Understanding workplace violence against medical staff in China: a retrospective review of publicly available reports.

BACKGROUND: Workplace violence against medical staff in China is a widespread problem that has negative impacts on medical service delivery. The study aimed to contribute to the prevention of workplace violence against medical staff in China by identifying patterns of workplace violence, key risk factors, and the interplay of risk factors that result in workplace violence. METHODS: Ninety-seven publicly reported Chinese healthcare violent incidents from late 2013 to 2017 were retrospectively collected from the internet and analysed using content analysis. A modified socio-ecological model guided analysis of the violent incidents focusing on risk. RESULTS: Physical violence, yinao, or a combination of physical and verbal violence were the typical forms of violence reported. The findings identified risk at all levels. Individual level risk factors included service users' unreasonable expectations, limited health literacy, mistrust towards medical staff, and inadequacy of medical staff's communication during the medical encounter. Organisational level risk factors under the purview of hospital management included problems with job design and service provision system, inadequacies with environmental design, security measures, and violence response mechanisms within hospitals. Societal level risk factors included lack of established medical dispute-handling mechanisms, problems in legislation, lack of trust and basic health literacy among service users. Situational level risks were contingent on risk factors on the other levels: individual, organisational, and societal. CONCLUSIONS: Interventions at individual, situational, organisational, and societal levels are needed to systematically address workplace violence against medical staff in China. Specifically, improving health literacy can empower patients, increase trust in medical staff and lead to more positive user experiences. Organizational-level interventions include improving human resource management and service delivery systems, as well as providing training on de-escalation and violence response for medical staff. Addressing risks at the societal level through legislative changes and health reforms is also necessary to ensure medical staff safety and improve medical care in China.

General well-being of intensive care nurses: A prototype analysis.

BACKGROUND: Prototype analyses of well-being have identified central characteristics and prototypicality for New Zealand teachers, lawyers, adolescents, and work well-being of nurses. What has not yet been explored is the broad construct of well-being in intensive care nurses. AIMS: To identify intensive care nurses' conceptions of general well-being and investigate whether their general well-being is prototypically organized. DESIGN: Prototype analysis. METHODS: Three linked studies conceptualize well-being in this prototype analysis. In study 1, nurses reported features of well-being. Study 2 investigated the organization of these features. Study 3 sought confirmation of prototypical organization. RESULTS: Sixty-five New Zealand nurses participated. For study 1 (n = 23), the most frequently reported elements of well-being included physical health (n = 26), work-life balance (n = 20), and personal relationships (n = 18). For study 2 (n = 25), the highest rated elements included mental and emotional health, [general] health, work-life balance, and love. Work-life balance, physical health, and personal relationships were in the top five most frequently reported and were rated in the top 12 most central. Overall, ratings of centrality and the number of times reported were positively correlated (r = 0.33, P < .005). For study 3 (n = 17), confirmatory analyses did not reach statistical significance (P = .15). CONCLUSIONS: Physical health, work-life balance, and personal relationships are key characteristics of well-being for intensive care nurses. Mental, emotional, and general health and work-life balance were considered most important for well-being. RELEVANCE TO CLINICAL PRACTICE: Physical health, work-life balance, and personal relationships are key characteristics of well-being for intensive care nurses. These characteristics of the broad construct of well-being are helpful in both defining and identifying conceptual models of well-being that may be used to inform the development and measurement of well-being programmes.

Child abuse knowledge and attitudes among dental and oral health therapists in Aotearoa New Zealand: a cross-sectional study.

BACKGROUND: Child abuse and neglect are significant social and health issues in New Zealand. As the government provides free oral care to children and adolescents, oral health practitioners are positioned to respond to child protection concerns. However, research on the knowledge and attitudes of oral health practitioners is limited. This study aimed to understand the knowledge and attitudes of New Zealand dental and oral health therapists in detecting and reporting child abuse and neglect. METHODS: In this descriptive exploratory cross-sectional study, we invited registered New Zealand dental and oral health therapists treating children and adolescents to the anonymous online survey. RESULTS: Among the 92 dental and oral health therapists, 72% agreed that they could recognise the signs and symptoms of child abuse and neglect. Yet, only 48% agreed they were familiar with the reporting process. During their professional careers, 62% had at least 1 suspected case; and only 21% had ever reported their concerns. Fear of false reporting (70%) was the most significant barrier. CONCLUSIONS: Participants understood child abuse and neglect as significant social issues; however, the knowledge and attitudes to respond were limited. Efforts to enhance the knowledge and attitudes will be necessary to promote child safety and wellbeing.

