Prioritized strategies to improve diagnosis and early management of cerebral palsy for both Maori and non-Maori families.

AIM: To identify prioritized strategies to support improvements in early health service delivery around the diagnosis and management of cerebral palsy (CP) for both Maori and non-Maori individuals. METHOD: Using a participatory approach, health care professionals and the parents of children with CP attended co-design workshops on the topic of early diagnosis and management of CP. Health design researchers facilitated two 'discovery' (sharing experiences and ideas) and two 'prototyping' (solution-focused) workshops in Aotearoa, New Zealand. A Maori health service worker co-facilitated workshops for Maori families. RESULTS: Between 7 and 13 participants (14 health care professionals, 12 parents of children with CP across all functional levels) attended each workshop. The discovery workshops revealed powerful stories about early experiences and needs within clinician-family communication and service provision. The prototyping workshops revealed priorities around communication, and when, what, and how information is provided to families; recommendations were co-created around what should be prioritized within a resource to aid health care navigation. INTERPRETATION: There is a critical need for improved communication, support, and guidance, as well as education, for families navigating their child with CP through the health care system. Further input from families and health care professionals partnering together will continue to guide strategies to improve health care service delivery using experiences as a mechanism for change.

Patients' perspectives on digital health tools.

Objective: Digital technology has changed the way healthcare is delivered and accessed. However, the focus is mostly on technology and clinical aspects. This review aimed to integrate and critically analyse the available knowledge regarding patients' perspectives on digital health tools and identify facilitators and barriers to their uptake. Methods: A narrative review was conducted using the Scopus and Google Scholar databases. Information related to facilitators and barriers to uptake was synthesised and interpreted using thematic and content analyses, respectively. Results: Seventy-one out of 1722 articles identified were eligible for inclusion. Patient empowerment, self-management, and personalisation were identified as the main factors that contributed to patient uptake in using digital health tools. Digital literacy, health literacy, and privacy concerns were identified as barriers to the uptake of digital health technology. Conclusion: Digital health technologies have changed the way healthcare is experienced by patients. Research highlights the disconnect between the development and implementation of digital health tools and the patients they are created for. This review may serve as the foundation for future research incorporating patients' perspectives to help increase patients' engagement with emerging technologies. Innovation: Participatory design approaches have the potential to support the creation of patient-centred digital health tools.

Exploring the current and future osteoarthritis health service delivery needs in Aotearoa New Zealand.

AIM: Osteoarthritis (OA) affects the wellbeing of one in 10 people in Aotearoa New Zealand, yet current healthcare delivery for these people is fragmented, un-coordinated and inconsistent. How current and future needs should be addressed has not been systematically explored. This study aimed to describe the views of interested people from the health sector regarding current and future OA health service delivery in the public health system in Aotearoa New Zealand. METHOD: Data were collected via a co-design approach within an interprofessional workshop at the Taupuni Hao Huatau Kaikoiwi: Osteoarthritis Aotearoa New Zealand Basecamp symposium and analysed using direct qualitative content analysis. RESULTS: The results highlighted several promising current healthcare delivery initiatives. Health literacy and obesity prevention policies featured in the thematic analysis suggesting a lifespan or systemwide approach is needed. Data highlighted a need for reformed systems that enhances hauora/wellbeing, promotes physical activity, facilitates interprofessional service delivery and collaborates across care settings. CONCLUSION: Participants identified several promising healthcare delivery initiatives for people with OA in Aotearoa New Zealand. Public health policy initiatives are needed to reduce osteoarthritis risk factors. Developing future care pathways should support the diverse needs within Aotearoa New Zealand, coordinate and stratify care, value interprofessional collaboration and practice, and improve health literacy and self-management.

A Systematic Review of Patient and Caregiver Experiences with a Tracheostomy.

BACKGROUND: A tracheostomy is a surgically created opening through the anterior neck tissues and the trachea, into which a tube is inserted. Despite its influence on basic human needs such as respiration, communication and nutrition, little is known about the impact of tracheostomy on patients and their caregivers or what could be done to enable better care and quality of life (QoL) for these individuals. OBJECTIVE: The aim of this review was to better understand the current knowledge related to the experience and QoL of adults living with a tracheostomy and their caregivers so as to be able to improve these experiences. METHOD: A systematic review of the English-language, peer-reviewed literature was conducted in PubMed, Scopus, PsychINFO, Google Scholar, and CINAHL databases. Articles were eligible if they included adult patient or lay caregiver-reported experiences of tracheostomy. RESULTS: Overall, 1080 articles were identified and 17 eligible for inclusion. Fourteen articles reported on experiences of tracheostomy patients, while three focused on those of their caregivers. Studies were conducted in the home setting (n = 5), on a hospital ward (n = 4), in an intensive care unit (n = 3), in an outpatient clinic (n = 3), in a rehab facility (n = 1), and online (n = 1). Patients and their caregivers reported a range of mostly negative experiences related to the care, support, and management of a tracheostomy, speech and communication, wellbeing and QoL, disfigurement and body image, and stigma and social withdrawal. CONCLUSION: Few studies have published data on the patient and caregiver experiences with tracheostomy, especially in the community setting. There is a need to better understand these experiences in order to be able to formulate strategies and provide resources to improve the quality of care and overall QoL of patients with a tracheostomy and their caregivers in-hospital and in the community.

