Achieving peace and harmony in life: Thai Buddhists living with HIV/AIDS.

This study aimed to reveal the process of achieving peace and harmony in life by Thai Buddhists living with HIV/AIDS in Southern Thailand. Data were gathered from 28 Thai Buddhist participants aged 18 years or older, who had lived with HIV/AIDS for 5 years or more. Purposive, snowball and theoretical sampling techniques were used to recruit the participants. Data collection, using in-depth interviews, was carried out over a 7 month period between 2011 and 2012. Grounded theory was used to guide the process of data analysis. Two categories emerged to describe the core category 'Achieving Peace and Harmony in life': (i) understanding and accepting that nothing is permanent and (ii) living life with contentment. Findings are valuable for health professionals in enhancing peace and harmony for their patients.

Learning from people with chronic pain: messages for primary care practitioners.

INTRODUCTION: A large number of people live with chronic, non-malignant pain, which impacts on their work, social activity and quality of life. For many people pain appears to be inadequately treated and controlled, in part due to a reluctance to take appropriate medication. The aim of this study was to learn more about people's experience of pain in the context of long-term illness, in order to inform primary health care practice. METHODS: Twenty people previously identified from a survey about chronic illness care were interviewed about their pain-related experiences. Interviews were taped and transcribed and a thematic analysis was carried out to identify the key themes relating to practitioners' support of people with chronic pain. FINDINGS: Three main themes, which were common to all authors' analyses and are considered most relevant to practice, are presented and discussed. These themes were labelled 'medication concerns', which encompasses side-effects, reluctance to take pills and pain medication as a choice; 'coping with pain', including acceptance, pacing yourself and non-pharmaceutical pain relief; and 'seeking help for pain', which included negative and positive experiences and lack of care continuity. CONCLUSION: Pain limited how participants lived, yet many were reluctant to take pain relief as prescribed, if at all. They found other ways of coping, and accepted their pain. Messages for practitioners include the importance of asking people about their pain, listening and acknowledging the reality of pain and its effect on daily life and providing education, reassurance and support for taking pain medication.

Rural nurse to nurse practitioner: an ad hoc process.

INTRODUCTION: Despite a 10-year history of nurse practitioner (NP) development in New Zealand (NZ) there is no formalised or universal process for ensuring the transition of willing nurses to NP status. This unmet need is of particular interest in the rural context where workforce issues are paramount. The aim of this study was to explore the transition from rural nurse to NP in NZ. METHOD: A qualitative descriptive survey was sent to all NZ nurses with a rural address. Ninety-two questionnaires were returned, of which 21 respondents were working in a rural location and aiming to become an NP. Data analysis included description of demographic data and thematic analysis of open-ended question responses. FINDINGS: Four themes encompassed the experiences of the 21 potential NP candidates: uncertainty about opportunities for employment as an NP and legislative and funding barriers for NP practice; support or resistance from GPs and nurse colleagues, self-doubt, and the importance of mentoring; difficulties with the NP authorisation process; and meeting the NP competencies within the challenges imposed by rural location. CONCLUSION: At the systems level of workforce design, stronger linkages between policy development, investment, employment creation, funding streams, professional regulation and overall communication require attention.

Feelings of abandonment and quality of life among older persons in rural northeast Thailand.

The purpose of this study was to determine the extent to which older persons in rural Northeast Thailand felt abandoned by the emigration of their children and the impact this may have on their quality of life. A cross sectional survey, consisting of 113 questions including the 26-item WHOQOL-BREF and the 24-item WHOQOL-OLD was administered to 212 participants. Participants ranged in age from 60 to 107 with a mean age of 71. While only 9% were found to live alone, 20% stated that they felt abandoned to some degree. A one-way between groups MANOVA was conducted to determine if those who felt abandoned differed from those who did not on a single-item question of Overall QOL and the total scores for the WHOQOL-BREF and WHOQOL-OLD. A statistically significant difference was found between the groups on the combined dependent variable [F (3, 208) = 4.75, p = .003; Wilks' Lambda = .94]. When the results for each of the dependent variables were considered separately, statistically significant differences were found on the WHOQOL-BREF [F (1, 210) = 13.61, p < .001] and the WHOQOL-OLD [F (1, 210) = 9.85, p = .001] only.

The effects of staff education on the practice of 'specialling' by care assistants in an acute care setting.

This paper reports the results of a project aimed at decreasing the use of, and costs associated with, the practice of using care assistants to provide one-to-one observation or 'specialling' in five acute adult medical and surgical wards at a North Island hospital. Education sessions were provided to staff to prompt better management of patients receiving this level of observation. Using a time-series design, a retrospective study was completed for the six months pre- and six months post-intervention (staff education). Data were collected and analysed on all patients in the five acute wards who had required 'specialling' during the specified twelve-month period. Results showed that following the intervention there had been a reduction in the incidence and duration of 'specialling,' and a halving of costs associated with this practice. The findings have implications for patient management and cost effectiveness. Incident statistics were not retrospectively reviewed in this study.

