim of this reported constructivist grounded theory study was to investigate practice nurses' use of information. Conducted in Auckland, New Zealand, data were collected through ethnographic techniques in one general practice between September 2009 and January 2010 to enhance theoretical sensitivity to the area of information use. Subsequently, six experienced practice nurses (one twice after moving jobs) and five new graduate nurses from five different general practices were interviewed, using open-ended questions, between January 2010 and August 2011. Concurrent data collection and analysis occurred throughout the study period. The use of memos, the constant comparative method, data categorisation and finally, data abstraction resulted in the final theory of reciprocal role modelling. Experienced practice nurses role modelled clinical skills to new graduate nurses. Unexpectedly, new graduate nurses were unconscious experts at sourcing information and role modelled this skill to experienced practice nurses. Once this attribute was acknowledged by the experienced practice nurse, mutual learning occurred that enabled both groups of nurses to become better practitioners. Graduate nurses of the millennial generation were identified as a resource for experienced practice nurses who belong to the baby boomer generation and generation X. [ABSTRACT FROM AUTHOR]

Community capacity building (CCB) is held up as a benchmark for sustainable health promotion, reflecting the empowering discourse of the Ottawa Charter (). In light of concerns that this language may be that of the presiding bureaucratic elite rather than the realities of those working directly with communities (), we question whether CCB reflects the work of New Zealand health promoters. The aim of this study is to assess what CCB means to health promoters and how relevant it is to their work in New Zealand. Focus groups and interviews were carried out with 64 health promoters between January 2008 and March 2009. The results of this qualitative study indicated that, while the terminology of CCB is poorly established in New Zealand, the overwhelming majority of participants felt that, to be an effective health promoter, they needed the buy-in and support of the communities in which they work. As a result, community-driven approaches have emerged as a core component of good health promotion practice in New Zealand. Yet, the concept of CCB was applied loosely with health promoters adopting language and practices corresponding more with the nuances of community development. The limited use of systematic approaches to building community capacity was accompanied by few successes achieving sustainable health promotion programmes. In prioritising community relationships many health promoters were placed in an ideological bind whereby achieving community ownership over health promotion meant compromising the evidence base of their programmes. Academic discussions of CCB appear to have gained little traction into the realm of health promotion practice in New Zealand highlighting the need for relevant research with a strong grounding in practice. [ABSTRACT FROM AUTHOR]

Language, culture and not knowing how to access services are barriers to the use of health services for Asian migrants. Asian Smokefree Communities (ASC) pilot-tested a novel Asian-specific service model to address these issues for Asian smokers. Korean- and Chinese-speaking coordinators delivered home-, workplace- or clinic-based interventions to support smokers with cessation and create smoke-free environments with families. A prior planned evaluation investigated the acceptability of the service, quit rates and exposure to second-hand smoke. The methods included analysis of ASC service records, a client satisfaction survey and key informant interviews. Clients were satisfied with factors associated with culture, such as being comfortable when talking to coordinators (88.9%) and family involvement in treatment (79.4%). Appointment attendance was high (97%). The self-reported quit rate for the 93 cessation clients was 72% at 1 month, 53.8 % at 3 months and 40.9 % at 6 months. All homes (100%) were smoke-free after the intervention, an increase of 18% from preintervention levels. The ASC model was acceptable to Asian clients. It helped them stop smoking and increased household protection from second-hand smoke. The model could make an effective contribution to smoke-free services for Asian populations in western countries. [ABSTRACT FROM AUTHOR]

PURPOSE. Prescriptive authority in the area of mental health care is significantly different between New Zealand and the United Kingdom. Exploring the educational preparation and context differences aids understanding of the present dearth of mental health nurse prescribers in New Zealand. CONCLUSIONS. The barriers experienced in implementation and extension of prescribing rights have been similar in both countries. PRACTICE IMPLICATIONS. Until roles change, registered nurses in New Zealand may be reluctant to undertake the challenging and demanding step to gain prescribing rights. The potential for nurses to make a difference in the lives of people with mental illness in New Zealand is therefore constrained. [ABSTRACT FROM AUTHOR]

Abstract Investigations into factors affecting the growth of the first hatchery-produced juvenile New Zealand turbot Colistium nudipinnis (Waite 1910) showed that this endemic flatfish can be reared in raceways and tanks. After initial high mortality (> 60%) in the post-weaning period (to 120 days post-hatch), the juveniles showed high survival over the grow-out period. Growth of the juveniles was better at lower (16–18 °C) than at higher (> 20 °C) water temperatures, and better in a deep tank than in shallow raceways. Under the experimental rearing conditions, growth (to mean weight of 0.2 kg in 20 months) was relatively slow and food conversion (FCRs > 1.4) relatively high, both factors being related to the feeding behaviour of this species. C. nudipinnis feeds directly from the bottom, and this behavioural characteristic influences aspects of fish farming practice, such as stocking density and feeding strategy, that are critical to its economic viability. There is potential to improve the growth by optimizing the rearing conditions, so that it may not be unrealistic to achieve the maximum growth reached in these trials commercially and produce marketable farmed turbot, of over 400 g weight, within 2 years. [ABSTRACT FROM AUTHOR]