A quest for quality care: Exploration of a model of leadership relationships, work engagement, and patient outcomes.

AIM: To explore the effects of resonant leadership, leader exchange relationships and perceived organizational support on work engagement and patient outcomes. DESIGN: A cross-sectional survey design. METHODS: Data were collected in June and July 2016 from 252 nurses and clerical staff and institutional patient safety (falls rates) and patient satisfaction (Friends and Family Test) in New Zealand. Data were analysed with structural equation modelling (SEM). RESULTS: The final model was an excellent fit to the data (χ2 (22, N = 252) = 39.048, p = 0.014). Resonant leadership was significantly and positively associated with relationships at work, perception of unit care quality (ß = 0.28, p < 0.001), reduced falls rates (ß = -0.14, p < 0.05) and better patient satisfaction (ß = -0.41, p < 0.001). A direct effect of resonant leadership was demonstrated on patient satisfaction (ß = 0.20, p < 0.01). Perceived organization support (ß = 0.40, p < 0.001) and leader-member exchange (ß = 0.46, p < 0.001) were confirmed antecedents of work engagement. Work engagement was confirmed as an antecedent of nurse perception of unit care quality (ß = 0.21, p < 0.001). Where social exchanges exist, work engagement mediates these. Three further mediated paths bypassed work engagement altogether. CONCLUSION: Existing literature investigating the drivers and impacts of work engagement predominantly focuses on staff outcomes rather than patient outcomes. The findings identify modifiable factors to improve staff experience, patient safety, and ultimately patient satisfaction. Resonant leadership, a relational style, is a core antecedent of quality care and positively associated with staff experience and patient outcomes. IMPACT: This investigation into a real-world problem for nurse leaders also confirmed that an organizational focus on work engagement is not always required. Resonant leadership improves staff work experience, patient safety, and patient satisfaction. Nurse leaders should measure, foster, and develop resonant leadership in practice.

Accessibility and acceptability of health promotion services in New Zealand for minority refugee women.

Refugees are forced to flee their native country to escape war or oppression. They are resilient and generally have a high level of motivation to rebuild their lives, as well as to make a meaningful contribution to the host country. However, refugees in general have complex health needs and they often face significant barriers in accessing health services in their host countries. Health promotion has been identified as an effective approach for increasing service utilization by minority populations such as refugees, and contributing to their overall positive health outcomes. This qualitative study examined the accessibility and acceptability of health promotion services for Bhutanese refugee women who resettled in New Zealand. The study consisted of two phases: focus group discussions with 32 Bhutanese women and eight Bhutanese men, followed by individual interviews with 12 health professionals including five nurses, four doctors and three midwives. The data were collected in two regional towns of New Zealand in 2014. The study's conceptual framework utilized the strategies and actions underpinning the Ottawa Charter for Health Promotion. Findings of this study revealed that Bhutanese women were missing some essential health promotion services, such as antenatal education sessions mainly due to language and cultural barriers. This study recommends to develop health promotion resources in the Nepali language; and to deliver the health promotion sessions by culturally and linguistically competent providers. This study also uncovered resiliency and strengths of Bhutanese women that could be recognized, strengthened and utilized in promoting their health and well-being.

Availability, Accessibility, Acceptability, and Quality of Interpreting Services to Refugee Women in New Zealand.

