Search

Articulating the complexities of relational wellbeing can be challenging at the best of times, and even more complex during periods of heightened stress and uncertainty. Taking inspiration from feminist materialisms and recent writings on material methods, we explore the potential of object interviews to reveal the material-discursive dimensions of women's experiences of wellbeing during the pandemic. In this paper we describe our research process conducting object interviews with 38 women living in Aotearoa New Zealand from a range of socio-economic, cultural, and ethnic backgrounds. We explore the potential and challenges of object interviews for surfacing new ways of knowing (theoretically, methodologically, and cross-culturally) wellbeing beyond human-oriented health, medical and social-constructionist models, and towards more multidimensional and relational understandings. This paper offers our reflections and learnings about the process of re-turning object interviews and the potential of such approaches for evoking complex ways of knowing wellbeing during and beyond pandemic times. [ABSTRACT FROM AUTHOR]

Introduction: It is now widely recognised that engaging consumers in research activities can enhance the quality, equity and relevance of the research. Much of the commentary about consumer engagement in research focuses on research processes and implementation, rather than dissemination in conference settings. This article offers reflections and learnings from consumers, researchers and conference organisers on the 12th Health Services Research Conference, a biennial conference hosted by the Health Services Research Association of Australia and New Zealand (HSRAANZ). Method: We were awarded funds via a competitive application process by Bellberry Limited, a national not‐for‐profit agency with a focus on improving research quality, to incorporate consumer engagement strategies in conference processes and evaluate their impact. Findings: Strategies included consumer scholarships, a buddy system, designated quiet space and consumer session co‐chairs; the reflections explored in this paper were collected in the funded, independent evaluation. Our insights suggest a need for more structured consumer involvement in conference planning and design, as well as the development of specific engagement strategies. Conclusion: To move toward active partnership in scientific conference settings, our experience reinforces the need to engage consumers as members in designing and conducting research and in presenting research and planning conference content and processes. Public Contribution: Consumer engagement in research dissemination at conferences is the focus of this viewpoint article. Consumers were involved in the conception of this article and have contributed to authorship at all stages of revisions and edits. [ABSTRACT FROM AUTHOR]

Introduction. Through a unique, inter-sectoral and interprofessional initiative, practitioners from education, health and social service sectors were invited to participate in communities of practice, facilitated online. The focus was on building workforce capacity to address the mental health needs of children and youth. Aim. This paper explores interprofessional workforce development by translating knowledge from a mental health promotion initiative developed overseas into the Aotearoa New Zealand context. Methods. Over a 6-month period, practitioners engaged in an iterative, capacity-building process, where they had access to the initiative materials and resources, shared practice stories, networked, and discussed barriers and facilitators for implementation. Qualitative thematic analysis was used to interpret data. Results. Members of the communities of practice engaged in storytelling and made sense of the initiative in relation to their previous knowledge and experiences: practice and thinking were validated. Mental health promotion was positioned as the responsibility of all sectors and the need for effective interprofessional collaboration was deemed essential. Furthermore, translation of the initiative into the bicultural context of Aotearoa New Zealand demanded and deserved sustained attention. Discussion. This study contributes interprofessional and inter-sectoral evidence for building workforce capacity to address the mental health needs of children and youth. Further research is warranted to investigate the outcomes for the children and youth served. Interprofessional communities of practice were shown to provide a sustainable mechanism by which knowledge can be received, transformed and translated into practice. [ABSTRACT FROM AUTHOR]

Introduction. Within primary health care policy, there is an increasing focus on enhancing involvement with secondary health care, social care services and communities. Yet, translating these expectations into tangible changes frequently encounters significant obstacles. As part of an investigation into the progress made in achieving primary health care reform in Aotearoa New Zealand, realist research was undertaken with those charged with responsibility for national and local policies. The specific analysis in this paper probes primary health care leaders' assessments of progress towards more collaboration with other health and non-health agencies, and communities. Aim. This study aimed to investigate how ideas for more integration and joinedup care have found their way into the practice of primary health care in Aotearoa New Zealand. Methods. Applying a realist logic of inquiry, data from semi-structured interviews with primary health care leaders were analysed to identify key contextual characteristics and mechanisms. Explanations were developed of what influenced leaders to invest energy in joined-up and integrated care activities. Results. Our findings highlight three explanatory mechanisms and their associated contexts: a willingness to share power, build trusting relationships and manage task complexity. These underpin leaders' accounts of the success (or otherwise) of collaborative arrangements. Discussion. Such insights have import in the context of the current health reforms for stakeholders charged with developing local approaches to the planning and delivery of health services. [ABSTRACT FROM AUTHOR]

Stable, healthy families are the loto or heart of strong Pacific communities. This paper addresses the problem of a decline in the strength of Pacific families. It introduces and discusses the Tongan concept of O'ofaki , as the way in which shared, core relational commitments can bring Pasifika peoples together to support one another for health and community development. This process is based on a reciprocal sharing of social capital to promote cultural solidarity and social justice. We describe two studies by the lead author, through which the concept of O'ofaki emerged. The first study utilized an action research model while the second study focused on two Pasifika-centric research approaches: talanga , which is a Tongan word for interactive talking for a purpose, and the kakala (Tongan garland) research approach. The latter approach is incorporated within a general inductive methodology as well as luva— the dissemination of the results. Finally, the paper focuses on the components of O'ofaki and its application to Pasifika communities. [ABSTRACT FROM AUTHOR]

Aim and objective: This paper reports on the proceedings of the second Australasian International Learning Collaborative conference and summit. Background: In December 2019, over a hundred people attended the second Australasian International Learning Collaborative Conference and Summit. This was the first to be held in Aotearoa New Zealand, the land where cultural safety was developed, its origins being in nursing education. Perhaps not surprisingly, culture, cultural safety and the context of care featured highly in the presentations and workshops. Design and methods: Discussion paper. Results: A key outcome of the conference proceedings and workshops was the call for nurses and the International Learning Collaborative to work in partnership with indigenous groups to iterate the importance of the Fundamentals of Care framework and evaluate the impact of that on health equity. Other essential messages were to value establishing relationships, to continue to talk about the fundamentals of care, to research and to own them. Nurses were reminded to use their humanity to create a climate and culture in which patients and staff feel valued, safe and trusted. Conclusions: Future iterations of the Fundamentals of Care framework must incorporate indigenous worldviews, which emphasise the importance of relationships, family and spirituality on wellbeing. Such additions will provide an opportunity for the International Learning Collaborative to optimally respond and direct nursing practice. Relevance to clinical practice: International Learning Collaborative members and conference attendees learned, listened and worked on meeting the challenges of consistently implementing and applying the fundamentals of care in practice and its importance to education, research and policy. The takeaway message is, when this does not happen, nurses must speak up. [ABSTRACT FROM AUTHOR]