The genesis of advanced nursing practice in New Zealand: policy, politics and education.

When New Zealand's first Nurse Practitioner was approved by the Nursing Council of New Zealand in December 2001, it was the centenary year of New Zealand nursing registration, but less than a decade after the commencement of New Zealand's first pre-registration nursing degrees. What were the conditions and forces in play that saw nursing achieve a new emphasis on advanced clinical education and practice, culminating in the development of an advanced, expanded scope of nursing practice? This contemporary historical study examines the professional and sectoral milieu of the 1990s and the turn of the 21st century, together with the policy initiatives undertaken to advance nursing in New Zealand during that period.

Culturally specific process measures to improve mental health clinical practice: indigenous focus.

OBJECTIVE: In New Zealand and Australia, a renewed emphasis on equity and efficiency in the provision of mental health care has seen outcomes-focused, culturally appropriate clinical practice become essential within mental health services. Ascertaining the degree to which quality improvement and monitoring systems are enhancing professional practice and patient outcomes, however, is hindered by the difficulty of measuring the process of quality care delivery. METHOD: This paper argues that it is the process of care delivery (i.e. what clinicians do to, and for, patients) that is critical to the effectiveness of treatment and the degree to which treatment either inhibits or promotes an improvement in mental health recovery. Identification of the underlying causes of poor achievement of process factors is likely to positively impact on things such as readmission rates, shared care initiatives, and ultimately patient recovery. Such attention could be the difference between low-quality service provision and a high-quality service provision with positive recovery outcomes for patients. RESULTS: Ascertaining the degree to which quality improvement and monitoring systems are enhancing professional practice and patient outcomes for indigenous people, however, is hindered by the difficulty of measuring such concepts. Australia has indeed embraced 'culturally appropriate' practice in recent years, but this appears to be piecemeal when compared with New Zealand. Certainly, there are inconsistent and variable approaches to cultural practices with indigenous people when comparing the two countries. CONCLUSIONS: Using evidence from a bicultural mental health nursing study that developed and validated generic and Mâori-specific (indigenous) clinical indicators for mental health nursing standards of practice in New Zealand, it is argued that the process of care delivery is equally as important as outcome measures when ascertaining the effectiveness of nursing care. Second, this paper contends that accurate process measures must be culturally responsive to indigenous and other ethnic groups.

Clinical indicators as measures of mental health nursing standards of practice in New Zealand.

This paper discusses the utility of Consumer Notes Clinical Indicators (CNCI) as a means to monitor mental health nursing clinical practice against the Australian and New Zealand College of Mental Health Nurses' (ANZCMHN) Standards of Practice for mental health nursing in New Zealand. CNCI are statements describing pivotal mental health nursing behaviours for which evidence can be found in the nurses' case notes. This paper presents 25 valid and reliable CNCI that can be used to monitor mental health nursing practice against the ANZCMHN's Standards of Practice for mental health nursing in New Zealand. The bicultural clinical indicators were generated in focus groups of Maori and non-Maori mental health nurses, prioritized in a three-round reactive Delphi survey of expert mental health nurses and consumers, pilot tested, and applied in a national field study. This paper reports the development and validation of the CNCI, for which achievement is assessed by an audit of the nursing documentation in consumer case notes. The CNCI were tested in a national field study of 327 sets of consumer case notes at 11 District Health Board sites. The results of the national field study show wide variation in occurrence of individual indicators, particularly in the areas of informed consent, information about legal rights, and provision of culturally safe and recovery-focused care. We discuss the implications of using the CNCI to assess the professional accountability of mental health nurses to provide quality care. Recommendations are made regarding the application of the clinical indicators and future research required, determining appropriate benchmarks for quality practice. The CNCI could be adapted for application in other mental health nursing and other mental health professional clinical settings.

The New Zealand development and trial of mental health nursing clinical indicators--a bicultural study.

This paper describes the development and validation of bicultural clinical indicators that measure achievement of mental health nursing practice standards in New Zealand (ANZMCHN, 1995, Standards of practice for mental health nursing in New Zealand. ANZCMHN, Greenacres). A four-stage research design was utilised including focus groups, Delphi surveys, a pilot, and a national field study, with mental health nurses and consumers as participants. During the national field study, consumer files (n=327) from 11 District Health Boards, and registered nurses (n=422) completed an attitude questionnaire regarding the regularity of specific nursing and service activities. Results revealed a variation in the mean occurrence of the clinical indicators in consumer case notes of 18.5-89.9%. Five factors with good internal consistency, encompassing domains of mental health nursing required for best practice, were derived from analysis of the questionnaire. This study presents a research framework for developing culturally and clinically valid, reliable measures of clinical practice.