A significant number of people have been displaced from their country of origin and become refugees. Good health is essential for refugees to actively engage and take up opportunities within the society in their host countries. However, negotiating a new and unfamiliar health system hinders refugees' ability to access and make use of the available health services. Communication difficulties due to language barriers are the most commonly cited challenges faced by refugees in accessing and utilizing health services post-resettlement. In this study, we aimed to examine effectiveness of interpreting services for refugee women in New Zealand. Data were collected through three sources: focus groups with Bhutanese women, focus group with Bhutanese men, and individual interviews with health professionals. The findings of this study reveal inadequacies and constraints in the provision of a socioculturally and linguistically effective interpreting service to Bhutanese women and provide evidence for recommendations to address these inadequacies.

Conceptual model for intensive care nurse work well-being: A qualitative secondary analysis.

BACKGROUND: There had been little focus on the well-being of intensive care nurses until a recent programme of research found work well-being to be best described as a collection of elements, a multifaceted construct. Strengtheners of intensive care nurses' work well-being were found to extend across individual, relational, and organizational resources. Actions such as simplifying their lives, giving and receiving team support, and accessing employee assistance programmes were just a few of the intensive care nurses' identified strengtheners. AIMS AND OBJECTIVES: To synthesize intensive care nurse perceptions of work well-being characteristics and strengtheners to identify opportunities for job crafting and redesign. DESIGN: This was a qualitative secondary analysis. METHODS: Intensive care nurse work well-being characteristics and strengtheners were explored using applied thematic analysis and pre-design, open card-sort technique. RESULTS: Five facets were identified in the analysis: (a) healthy, (b) authentic, (c) meaningful, (d) connected, and (e) innovative. These five facets were described from a theoretical perspective and illustrated as a conceptual model for intensive care nurse job crafting and redesign. CONCLUSIONS: The proposed conceptual model contributes new knowledge to be explored in meaningful discussions about intensive care nurse work well-being and empirically investigated in terms of construct validity and theory development. Furthermore, the model provides practical opportunities to explore individual and collaborative ways to enhance intensive care nurse work well-being across a range of levels. RELEVANCE TO CLINICAL PRACTICE: Opportunities for job crafting and redesign were identified and presented in a conceptual model of intensive care nurse work well-being. This model provides individual nurses, intensive care teams, health care organizations, and workers' well-being programme and policy developers practical opportunities to explore individual and collaborative ways to enhance intensive care nurse work well-being.

Intensive care nurses' well-being: A systematic review.

BACKGROUND AND PURPOSE: Unique work challenges of intensive care nurses can cause both stress and distress to nurses, evident in prevailing literature regarding burnout, compassion fatigue, and moral distress. Identifying factors contributing to intensive care nurses' well-being would complement this focus on nurse ill-being, supporting the development of workplace well-being initiatives. The review seeks to balance the existing negatively skewed evidence base by investigating intensive care nurses' well-being rather than ill-being. OBJECTIVES: The objective of this review was to systematically identify, appraise, and synthesise primary research reporting intensive care nurses' well-being. METHODS: The electronic search strategy included (1) bibliographic databases for published work and (2) forward and backward citation searches. Key search terms included [critical OR intensive] AND [nurs*] AND [well*]. Inclusion criteria were as follows: (1) population: critical or intensive care nurses working with adult or mixed adult and paediatric patients, (2) study type: primary research studies, (3) outcome: intensive care unit nurses' well-being, and (4) publication available in the English language. Studies were excluded if the group of intensive care nurses was not independently reported. Included studies were critically appraised, and results were synthesised and presented descriptively. Semantics of the included studies were explored to identify frequently used terms. RESULTS: Four primary research studies met the inclusion criteria, focussing on spiritual well-being, team commitment, emotional well-being, and the effects of a mindfulness programme. The studies were heterogeneous in terms of study focus, definitions, and measures, with small sample sizes, and of variable quality and generalisability. CONCLUSIONS: The well-being of intensive care nurses is currently understudied. Conceptualising intensive care nurses' well-being, understanding correlates of well-being, and testing workplace interventions to improve well-being remain significant opportunities for future research.

'Yarn about it': Aboriginal Australian women's perceptions of the impact of routine enquiry for intimate partner violence.