This paper shares a report of how one New Zealand District Health Board (DHB) employed interprofessional health project teams to deliver system-wide health improvements and solve its immediate demand for additional hospital beds. CM Health provides health and disability services to approximately 512,000 people in its district. With increasing patient demand and no opportunity to increase capacity, CM Health needed a fast solution for its bed shortage. The Health Board set a goal to reduce the pressure on Middlemore Hospital by giving back to the community 20,000 well and healthy days over two years. The interprofessional health project teams identified best practices through 11 key workstreams. Over the two year period, an estimated 23,060 bed days (the difference between actual bed day usage and the predicted growth) were saved. This case demonstrates how interprofessional health teams can help Health Boards solve complex challenges and achieve sustainable change across their organizations.

The Australian and New Zealand Clinician Educator Network (ANZCEN) is a collaborative interprofessional group developed to promote the development of education in critical care healthcare practice. In November 2018, 45 critical care practitioners met at the first ANZCEN Unconference. In an unconference, the participants drive the agenda, and learning occurs from the active process of engaging in a community of practice. The aim of this unconference was to develop an innovative approach to learning through a collaborative framework with interprofessional representation across critical care specialties. Four key themes were identified in the unconference as drivers of interprofessional critical care educational priorities: interprofessional learning, workplace learning, faculty development, research, and scholarship. In this discussion paper, we describe our experiences organizing, participating in, and evaluating an unconference, and we examine its usefulness as a medium for promoting the interprofessional learning agenda in critical care. We hope that the processes outlined in this discussion paper will provide a useful resource for other clinicians who are considering developing an unconference. Finally, we argue that the unconference offers a unique and important model for future education of critical care practitioners where the emphasis on collaboration and communication through interprofessional learning and practice will be required to improve health outcomes and promote a patient-centered model of care.

Public health problems are often complex and 'wicked' in nature. Wicked problems have multi-factorial causation, are dynamic and often understood and acted upon differently by different actors. Multi-sectoral collaboration is increasingly emphasized for tackling wicked problems through developing a strategic multi-sectoral plan and then taking collective action. Critical systems thinking can support the development of a shared perspective of the problem, strengthen participation in collective action and foster reflective practices to continuously improve both problem understanding and action. In this paper, we present a critical collaboration model, drawing together two complementary theoretical frameworks, as well as insights from three case studies from New Zealand, to offer a systematic approach to adopting a critical systems perspective in public health collaboration. The model provides six questions to make explicit individuals' understandings or assumptions about how others perceive an issue, problem or evidence, and the process of identifying answers strengthens the dialogical and reflective aspects of the collaboration. We indicate some potential areas for the application of the model to integrate critical systems thinking in collaborative practices. [ABSTRACT FROM AUTHOR]

Purpose: Self-direction–also known as participant direction, personalization and self-directed care–is a service delivery model that enables people to manage their personal budget and purchase services and supports tailored to their needs based on a person-centered plan. This paper, the outcome of an international learning exchange on self-direction, describes approaches across four countries' successful strategies, unresolved questions and recommendations to enhance self-direction globally. Design/methodology/approach: The findings are a product of discussions at the 2019 International Initiative for Mental Health Leadership and International Initiative for Disability Leadership Exchange on Advances in Self-Direction. Participants included people who are self-directing, providers and caregivers who support people who are self-directing, advocates, fiscal agents and public managers who administer self-direction from the United States, England, Australia and New Zealand. Findings: In all four countries, people who self-direct exercise high levels of choice and control and are able to individualize their services and supports to promote a good life in the community. The exchange also revealed challenges and possible solutions to improve and expand self-direction. Practical implications: The results of the meeting provide guidance for public managers, providers and advocates for initiating and expanding self-direction. Originality/value: This international meeting was a unique opportunity to compare self-direction across four different countries and across multiple perspectives, including people with disabilities, caregivers, providers and administrators. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Pegasus Health Charitable Ltd, a Christchurch Primary Health Organisation, is contracted by the Canterbury District Health Board to provide continuing professional development for primary care practitioners in the region. Rurally located health practitioners have largely been unable to participate because of the travel time and distances involved. AIM: The initiative reported in this paper aimed to fill this gap by developing an accessible and high-quality multidisciplinary model of professional development for general practitioners, nurse practitioners, practice nurses and community pharmacists in rural areas of North Canterbury, New Zealand. METHODS: A survey was conducted to learn from the experiences of 14 health professionals in an existing multidisciplinary group, which had developed as a local initiative in one rural community. RESULTS: The survey had an 86% response rate. All respondents believed the multidisciplinary format worked well, had improved collaborative working and increased the consistency of patient care. Access to professional development had improved and the meetings provided a useful forum for the mostly part-time staff to interact as a group. The main caution noted was the potential to become inward looking without being exposed to fresh ideas from other practices. DISCUSSION: The multidisciplinary model was considered workable and valuable by the survey respondents. Based on our findings, the multidisciplinary model has been formalised by the Pegasus team responsible, and three new groups are now operating successfully in rural areas of North Canterbury. [ABSTRACT FROM AUTHOR]

BACKGROUND AND CONTEXT: Rural health services without an onsite laboratory lack timely access to haematology results. Set in New Zealand's far north, this paper provides a rural nursing perspective on how a health service remote from a laboratory introduced a haematology analyser suitable for point-of-care use and established the associated quality assurance programme. ASSESSMENT OF PROBLEM: Five broad areas were identified that could impact on successful implementation of the haematology analyser: quality control, staff training, physical resources, costs, and human resource requirements. RESULTS: Quality control testing, staff training and operating the haematology analyser was more time intensive than anticipated. Finding adequate physical space for placement and operation of the analyser was challenging and costs per patient tests were higher than predicted due to low volumes of testing. STRATEGIES FOR IMPROVEMENT: Through a collaborative team approach, a modified quality assurance programme was agreed on with the supplier and regional point-of-care testing co-ordinator, resulting in a reduced cost per test. The supplier provided dedicated hours of staff training. Allocated time was assigned to run point-of-care testing quality assurance. LESSONS: Having access to laboratory tests can reduce inequalities for rural patients, but natural enthusiasm to introduce new point-of-care technologies and devices needs to be tempered by a thorough consideration of the realities on the ground. Quality assurance programmes need to fit the locality while being overseen and supported by laboratory staff knowledgeable in point-of-care testing requirements. Associated costs need to be sustainable in both human and physical resources. [ABSTRACT FROM AUTHOR]