Assessing the similarity of mental models of operating room team members and implications for patient safety: a prospective, replicated study.

BACKGROUND: Patient safety depends on effective teamwork. The similarity of team members' mental models - or their shared understanding-regarding clinical tasks is likely to influence the effectiveness of teamwork. Mental models have not been measured in the complex, high-acuity environment of the operating room (OR), where professionals of different backgrounds must work together to achieve the best surgical outcome for each patient. Therefore, we aimed to explore the similarity of mental models of task sequence and of responsibility for task within multidisciplinary OR teams. METHODS: We developed a computer-based card sorting tool (Momento) to capture the information on mental models in 20 six-person surgical teams, each comprised of three subteams (anaesthesia, surgery, and nursing) for two simulated laparotomies. Team members sorted 20 cards depicting key tasks according to when in the procedure each task should be performed, and which subteam was primarily responsible for each task. Within each OR team and subteam, we conducted pairwise comparisons of scores to arrive at mean similarity scores for each task. RESULTS: Mean similarity score for task sequence was 87 % (range 57-97 %). Mean score for responsibility for task was 70 % (range = 38-100 %), but for half of the tasks was only 51 % (range = 38-69 %). Participants believed their own subteam was primarily responsible for approximately half the tasks in each procedure. CONCLUSIONS: We found differences in the mental models of some OR team members about responsibility for and order of certain tasks in an emergency laparotomy. Momento is a tool that could help elucidate and better align the mental models of OR team members about surgical procedures and thereby improve teamwork and outcomes for patients.

Self-reported health-related quality of life of mental health service users with serious mental illness in New Zealand.

INTRODUCTION: Although people with serious mental illness (SMI) have a high prevalence of physical illness, health-related quality of life (HQoL) has not been sufficiently explored. AIM: To explore the self-reported HQoL of mental health service users in New Zealand. METHODS: Responses on the Medical Outcomes Study 36 Item Short Form (SF-36) measure of HQoL from 404 adult mental health service users in a metropolitan district health board area in New Zealand were analysed and compared to a representative sample of the general population. RESULTS: Mental health service users scored significantly lower on all eight domains of the SF-36 than the general population, the largest difference being in the role limitation-emotional domain. DISCUSSION: Being female, younger than 25, obese or overweight, or of New Zealand European/Other ethnicity were associated with poorer functioning on multiple HQoL domains. Future studies should seek to understand the factors contributing to perceptions of HQoL of mental health service users in New Zealand.

Reporting of suicide by the New Zealand media.

BACKGROUND: Rates of suicide in New Zealand are high compared with those of other countries. International evidence suggests that the reporting of suicide may influence rates of suicidal behavior. No research exists, however, on the reporting of suicide by New Zealand media. AIMS: This study provides the first baseline picture of the reporting of suicide by New Zealand media. The overall objective was to use the findings to inform future development of media guidelines by the Ministry of Health. METHOD: Newspaper, Internet, television and radio news items on suicide were collected over 12 months. Descriptive statistical data on the nature and extent of the reporting of suicide were generated through content analysis of applicable items. A random sample of 10% was then subjected to a quality analysis to determine whether items aligned with the Ministry of Health's guideline for the reporting of suicide. RESULTS: A total of 3,483 items were extracted, most of which reported on an individual's attempted or completed suicide, while suicide methods were not often mentioned. Few items focused on people overcoming their difficulties or provided information to assist people struggling with suicidal ideation. CONCLUSIONS: The reporting of suicide by New Zealand media was extensive and generally of good quality. Better collaboration between the media and mental health professionals is needed, however, to increase information supplied within items on support services. More succinct guidelines and increased journalist awareness of their existence would also contribute to the quality of reporting on suicide.

New Zealand nurses' reports on hospital care: an international comparison.

Despite the differences in health care systems, nursing shortages and their contributing factors and consequences no longer seem to be solely country-specific. The present study replicated a cross-national study of nurses' perceptions of staffing, work organisation and outcomes conducted in more than 700 hospitals in the United States, Canada, England, Scotland, and Germany. This paper compares the 2001 New Zealand findings with the findings of the five-country study. New Zealand nurses report similar shortcomings in their work environment as do the nurses in countries with distinctly different health care systems. While they report similar high levels of competence and good relations between doctors and nurses as the respondents in the other five countries, higher numbers of New Zealand nurses 30 years of age or younger report their intention to leave their current jobs. New Zealand nurses also report the highest levels of job related stress, high levels of job dissatisfaction, and more than half report receiving inadequate organisational support. The implications of these findings are discussed in light of recent changes in the hospital environment.