Aboriginal women globally are disproportionately affected by intimate partner violence (IPV) and face additional barriers to help-seeking. It is crucial that interventions for IPV are made safe for Indigenous women, given inflated rates of statutory intervention and widespread institutional racism. As part of a larger study of antenatal IPV screening, we interviewed 12 Aboriginal Australian women about the perceived impact of an antenatal IPV routine enquiry intervention. Seven women reported positive impact, and five women reported the absence of positive impact. Qualitative comparative analysis was used to map pathways to perceived impact. Cultural safety - the practice of countering tendencies in health care that undermine safety - was a key condition for positive impact. Others included: (i) continuity of care; (ii) asking about abuse without judgement and with care; and (iii) support and validation. Absence of these factors also typified pathways for nil positive impact. Naming the abuse, a sense of connection, unburdening, taking steps to safety and enabling informed care were all reported benefits. Two women reported explicitly negative impacts: one noted a sense of intrusion, and the other, disengagement from the health service. Interventions for IPV have the potential to benefit Indigenous women where cultural safety is prioritised.

Patterns of Family and Intimate Partner Violence in Problem Gamblers.

While the evidence about the statistical co-occurrence of family violence and problem gambling is growing, the mechanism by which the two behaviours are related is less clear. This study sought to clarify the dynamics of the problem behaviours, including the role of gender in victimisation and perpetration of violence in the family. Two-hundred-and-twelve treatment seeking problem gamblers (50.5% females) were recruited for interviews about past year FV and IPV experiences. The interviews included questions about the types of FV and IPV using the HITS tool (Sherin et al. in Fam Med Kans City 30:508-512, 1998). The questions addressed multiple family members, the temporal order of violence and gambling and the perceived associations between the two behaviours. The result show that well over half (60.8%; 95 CI = 54.1-67.2) of the participants reported some form of violence in the past 12 months, with no gender differences in relation to perpetration and victimisation. Bidirectional violence (43.9%; 95 CI = 37.4-50.6) was significantly more common than 'perpetration only' (11.3%; 95 CI = 7.7-16.3) or 'victimisation only' (5.7%; 95 CI = 3.3-9.6). Violence was mostly verbal, although considerable rates of physical violence also featured in the responses. 'Participants' own gambling preceded violence in a majority of the interviews but a small group of IPV victims reported that being a victim had led to their problematic gambling. These results can be used inform prevention, better treatment matching and capacity building in family violence and problem gambling services, where a significant focus should be on situational IPV.

Working With Asian Language Interpreters in Qualitative Research: A Comparative Study.

Health researchers employ health interpreters for research interviews with linguistically diverse speakers. Few studies compare inconsistencies between different interpretations of the same interview data. We compared interpreted with independently reinterpreted English language transcripts from five in-home family interviews conducted in five different Asian languages. Differences included augmented, summarized, and/or omitted information. Researchers should ensure that they, and their interpreters, follow rigorous processes for credible qualitative data collection, and audit their interpreted data for accuracy. Different interpretations of the same data can be incorporated into analyses.

Bibliometric mapping of intensive care nurses' wellbeing: development and application of the new iAnalysis model.

BACKGROUND: Intensive care nurse wellbeing is essential to a healthy healthcare workforce. Enhanced wellbeing has widespread benefits for workers. Bibliometrics enables quantitative analysis of bourgeoning online data. Here, a new model is developed and applied to explore empirical knowledge underpinning wellbeing and intensive care nurse wellbeing in terms of size and impact, disciplinary reach, and semantics. METHODS: Mixed methods bibliometric study. Firstly, a new model coined 'iAnalysis' was developed for the analysis of published data. Secondly, iAnalysis was applied in two studies to examine wellbeing and ICU nurse wellbeing. Study one explored data from a title search with search terms [wellbeing OR well-being], identifying 17,543 records with bibliographic data. This dataset included 20,526 keywords. Of the identified records, 10,715 full-text manuscripts were retrieved. Study two explored data from a topic search with search terms [(intensive OR critical) AND (nurs*) AND (wellbeing OR well-being)], identifying 383 records with bibliographic data. This dataset included 1223 author keywords. Of the identified records, 328 full-text manuscripts were retrieved. RESULTS: Once data were collected, for size and impact, WoS Clarivate Analytics™ and RStudio™ were used to explore publication dates, frequencies, and citation performance. For disciplinary reach, RStudio™ (with the Bibliometrics™ package & Vosviewer™ plugin) was used to explore the records in terms of country of publication, journal presence, and mapping of authors. For semantics, once the bibliographic data was imported to RStudio™ (with the Bibliometrics™ package & Vosviewer™ plugin) keyword co-occurrences were identified and visualised. Full-text manuscripts were imported to NVivo™ to explore word frequencies of both the keywords and full-text manuscripts using the word frequency search. For both studies, records were predominantly published in the past 5 years, in English language, and from USA. The highest keyword co-occurrence for study one was "health and well-being", and for study two, "family and model". CONCLUSIONS: Terms commonly associated with 'illbeing', as opposed to 'wellbeing', were highly prevalent in both study datasets, but more so in intensive care nurse wellbeing data. Intensive care nurse wellbeing was virtually absent in this literature. The iAnalysis model provided a practice-friendly tool to explore a large source of online published literature.