Interprofessional practice is recognized as essential to providing patient-centered, collaborative and high quality care, contributing to optimal health outcomes. Understandings of how best to cultivate practitioners able to 'be' and 'become' interprofessional remain problematic. To advance that understanding, this hermeneutic phenomenological study addressed the question: 'What are health professionals' experiences of working with people from other disciplines?' In-depth, semi structured interviews with 12 health professionals from nursing, occupational therapy, physiotherapy, speech and language therapy, medicine, social work, and midwifery were undertaken using a conversation style. Three unifying themes revealed things which appear to be at the 'heart' of interprofessional practice; the call to interprofessional practice, working in a spirit of interprofessional practice and safeguarding and preserving interprofessional practice. This paper focuses on the first two themes. The findings contribute to a deeper understanding of interprofessional practice as a way of being that extends beyond known and measureable skills and knowledge, to dispositions and qualities. Dispositional qualities come from within a person and what they care about, and from experiences that shape their understandings. This study points toward interprofessional practice as being about a spirit. Who people are, what they bring and how they act is what matters.

Consumer trust in the modern food system is essential given its complexity. Contexts vary across countries with regard to food incidents, regulation and systems. It is therefore of interest to compare how key actors in different countries might approach (re)building consumer trust in the food system; and particularly relevant to understanding how food systems in different regions might learn from one another. The purpose of this paper is to explore differences between strategies for (re)building trust in food systems, as identified in two separate empirical studies, one conducted in Australia, New Zealand and the UK (Study 1) and another on the Island of Ireland (Study 2). Interviews were conducted with media, food industry and food regulatory actors across the two studies (n  = 105 Study 1; n  = 50 Study 2). Data were coded into strategy statements, strategies describing actions to (re)build consumer trust. Strategy statements were compared between Studies 1 and 2 and similarities and differences were noted. The strategy statements identified in Study 1 to (re)build consumer trust in the food system were shown to be applicable in Study 2, however, there were notable differences in the contextual factors that shaped the means by which strategies were implemented. As such, the transfer of such approaches across regions is not an appropriate means to addressing breaches in consumer trust. Notwithstanding, our data suggest that there is still capacity to learn between countries when considering strategies for (re)building trust in the food system but caution must be exercised in the transfer of approaches. [ABSTRACT FROM AUTHOR]

The Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network was formed to build capacity and infrastructure for high‐quality musculoskeletal clinical trials in our region. The purpose of this paper is to describe the steps taken in its formation to help others interested in establishing similar networks. In particular, we describe the steps taken to form the collaboration and our progress in achieving our vision and mission. Our aim is to focus on trials of highest importance and quality to provide definitive answers to the most pressing questions in our field. [ABSTRACT FROM AUTHOR]

To be more prepared for future hazard events, learnings from past events must be identified, shared, and applied. This task does not belong solely to either practice or academia but requires a collaborative approach. In line with this goal, this special issue presents a combination of empirical research papers, research updates, and practice updates which contribute to knowledge of the impacts and outcomes of the M7.8 14th November 2016 Kaikōura earthquake in Aotearoa New Zealand, focusing particularly on lessons for the capital city of Wellington. The main focuses are how the event affected the thoughts and behaviours of Wellington residents; how organizations can improve their operation during disruptive events; and using collaborative, multi-sector approaches to identify how resilience can be understood and demonstrated. The title "Pathways to Earthquake Resilience" reflects the nature of the papers included in this special issue, bringing focus to the ways in which various sectors and disciplines can contribute to increasing resilience to earthquakes by implementing the lessons learned from past events. [ABSTRACT FROM AUTHOR]

Development and maintenance of professional competencies are essential for practitioners across all disciplines within the helping professions to ensure safe, accountable and ethical practice. This includes the practice of supervision which is considered as a set of competencies in its own right. For many supervisors, however, there is a struggle to find the opportunity for in-depth critical reflection and review of their supervision for the purpose of continuous professional development. This paper describes a learning community for supervision where, through a process of collaborative enquiry, four experienced supervisors, in Aotearoa New Zealand, from diverse professional and practice backgrounds critically reflected on audio-recordings of their supervision of practitioners. From this focus on direct practice, the group members created a model for critique and feedback which is centred on a 'thinking aloud' process. Key themes, which included supervisor authenticity and presence, encouraging reflection, participation and uncovering assumptions and the benefits of the thinking aloud process were identified and explored. Rarely is the practice of supervision scrutinised in a group setting for the purpose of learning and development. Placing supervision practice 'under the microscope' allows for creative opportunities and the promotion of different models of supervision development. [ABSTRACT FROM AUTHOR]

There is widespread and growing support and requirement for researchers and larger organisations to collaborate with communities. This ensures that social, educational, or health programmes are relevant and acceptable and address the needs of groups that experience inequity. There is limited research about the processes and approaches that impact successful collaboration. The aim of this study was to identify the best‐practice processes used to develop and sustain collaborative partnerships between community members and formal organisations in Aotearoa New Zealand. Using a qualitative case study methodology and guidance from our community advisory group, we selected three effective collaborations with groups that experienced inequity in Aotearoa New Zealand. We examined these by reviewing their publicly available documents and conducting focus group discussions and interviews with key stakeholders. We coded and analysed transcriptions thematically to develop case study summaries of findings and then conducted cross‐case analysis to identify themes inherent in the data. Seven themes emerged from the data: (1) work together under Te Tiriti to ensure that collaborations are built on the articles of this founding document of Aotearoa New Zealand; (2) start before the beginning by forming strong relationships with diverse and representative community members; (3) walk the talk by using critically reflexive processes built on shared values and equal power relations; (4) use pencils not pens to implement ensuring an iterative project process; (5) recognise all contributions and especially the value of lived experience and local knowledge; (6) journey at a pace that allows all to participate; and (7) listen twice, talk once to give priority to hearing quieter voices. These seven practices can be utilised by other collaborative initiatives to increase genuine and power‐shared participation. These participatory processes can make sure that collaborative projects respect local knowledge, indigenous culture, and respond iteratively to community needs. [ABSTRACT FROM AUTHOR]