Strengthening workplace well-being: perceptions of intensive care nurses.

BACKGROUND: Intensive care nursing is a professionally challenging role, elucidated in the body of research focusing on nurses' ill-being, including burnout, stress, moral distress and compassion fatigue. Although scant, research is growing in relation to the elements contributing to critical care nurses' workplace well-being. Little is currently known about how intensive care nurse well-being is strengthened in the workplace, particularly from the intensive care nurse perspective. AIMS AND OBJECTIVES: Identify intensive care nurses' perspectives of strategies that strengthen their workplace well-being. DESIGN: An inductive descriptive qualitative approach was used to explore intensive care nurses' perspectives of strengthening work well-being. METHOD: New Zealand intensive care nurses were asked to report strategies strengthening their workplace well-being in two free-text response items within a larger online survey of well-being. FINDINGS: Sixty-five intensive care nurses identified 69 unique strengtheners of workplace well-being. Strengtheners included nurses drawing from personal resources, such as mindfulness and yoga. Both relational and organizational systems' strengtheners were also evident, including peer supervision, formal debriefing and working as a team to support each other. CONCLUSIONS: Strengtheners of intensive care nurses' workplace well-being extended across individual, relational and organizational resources. Actions such as simplifying their lives, giving and receiving team support and accessing employee assistance programmes were just a few of the intensive care nurses' identified strengtheners. These findings inform future strategic workplace well-being programmes, creating opportunities for positive change. RELEVANCE TO CLINICAL PRACTICE: Intensive care nurses have a highly developed understanding of workplace well-being strengtheners. These strengtheners extend from the personal to inter-professional to organizational. The extensive range of strengtheners the nurses have identified provides a rich source for the development of future workplace well-being programmes for critical care.

Efficacy of a Web-Based Safety Decision Aid for Women Experiencing Intimate Partner Violence: Randomized Controlled Trial.

BACKGROUND: Intimate partner violence (IPV) is a human rights violation and leading health burden for women. Safety planning is a hallmark of specialist family violence intervention, yet only a small proportion of women access formal services. A Web-based safety decision aid may reach a wide audience of women experiencing IPV and offer the opportunity to prioritize and plan for safety for themselves and their families. OBJECTIVE: The aim of this study was to test the efficacy of a Web-based safety decision aid (isafe) for women experiencing IPV. METHODS: We conducted a fully automated Web-based two-arm parallel randomized controlled trial (RCT) in a general population of New Zealand women who had experienced IPV in the past 6 months. Computer-generated randomization was based on a minimization scheme with stratification by severity of violence and children. Women were randomly assigned to the password-protected intervention website (safety priority setting, danger assessment, and tailored action plan components) or control website (standard, nonindividualized information). Primary endpoints were self-reported mental health (Center for Epidemiologic Studies Depression Scale-Revised, CESD-R) and IPV exposure (Severity of Violence Against Women Scale, SVAWS) at 12-month follow-up. Analyses were by intention to treat. RESULTS: Women were recruited from September 2012 to September 2014. Participants were aged between 16 and 60 years, 27% (111/412) self-identified as Maori (indigenous New Zealand), and 51% (210/412) reported at baseline that they were unsure of their future plans for their partner relationship. Among the 412 women recruited, retention at 12 months was 87%. The adjusted estimated intervention effect for SVAWS was -12.44 (95% CI -23.35 to -1.54) for Maori and 0.76 (95% CI -5.57 to 7.09) for non-Maori. The adjusted intervention effect for CESD-R was -7.75 (95% CI -15.57 to 0.07) for Maori and 1.36 (-3.16 to 5.88) for non-Maori. No study-related adverse events were reported. CONCLUSIONS: The interactive, individualized Web-based isafe decision aid was effective in reducing IPV exposure limited to indigenous Maori women. Discovery of a treatment effect in a population group that experiences significant health disparities is a welcome, important finding. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000708853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000708853 (Archived by Webcite at http://www.webcitation/61MGuVXdK).