Critically reflecting on researcher–community partnerships is a key component in implementing chronic condition interventions in Indigenous communities. This paper draws on the results and learnings from a process evaluation that measures how well two research–community partnerships have followed the He Pikinga Waiora (HPW) Implementation Framework while co-designing chronic condition interventions in primary care. The HPW framework is centred on Indigenous self-determination and knowledge surrounded by community engagement, cultural centredness, systems thinking and integrated knowledge translation. The evaluation included in-depth interviews and online surveys with 10 team members. The findings demonstrate that the HPW framework was followed well, with strengths particularly in community engagement and relationship building. Areas for improvement included systems thinking and integrated knowledge translation to support sustainability of the interventions. The need for partnerships to use process evaluation results to support critical reflection is asserted, which helps build strong trust and synergy, power sharing and effective and sustainable implementation practices. It is concluded that the HPW framework is well suited to evaluating implementation of health interventions in primary care as it assists in the facilitation of better collaboration between researchers and Indigenous communities, and encourages the implementation team to reflect on power and privilege. [ABSTRACT FROM AUTHOR]

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

Rangatahi Tū Rangatira (R2R) is a national health promotion programme in Aotearoa New Zealand which aims to promote cultural and physical wellbeing for rangatahi (young people) and their whānau (family). Grounded in tikanga Māori, the programme focuses on total wellbeing, leadership and cultural awareness providing rangatahi opportunities to increase their participation in physical activity and cultural knowledge through ngā taonga tākaro (Māori ancestral games). This paper focuses on an evaluation of this innovative health promotion programme focussing on the delivery of R2R by a local iwi provider in a rural area. Kanohi ki te kanohi (face-to-face) interviews and focus groups were used to collect data from a range of stakeholders including rangatahi, whānau, programme developers, and collaborating community organizations. A whānau ora (holistic) framework incorporating five core outcomes and key indicators specific to the programme was developed to assess the impact of delivery. Results demonstrated that rangatahi and their whānau were living healthier lifestyles through being more physically active; had gained an increased desire to succeed in their education and extra curriculum activities; and felt more connected to their community and te ao Māori. This demonstrates the importance of incorporating cultural elements to support improved lifestyle changes for rangatahi and their whānau and the connection between enhanced cultural identity and good health. [ABSTRACT FROM AUTHOR]

New Zealand is undergoing major change in service delivery to children and families. A new Ministry for Children Oranga Tamariki has been established to oversee 5 work streams, one of which provides intensive intervention with families requiring a statutory response to child protection concerns. The government minister responsible promised that the service would be child‐centred and trauma‐informed. To date, these terms remain undefined, and there is no shared understanding of their meaning. Practice frameworks to support the work of the new ministry are still being developed, creating something of a vacuum in the meantime. The focus of this paper is the challenge of implementing trauma‐informed practice in the child protection service provided by the Intensive Intervention work stream. Limited research or commentary on trauma‐informed practice in this context currently exists. Drawing on the relevant available literature, the concept and its application in child protection social work is explored. An ecological framework is used to discuss the changes needed to achieve this. Particular attention is paid to the impact of historical trauma for indigenous people due to New Zealand's colonial history and their over‐representation in care and protection services. [ABSTRACT FROM AUTHOR]

Accessible summary Comparing three bespoke practice development (PD) projects reveals similarities in the principles of person-centred practice and cathartic personal growth, as relevant concepts to mental health., PD offers a collaborative approach to practice-driven quality improvement initiatives suitable to the psychologically informed mental health context., Creating a workplace culture that allows all involved to contribute to service improvement can be achieved through embracing a PD-driven change management strategy that aims to stimulate culturally sensitive care delivery., Abstract Practice development ( PD) in mental health nursing has been progressing over the last decade; however, the level and impact of PD activity in the field of mental health remains poorly understood outside localized project impact. More specific reporting and comparative analysis of PD outcomes will improve this situation. In response, this paper presents three case scenarios from work taking place in Australia and New Zealand, as working examples of how PD methodologies have been applied within mental health practice settings. Using a comparative framework that captures the contributing assumptions, practices, processes and conditions imperative to effective PD work within a mental health-care context, three case vignettes are reviewed. The critical question driving this paper is 'what mental health-care services does PD offer in terms of transformational change approaches and the promotion of effective workplace cultures?' Conditions considered necessary for successful PD initiatives within mental health contexts are explored such as how PD converges and diverges with mental health-related theories, plus where and how PD activity best integrates with the specific elements associated with mental health-care provision. The findings are further reviewed in line with reports of PD outcomes from other fields of health care. [ABSTRACT FROM AUTHOR]

INTRODUCTION: There is growing interest in increasing uptake of hepatitis C (HCV) treatment. HCV is strongly associated with injecting drug use and is a stigmatised illness. People with HCV may be reluctant to engage with health care services. A community-based, nurse-led integrated care clinic was established in Christchurch, New Zealand with the intention of bridging the health care gap for those unwilling or unable to access mainstream health care. This paper explores the experiences and perceptions of health professionals regarding the implementation of this clinic, with particular attention paid to the interprofessional relationships relevant to the clinic. METHODS: Qualitative, in-depth interviews were conducted with 24 stakeholders, including four staff of the clinic and other service providers with varying relationships to the clinic. FINDINGS: Participants generally endorsed the clinic model and described its operation as easy to access, non-judgmental and non-threatening, and, therefore, able to attract and engage 'hard-to-reach' clients. The clinic model was also thought to support more effective use of health resources. Some participants expressed concerns regarding the potential 'poaching' of patients from other services (particularly general practice) and indicated a preference for HCV treatment services to be restricted to hospital settings. CONCLUSION: The findings of this study suggest the need to address concerns of general practitioners regarding patient poaching. Key information to disseminate is the clinic's success in engaging with complex clients and contribution to more efficacious use of health service resources. These activities may require the advocacy of a key local opinion leader acting as 'knowledge broker'. [ABSTRACT FROM AUTHOR]

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

Work-integrated learning (WIL) experiences rely heavily on the development of relationships between the university, industry and often community organizations. As participation in WIL is increasing, the issue of sustainability becomes paramount, requiring processes and practices for effective collaborations and partnerships. This paper reports on an action research project to develop a framework to represent the critical success factors for sustainable WIL relationships. Drawing on reflections from WIL practitioners on what they considered were the critical success factors and a review of literature, a framework was developed, prioritizing three key themes: communication, commitment and compatibility. Within these themes, nine key factors were identified and then evaluated by academic and industry stakeholders in New Zealand, Canada and Australia. Trust, expectations, reciprocity, coordination, vision, learning, resources, reputation, and recognition were confirmed as important factors for sustainable WIL relationships. The framework provides good practice guidelines for all WIL stakeholders. [ABSTRACT FROM AUTHOR]

A crucial development resulting from consumer involvement in mental health services has been engagement as active participants in mental health research, often conducted in collaboration with mental health researchers representing the health disciplines (referred to in this paper as 'other' researchers). Despite progress in mental health consumer research, unequal power relations continue to pose a major barrier. Although power issues are discussed in the literature, there is little research from the perspective of other mental health researchers who have collaborated with consumers on research projects. This qualitative study explored other mental health researchers' perspectives on the role of power in collaborative research with consumers. Semi-structured interviews were completed with 11 other mental health researchers. Thematic analysis of the transcript version of interview recordings was conducted. The findings were grounded in 'the table' as a literal and metaphorical site of power relations. The umbrella theme was prominence and presence (of consumers) at the table, followed by subthemes on barriers (tokenism, undermined potential) and surmounting them through reworking power (critical mass and openness to power dynamics). Overall it was found that while there continue to be significant power-related barriers to further building of robust collaborative research with consumers in mental health, there are several avenues that should be considered, much more assertively, to disrupt and transcend them. [ABSTRACT FROM AUTHOR]

Introduction. Community-based primary care physiotherapy has developed through private practice, fee-for-service model in Aotearoa New Zealand where independent businesses operate in competition. Aim. We aimed to explore how the private practice model of physiotherapy impacts patient care, physiotherapists, and professional behaviour. Methods. Six physiotherapists managing musculoskeletal conditions in a primary care private practice in Aotearoa New Zealand were recruited using maximum variation purposive sampling. In-depth individual face-toface semi-structured interviews were audio-recorded, transcribed verbatim, and analysed using Interpretive Description. Inductive data analysis synthesised and contextualised data, creating a thematic framework that developed across interviews. Results. All physiotherapy participants discussed concerns about culture and professionalism in private practice physiotherapy despite not being asked about these. Three themes were identified. 'Competitive business model and lack of collaboration' - participants thought that competition between practices resulted in a lack of trust, collegiality, and collaboration, and pressure on clinicians to maintain income. '(Un)professional behaviour' - participants thought that physiotherapists were defensive and averse to scrutiny, resulting in reluctance to admit when they needed help, or to undertake peer review or seek second opinions. 'Lack of support and mentoring' - the professional culture in private practice was perceived to reduce support and mentoring, with negative impacts that affected physiotherapists at all stages of career. Conclusion. This exploratory qualitative study suggests that competition dominates communication and collaboration in private practice physiotherapy and may have wider implications for professionalism and the quality of patient care. Competitive business models and an aversion to scrutiny may reduce collegial interaction and professional behaviour. [ABSTRACT FROM AUTHOR]

Purpose – Disabled people who are the end-users (EU) of health services have a poor record of inclusion, yet a major stake in the quality of scientific research that informs the development of health knowledge and interventions. In traditional rehabilitation research it has been the researcher who sets the agenda, including determining the research question, study design and methods, and who controls dissemination of findings. This paper aims to describe the development of an EU research consultation committee and to describe the evaluation protocol used to assess the effectiveness of the committee. Design/methodology/approach – The paper describes the context and development of an EU research consultation committee (the committee) to promote collaboration between researchers and lay-EUs within a research organization in New Zealand. It also describes the qualitative evaluation protocol to be used to assess the effectiveness of the committee over the first 12 months of operation in order to refine its process and procedures. Findings – The paper discusses the issues and challenges involved in achieving collaboration between researchers and EUs in the rehabilitation research space and describes this consultation model as a positive example of making inclusion a reality. Challenges include building research capacity within the EU community and development of real models of collaboration and partnership in rehabilitation research. Originality/value – It is argued that the integrity and relevance of clinical research is enhanced by the involvement of EUs in all aspects of the research process. [ABSTRACT FROM AUTHOR]

The Ministry of Pacific Island Affairs is charged with identifying the aspirations and needs of Pacific people residing in Aotearoa/New Zealand, providing high quality policy advice to governments and their ministries, and with advising ministries on how these might be achieved. With a large, dispersed client population, a small staff and limited resources, this represents a major task for the Ministry. However, the Ministry has been able to deliver these by forming a network of co-operative relationships with both its communities and the other ministries and agencies charged with formulating policy and delivering services to the communities. But limited resources prevent the Ministry mediating each of these relationships on a continuing basis. This paper focuses on the ways in which the Ministry of Pacific Island Affairs went about forming and using a web of "partnerships" with Pacific communities, social policy agencies, and service providers to overcome some of the challenges which a small ministry with limited resources faces. This paper attempts to show how a larger web of relationships became central to the Ministry's community development mission. The Ministry formed and nurtured a series of local partnerships between communities' representatives and the ministries which deliver local programs. The arrangements free the Ministry to monitor the relationships and the performance of the ministries and agencies. Previously, we have described the organisational model as an apogāleveleve, or spider web, in which the web is a series of defined relationships created and maintained by the "centre" for a specific purpose: obtaining the best possible outcomes for constituent communities. Each operative relationship is connected via the centre, and mediated by the centre, which also monitors the performance of the system as a whole and moves to repair damage anywhere it occurs to ensure that the web as a whole continues to deliver outcomes. The network of co-operative relationships, or partnerships, has made it possible for the Ministry to achieve significant results relatively quickly with limited resources. [ABSTRACT FROM AUTHOR]

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

Purpose The current healthcare environment provides several challenges to the existing roles of healthcare professionals. The value of the professional expert is also under scrutiny. The purpose of this paper is to generate a construction of professional expertise amongst practitioners in the current healthcare environment. It used the speech-language therapy community in New Zealand (NZ) as an example. Design/methodology/approach Speech-language therapists currently practicing in NZ completed an online survey including qualitative and quantitative components. The range of experience and work settings of participants ( n=119) was representative of the workforce. Findings Participants clearly identified being "highly experienced" and "having in-depth knowledge" as essential elements of professional expertise. Thematic analysis generated two interconnected themes of a professional expert being a personal leader and teacher, and a highly experienced, knowledgeable and skilful practitioner. Additionally, practitioners needed to be seen to contribute to the community in order to be known as experts. Clinical practice was valued differently from research generation. Originality/value This study is novel in exploring a construction of professional expertise amongst practitioners in a current healthcare community. Within that community, experts could be viewed as highly effective practitioners that visibly contribute to the professional community. The study draws attention to the role of reputation and the impacts of being a clinical teacher or leader compared with pursuing a research role. This could be particularly relevant in the promotion of evidence-based practice. [ABSTRACT FROM AUTHOR]