Exploring the complex pathway of the primary health care response to intimate partner violence in New Zealand.

BACKGROUND: Integrating sustainable responses to intimate partner violence in health care is a persistent and complex problem internationally. New Zealand holds a leading role, having established national health system infrastructure for responding to intimate partner violence within hospital and selected community settings. However, resources for, and engagement with, the primary health care sector has been limited. The present study focuses on what affects a sustainable response to intimate partner violence within New Zealand primary health care settings. METHODS: Utilising complexity theory, we reconceptualised a sustainable primary health care response to intimate partner violence as a complex adaptive system. To explore interactions between agents, we analysed the function(s) of key policy, strategy, guideline and evaluation documents informing intimate partner violence responsiveness in health care. We chronologically threaded these documents together by their function(s) to show how discourse influencing intimate partner violence responsiveness emerges from agent interactions. RESULTS: This paper presents a complexity informed implementation narrative of the New Zealand health system response to intimate partner violence across the last two decades, focused on the participation of the primary health care sector. We demonstrate how competing discourses have contributed to system gaps and unintended consequences over time. Our findings consider implications for a sustainable response to intimate partner violence in primary health care and call attention to system interactions that challenge a whole health system approach in New Zealand. CONCLUSIONS: Use of complexity theory facilitates an innovative perspective of a persistent and complex problem. Given the complexity of the problem and New Zealand's leadership, sharing the lessons learnt is critical for the international community involved in developing health care system approaches to intimate partner violence.

Evaluating fundamentals of care: The development of a unit-level quality measurement and improvement programme.

AIMS AND OBJECTIVES: The project aimed to develop a unit-level quality measurement and improvement programme using evidence-based fundamentals of care. BACKGROUND: Feedback from patients, families, whanau, staff and audit data in 2014 indicated variability in the delivery of fundamental aspects of care such as monitoring, nutrition, pain management and environmental cleanliness at a New Zealand District Health Board. DESIGN: A general inductive approach was used to explore the fundamentals of care and design a measurement and improvement programme, the Patient and Whanau Centred Care Standards (PWCCS), focused on fundamental care. METHODS: Five phases were used to explore the evidence, and design and test a measurement and improvement framework. RESULTS: Nine identified fundamental elements of care were used to define expected standards of care and develop and test a measurement and improvement framework. Four six-monthly peer reviews have been undertaken since June 2015. Charge Nurse Managers used results to identify quality improvements. Significant improvement was demonstrated overall, in six of the 27 units, in seven of the nine standards and three of the four measures. In all, 89% (n = 24) of units improved their overall result. CONCLUSION: The PWCCS measurement and improvement framework make visible nursing fundamentals of care in line with continuous quality improvement to increase quality of care. RELEVANCE TO CLINICAL PRACTICE: Delivering fundamentals of care is described by nurses as getting ?back to basics'. Patient and family feedback supports the centrality of fundamentals of care to their hospital experience. Implementing a unit-level fundamentals of care quality measurement and improvement programme clarifies expected standards of care, highlights the contribution of fundamentals of care to quality and provides a mechanism for ongoing improvements.

Intensive care nurse conceptions of well-being: a prototype analysis.