Background: The increase in multimorbidity or co-occurring chronic illnesses is a leading healthcare concern. Patients with multimorbidity require ongoing care from many different professionals and agencies, and often report a lack of integrated care. Objective: To explore the daily help-seeking behaviours of patients with multimorbidity, including which health professionals they seek help from, how professionals work together, and perceptions and characteristics of effective interprofessional, interagency multimorbidity care. Design: Using a case study observational research design, multiple data sources were assembled for four patients with multimorbidity, identified by two general practitioners in New Zealand. In this paper, two case studies are presented, including the recorded instances of contact and communication between patients and professionals, and between professionals. Professional interactions were categorized as consultation, coordination, or collaboration. Results: The two case studies illustrated two female patients with likely similar educational levels, but with different profiles of multimorbidity, social circumstances, and personal capabilities, involving various professionals and agencies. Engagement between professionals showed varying levels of interaction and a lack of clarity about leadership or care coordination. The majority of interactions were one-to-one consultations and rarely involved coordination and collaboration. Patients were rarely included in communications between professionals. Conclusion: Cases constructed from multiple data sources illustrate the complexity of day-to-day, interprofessional, interagency multimorbidity care. While consultation is the most frequent mode of professional interaction, targeted coordinated and collaborative interactions (including the patient) are highly effective activities. Greater attention should be given to developing and facilitating these interactions and determining who should lead them. [ABSTRACT FROM AUTHOR]

Introduction. This study presents an innovative model of integrated dermatology service delivery. Kauri HealthCare (KHC) is a general practice serving around 19 000 patients in Palmerston North, New Zealand. A 'mini clinic' is provided by an on-site dermatologist that is available for patients of KHC. Referring practitioners are required to attend with the patient to present their case and seek dermatologist input. This allows for patients to receive a specialist opinion, as well as for the referrer to receive practical and academic teaching, record findings, and arrange any further investigations, follow-up, or management. Aim. To describe the nature of patient presentations and clinical outcomes of a novel dermatologist-general practitioner integrated clinic based in a provincial healthcare practice. Methods. Descriptive analysis of all referrals to the Kauri HealthCare dermatology mini clinic from April 2017 to December 2022. Results. During the study period, 964 diagnoses were recorded across 806 patients booked into the mini clinic. The most common presenting conditions were: (1) eczema; (2) psoriasis; (3) actinic keratoses; (4) naevi; and (5) seborrheic keratosis. Practitioners sought dermatology opinion on the diagnosis and/or management of skin conditions. Further referral to secondary care was not required for 86% of patients. Discussion. Improvements could be made to better serve those of Māori and Pacific ethnicity, or living in high socioeconomic deprivation. Results indicate where teaching could be prioritised for practitioners, postgraduates, and medical students. Overall, this is an innovative clinic model, which seeks to provide equitable care, medical education, and collaboration between primary and secondary services. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) challenges health providers to commit to and champion interprofessional education (IPE) and interprofessional collaboration (IPC), arguing that IPE promotes IPC, which in turn improves health outcomes. Providing opportunities for students to engage in IPE, which occurs when current or future practitioners learn from, with, and about one another, ensures that health providers are in line with the WHO imperative of 2010. This paper describes the process of developing and implementing an undergraduate IPE initiative within a large New Zealand district health board, Counties Manukau Health, which provides clinical placements for over 500 students annually. This initiative involved 2 half-day interprofessional workshops attended by 123 students from seven disciplines. The impact of the interprofessional learning on students' perceptions and their confidence in relation to teamwork, communication, and interprofessional interaction were evaluated. Overall, students had a positive view of interprofessional communication and teamwork, and their opinion of relationships with other professionals improved following participation in the workshops.

Introduction. New Zealand pharmacists must complete a joint prescribing course offered by Otago and Auckland universities only, to be qualified as pharmacist prescribers. Aim. To identify knowledge and perceptions of New Zealand registered pharmacists, who are not pharmacist prescribers, on: pharmacist prescribing roles, courses and perceived barriers and facilitators to course uptake. Methods. Participants comprised registered practising New Zealand pharmacists (n = 4025), across all New Zealand regions. Invitations to participate in a questionnaire survey were sent in March 2021. Data were analysed using thematic analysis and descriptive statistics. Results. The response rate was 12% (482/4025), with 94% community pharmacists. Almost twothirds (65%) had over 10 years of working experience. Nearly all (95%) agreed that pharmacist prescribing would improve healthcare delivery in New Zealand. Most reported that barriers to pharmacist prescribing course uptake were funding, lack of institutional support, up-to-date pharmacological/pharmaceutical knowledge, and 2 years of experience in collaborative health team prerequisites for enrolment, finding medical supervisors, and lack of remuneration for prescribing roles. Discussion. Pharmacist prescribing in New Zealand is still in its growing phase. Optimising uptake of prescribing courses and role requires a multi-level approach including all stakeholders. Government/policymakers should consider pharmacist prescribing training and remuneration in their funding plans. Employing institutions should provide required time and human resources (staff backfills). Training providers should consider methods of course delivery and assessment that are suitable for trainees in full-time employment. [ABSTRACT FROM AUTHOR]

Police members can be exposed to morally transgressive events with potential for lasting psychosocial and spiritual harm. Through interviews with police members and police chaplains across Australia and New Zealand, this qualitative study explores the current role that police chaplains play in supporting members exposed to morally transgressive events. The availability of chaplains across police services and the close alignment between the support they offer, and the support sought by police, indicates they have an important role. However, a holistic approach should also consider organizational factors, the role of leaders, and access to evidence-based treatment in collaboration with mental health practitioners. [ABSTRACT FROM AUTHOR]

Pelvic exenteration (PE) is a potentially curative, ultra-radical surgical procedure for the treatment of advanced pelvic tumours, which involves surgical resection of multiple pelvic organs. Delivering such a complex low-volume, high-cost surgical program presents a number of unique health management challenges, and requires an organisation-wide approach involving both clinical and administrative teams. In contrast to the United Kingdom and France, where PE services have been historically decentralised, a centralised approach was developed early on in Australia and New Zealand (ANZ) with referral of these complex patients to a small number of quaternary centres. The PE program at the authors’ institution was established in 1994 and has since evolved into the highest volume PE centre in the ANZ region and the largest single institution experience globally. These achievements have required navigation of specific funding and management issues, supported from inception by a proactive and collaborative relationship with hospital administration and management. The comprehensive statewide quaternary referral model that has been developed has subsequently been successfully applied to other complex surgical services at the authors’ institution, as well as by more recently established PE centres in Australia. This article aims to summarise the authors’ experience with establishing and expanding this service and the lessons learned from a health management perspective. [ABSTRACT FROM AUTHOR]

This paper analyzes and explores varying discourses within the talk of new practitioner direct entry (DE) midwives in Aotearoa/New Zealand. In Aotearoa/New Zealand, midwifery is theorized as a feminist profession undertaken in partnership with women. Direct entry midwifery education is similarly based on partnerships between educators and students in the form of liberatory pedagogies. The context for the analysis is a large ethnographic study undertaken with a variety of differently positioned midwives based mainly in one city in New Zealand. I interviewed and observed over 40 midwives in their different practice settings in 2003. Complex and contesting forms of knowledge production are analyzed in this paper drawing on methodological insights from Foucauldian discourse analysis. New practitioners engage in techniques of self-monitoring and surveillance as they move towards becoming established practitioners. New midwifery subjectivities and forms of knowledge production which contest authoritative forms of knowledge are produced. Midwives in New Zealand are seen to inhabit a complex and liminal space of midwifery praxis. Paradoxically, they are exhorted to remain the 'guardians of normal birth' in a time of increasing interventions into birth both locally and internationally. Paradoxes encountered by new midwifery practitioners in New Zealand as they struggle to maintain ideals of 'normal' birth may be paralleled by the constraints inadvertently produced through governing discourses of emancipatory or liberatory pedagogies. The relevance of this is also highly critical for midwifery and birth practices internationally.

Throughout the world, particularly in colonized countries, the health status of indigenous people and the unequal representation of indigenous people within the health workforce is of concern. In 2002, as part of a national health workforce development strategy, a qualification was developed to provide Maori (Indigenous New Zealander) health professionals with the skills and confidence to teach and supervise students on clinical placements in Maori health environments. This project required close collaboration between two education providers, one a Maori private education provider and the other a traditional government-funded tertiary institution; and for both organizations to work cooperatively with Maori communities and Maori health providers. The Christchurch College of Education (CCE) and Mauri Ora Associates are jointly involved in the administration, design and delivery of the programme, recruitment of guest lecturers, and ongoing curriculum updates. The content for the programme is mainstream, international and interprofessional but the pedagogy is Maori, with Maori customs, values and traditions upheld and practised. A national Maori health workforce development organization contracts independently with both organizations and provides an oversight and quality monitoring role. Together, the three organizations work with other Maori health professional groups and Maori elders to deliver the qualification. This paper describes how this course was designed, how it is delivered within a Maori paradigm, and how the outcomes are achieved. It also describes the cooperation between Maori and Pakeha (white New Zealanders) across health, community and educational organizations that was required to sustain this programme over five years and identifies some themes that may be applied in a global context. In sharing our experiences, we hope to inspire others to consider ways they can meet the needs of indigenous learners within their mainstream programmes.

Purpose: The purpose of the paper is to explore the nature and causes of observed tensions among healthcare professionals in not-for-profit organizations such as hospices., Design/methodology/approach: In the paper the narratives collected from discipline leaders in each of five New Zealand hospices are thematically analysed in order to identify consistent and recurring sources of conflict both within and between disciplinary groups., Findings: The paper finds that motivational differences, poor conflict management, interdisciplinary tensions, divergent attitudes towards volunteerism, strategic planning processes, and poor consultation are identified as some of the starting-points for tensions in the participating hospices., Research Limitations/implications: The research in this paper is based in New Zealand and uses qualitative methods not intended to produce generalizable results. Nevertheless it was conducted in hospices typical of the Western developed countries and identifies focal points and potential avenues for further exploration., Practical Implications: The paper shows that researchers and managers involved in not-for-profit healthcare organization may find the identified issues useful as starting-points for actions to minimise the tensions between and within groups., Originality/value: This paper explores aspects of a rarely discussed issue, and suggests opportunities for more research in this field.

Purpose: The purpose of this paper is to understand the centrality of emotion, and how that emotion both created and contributed to meaning, in the communication of health professionals who worked in a regional pilot program for cancer screening., Design/methodology/approach: As the third phase of a larger study, thematic analysis of semi-structured interviews was carried out with the 19 members of the professional groups, which comprised the service. Brief comments were included from the questionnaire survey in phases 1 and 2 of the study to demonstrate the overflow effects on those served by the organization., Findings: Emotion was found to be a critical component in the communication interface between the groups. The complexity of the way in which emotion was managed with the client group overflowed into the management of the communication process between the professional groups in the organization. However, it was not always recognised, and thus created difficulties for a number of staff., Research Limitations/implications: Although the research was limited to one health-care organization, it is possible that other health professions are experiencing similar situations as they cope with the certainty of unending change. Also, although secondary interviews were carried out to ensure that themes were credible to participants, it is possible that carrying out the interviews in the work environment may have constrained some participants., Originality/value: Stresses the importance of the emotional component of communication and how it is recognised to facilitate effective working relationships and support staff coping with change and heavy workloads in health-care organizations.