BACKGROUND: Accurately conceptualizing intensive care nurse work well-being is fundamental for successful engagement with workplace well-being interventions. Little is currently known about intensive care nurse work well-being. AIMS: The study aimed to identify intensive care nurses' conceptions of work well-being and ascertain whether the term 'work well-being' is prototypically organized. METHODS: Three linked studies conceptualize intensive care nurse well-being. For study one, participants listed key features of work well-being as free-text responses. Study two measured whether there was prototypical organization of these responses. Study three sought to confirm the prototypical organization of the term 'work well-being' through narrative ratings. RESULTS: A total of 82 New Zealand intensive care nurses were randomly allocated to the three studies; 65 participated. In study one (n = 23), the most frequently endorsed elements included: workload (n = 14), job satisfaction (n = 13) and support (n = 13). In study two (n = 25), the highest rated elements included: feeling valued, respect, support, work-life balance and workplace culture. Elements of support, work-life balance and workload were in the top five most frequently endorsed elements and were also rated in the top 12 most central. Overall, the ratings of centrality and number of endorsements were positively correlated (r = 0.35, P < 0.05). In study three (n = 17), nine participants selected the same rating across both narratives with no differentiation on the 11-point scale and were excluded from analysis. The mean score for the central narrative was 7.88 and for the peripheral narrative was 7.38. Confirmatory analyses did not reach statistical significance. CONCLUSIONS: Unique conceptions of work well-being were identified. Workload and work-life balance were central characteristics. Feeling valued and experiencing respect and support were considered most important. RELEVANCE TO CLINICAL PRACTICE: Intensive care nurse conceptions of work well-being are fundamental for future measures of work well-being and future interventional studies and initiatives.

Methodological and Ethical Challenges in a Web-Based Randomized Controlled Trial of a Domestic Violence Intervention.

The use of Web-based methods to deliver and evaluate interventions is growing in popularity, particularly in a health care context. They have shown particular promise in responding to sensitive or stigmatized issues such as mental health and sexually transmitted infections. In the field of domestic violence (DV), however, the idea of delivering and evaluating interventions via the Web is still relatively new. Little is known about how to successfully navigate several challenges encountered by the researchers while working in this area. This paper uses the case study of I-DECIDE, a Web-based healthy relationship tool and safety decision aid for women experiencing DV, developed in Australia. The I-DECIDE website has recently been evaluated through a randomized controlled trial, and we outline some of the methodological and ethical challenges encountered during recruitment, retention, and evaluation. We suggest that with careful consideration of these issues, randomized controlled trials can be safely conducted via the Web in this sensitive area.

Effectiveness of Primary Health Care Services in Addressing Mental Health Needs of Minority Refugee Population in New Zealand.

Many people are displaced from their country of origin and become refugees, mostly due to armed conflicts, political violence and human rights abuse. Refugees have complex mental, physical, and social health problems related to their traumatic background and the experiences they have endured during their refugee journey. The aim of this qualitative exploratory study was to examine the effectiveness of primary health care services in addressing mental health needs of Bhutanese refugee women resettled in New Zealand. This study included focus group discussion with Bhutanese women and men followed by interviews with health service providers. The findings of this study highlighted inadequacies and constraints in addressing Bhutanese refugee women's mental health needs in New Zealand and provided evidence for recommendations to address these inadequacies.

The health-systems response to violence against women.

Health systems have a crucial role in a multisector response to violence against women. Some countries have guidelines or protocols articulating this role and health-care workers are trained in some settings, but generally system development and implementation have been slow to progress. Substantial system and behavioural barriers exist, especially in low-income and middle-income countries. Violence against women was identified as a health priority in 2013 guidelines published by WHO and the 67th World Health Assembly resolution on strengthening the role of the health system in addressing violence, particularly against women and girls. In this Series paper, we review the evidence for clinical interventions and discuss components of a comprehensive health-system approach that helps health-care providers to identify and support women subjected to intimate partner or sexual violence. Five country case studies show the diversity of contexts and pathways for development of a health system response to violence against women. Although additional research is needed, strengthening of health systems can enable providers to address violence against women, including protocols, capacity building, effective coordination between agencies, and referral networks.