The burden of diabetic kidney disease continues to escalate at significant cost to the patient and health care system. Health literacy and self-management are critical to improving the outcomes of chronic conditions such as chronic kidney disease (CKD).This paper describes a community-based CKD pilot study implemented in New Zealand (NZ) based on a self- management and educational model of care. The aim of the pilot study was to implement a collaborative, community-based intervention using specialist nephrology nursing support in a primary care setting, targeting people at increased risk of developing end-stage kidney disease. We have previously reported this pilot study to be effective in clinical terms by reducing proteinuria, improving blood pressure control, and reducing five-year absolute cardiovascular risk and to improve some patient-centred outcomes, (patients' knowledge of their health condition and medications/treatments, medication compliance, and adherence to a healthy lifestyle). In this article, we report the effect of the pilot on a more extensive range of self-management and patient-centred outcomes, such as patient perceptions around shared decision making, care that is appropriate to their cultural beliefs and values, their propensity to monitor and act upon medical early warning signs, and the impact of their condition upon daily physical activities, feelings, and social and family life. All but two of the domains showed significant improvement during this study, indicating the potential benefits of self-management models of care for patient-centred outcomes in CKD patients. [ABSTRACT FROM AUTHOR]

Traditional healers in many parts of the world have used family focused understandings and interventions well before the emergence of western family therapy theory and practice. This paper gives a detailed account of New Zealand Māori traditional healing work with a Cook Island Māori family in which the eldest daughter was in considerable distress as were her family, who believed that she had become maki tūpāpaku (possessed). This account is told from the perspectives of the child psychiatrist, the traditional healer and the mother of the family. While the intervention bears a superficial resemblance to western family therapy approaches, the theoretical foundation reflects the traditional healer's New Zealand Māori world views in which spiritual understandings are paramount, and concepts of mana, tapu and mauri guide him in the family healing process. The single session described here can be viewed as an indigenous family therapy intervention involving six generations of family members, both living and deceased, in the one room. Conclusions: Indigenous communities have called for traditional healers to be employed alongside child mental health workers and family therapists who work with their communities. Close and sincere collaboration between an indigenous traditional healer and a health professional can offer a family in distress healing possibilities that may not be available to them in conventional child mental health or other family therapy settings. [ABSTRACT FROM AUTHOR]

With the increasing burden of chronic kidney disease (CKD) in New Zealand (NZ) the number of people requiring pre-dialysis care is increasing. Pre-dialysis nurses play a central role in the delivery of this care. This paper describes and discusses what pre-dialysis nurses perceive to be key influences on effective pre-dialysis nursing care in NZ. It is based on findings from a wider qualitative study that interviewed the majority of NZ pre-dialysis nurses. Following inductive data analysis four main influences were identified. They were: having time from referral to commencement of renal replacement therapy (RRT) to provide adequate education and support; having good access to cultural and other supports and an understanding of differing cultural views of health; the importance of good inter-professional relationships; and support from nursing management and doctors to advance professionally. With the knowledge of the projected increase in patients with CKD, we argue that it is important to ensure the positive aspects of these influences are enhanced in order to ensure effective pre-dialysis nursing care, nurse satisfaction and professional advancement. [ABSTRACT FROM AUTHOR]

Social work in health care has been a significant field of practice within social work in New Zealand since the 1940s. This paper reports on a project inspired by a fruitless search for a current discussion on the development of health social work in New Zealand. Analysis of a bibliographic search reveals an interesting history of health social work, as it emerged as an extension of the nursing role. Five distinct periods of development are identified through analysis of the literature. The paper concludes with a brief discussion of challenges and opportunities for health social work. [ABSTRACT FROM AUTHOR]

Aims: The first aim of this study was to measure the extent of care planning and support for health goals within a sample of Māori/non-Māori people with long-term conditions (LTCs). The second aim was to compare those with and without care plans, and those with and without support for health goals, with respect to health and experiences with general practice. Background: Collaborative care planning, resulting in a written care plan, and providing support for patient-identified goals are important aspects of LTC management. In the MidCentral District Health Board region, primary care practitioners have had help to achieve this through the introduction of comprehensive assessment and care-planning tools. Methods: 569 people with at least one LTC, who had recently enrolled in a local EnhancedCare+ programme or were receiving care from an LTC community clinical nurse, were recruited into the region's "Talking about Health" study, designed to explore LTC care from patient and provider perspectives. Consenting participants chose to complete a paper (by post) or electronic (email link) questionnaire, which included measures of health, healthy behaviours, experiences with doctors and nurses in general practice, patient activation, care planning/goal support and demographics. Results: People with written care plans were more active self-managers, reported better interactions with primary-care doctors and nurses, and perceived receiving more support from the general practice team than those without. Results were similar for people receiving support for their health goals, but differences in mental and physical health were also evident. More Māori than non-Māori reported having a written care plan, and support for health goals in the absence of a written care plan. A slightly broader range of benefits was evident for non-Māori than Māori, but the different sample sizes need to be taken into account when drawing conclusions. Conclusions: Written care plans and practitioner support for health goals appear to benefit people with LTCs. Support for health goals is important as, even without a written care plan, it was associated with better health and more positive ratings of practitioner interactions. Challenges for the region are to involve more people/whanau in collaborative care planning and to address system-wide barriers to embedding care-planning practices into routine care. [ABSTRACT FROM AUTHOR]

In this paper we reflect on discussions with people of advanced age in Āotearoa New Zealand, and draw on theoretical frameworks of resilience and place in old age, to explore insights about the ways older people maintain quality of life and health. Twenty community-dwelling people of advanced age (85+) were recruited in 2015–16 from a large multidisciplinary longitudinal study of advanced age. These twenty participated in interviews about health in advanced age, impact of illnesses, interactions with clinicians, access to information, support for managing health, and perceptions of primary care, medications, and other forms of assistance. We use a positioning theory framework drawing on thematic and narrative analysis to understand the dynamic ways people in advanced age position themselves and the ways they age well through speech acts and storylines. People in advanced age saw themselves as challenged, rather than threatened, by adversities, and positioned themselves as able to draw on a lifetime of experience and resourcefulness and collaborations with supporters to deal with challenges. Key strategies include downplaying illness and resisting biomedical discourses of complexity, positioning embodied selves as having agency, and creative adaptation in the face of loss. People in advanced age exhibit resilience, maintaining wellbeing, autonomy and good physical and mental quality of life even while living with challenges such as functional decline and multi-morbidities. These findings have significance for supporters of older people, emphasising the need to move away from a narrow focus on problems to working together WITH people in advanced age to offer a more holistic approach that encourages and enhances adaptation and flexibility, rather than rigid and counterproductive coping patterns. • Older people position themselves as active co-managers in their support arrangements. • Framing problems as challenges not threats facilitates older people's resourcefulness. • People in old age adapt resiliently to health conditions as part of living and ageing. [ABSTRACT FROM AUTHOR]

There is a growing body of evidence supporting the provision of interprofessional education for pre‐registration health science students. Furthermore, there is emergent evidence supporting the provision of interprofessional opportunities in rural workplaces. The strategies used by tertiary education providers in establishing and sustaining these rural interprofessional initiatives currently remain unclear, including how to foster authentic engagement with indigenous rural communities. This short commentary seeks to provide some practical guidance on how to successfully implement and maintain rural interprofessional experiences for pre‐registration students. [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]