Approaches to visual arts-based data collection with hospitalized children: A discussion of lessons learnt and suggestions for practice.

AIMS: To discuss the experience in using a visual arts-based method of draw and talk with hospitalized children, lessons learnt and strategies for practice. DESIGN: Discussion paper. DATA SOURCES: Data were drawn from two sources: first, the databases Ovid MEDLINE, CINAHL, and SCOPUS were searched for approaches to visual arts- based data collection with children. Secondly, relevant literature and the experience of our research team using visual arts-based data collection with children informed this paper. IMPLICATIONS FOR NURSING: This paper draws on the literature and our experiences of using a visual arts-based approach when conducting research with hospitalized children and foreshadows practical approaches that can be applied when undertaking such research. CONCLUSION: When undertaking research with sick children a high level of reflexivity is essential when planning and implementing a visual arts-based approach. IMPACT: The paper discusses a visual arts-based method and the issues that are important considerations to the conduct of research with hospitalized children. We provide suggestions for practice and argue that nurses and healthcare professionals researching with hospitalized children using an arts-based method, practice a high level of reflexivity.

Exploring the impacts of mindfulness and yoga upon childbirth outcomes and maternal health: an integrative review.

BACKGROUND: Foetal development and the long-term outcomes of the infant are influenced by the intrauterine environment. Strategies to enhance maternal health in pregnancy are needed to improve health outcomes for childbearing women and babies, advancing the well-being of our general population. AIM: To synthesise the existing literature to determine the impacts of mindfulness and yoga practice upon birth outcomes and maternal health. METHODS: An integrative literature review using Whittemore and Knafl's framework was undertaken in 2016-2017. Two search strategies included database peer-reviewed journal articles and ancestry searching, that is exploring the reference list of relevant research articles. After screening and checking the eligibility, a total of 12 articles were included in this review. Data analysis involved coding, visual displays, thematic analysis and comparison, and conclusion drawing. RESULTS: The results of this review identified a broad theme that mindfulness and yoga practice is associated with improved maternal mental health antenatally and postnatally. Subthemes have been presented under the central theme including the following: increased mindfulness correlates with decreased fear of childbirth; reduced symptoms of anxiety and depression; and supportive group settings found to be beneficial by pregnant women. CONCLUSION: The evidence presented in this review suggests that mindfulness and yoga practice are feasible and cost-effective interventions to enhance maternal mental health, particularly for women experiencing mental health challenges. Mindfulness and yoga practised regularly in the antenatal period can significantly promote the health of pregnant women and potentially their developing babies.

Real-life experiences of people with transient ischaemic attack or minor stroke: A qualitative literature review.

AIMS AND OBJECTIVES: To explore and present findings of qualitative studies exploring real-life experiences of people with transient ischaemic attack or minor stroke. BACKGROUND: Transient ischaemic attack and minor stroke significantly increase the risk of stroke. Primarily, literature has examined healthcare pathways, patient outcomes and models of care through quantitative methodologies. Several studies have explored patient experiences using qualitative approaches. However, these findings have not been systematically collated or critically appraised to better understand the experiences of this population. DESIGN: A literature review of the qualitative evidence. METHOD: A systematic literature search was conducted in CINAHL, MEDLINE, EMBASE and PsycINFO between January 2005-October 2016 to identify qualitative studies that explored real-life experiences of people with transient ischaemic attack or minor stroke. The relevant EQUATOR guidelines were followed. Findings of relevant studies were critically appraised and collated using a thematic approach. RESULTS: The search retrieved 709 articles. Twelve articles were included after critical review. Three themes emerged including recognition, awareness and action; the vulnerable self; and social and personal life change. Participants experienced ongoing vulnerability and change in their personal and social lives. Specifically, people believed that their condition did not reflect their physical appearance and led to their needs being unmet by health professionals. CONCLUSIONS: This is the first review of the literature to collate the thoughts, perspectives and experiences of people living with transient ischaemic attack or minor stroke. They reveal a complex, life-altering experience characterised by vulnerability, instability and change. Education that assists clinicians to connect with these experiences may alleviate the patient-reported disconnection with health professionals. RELEVANCE TO CLINICAL PRACTICE: Physical and psychosocial dysfunctions were consistently reported to be overlooked or undetected by clinicians. Educating clinicians might enable them to better understand patient experiences, improve therapeutic interactions and meet the needs of this population.

Tai chi and yoga in residential aged care: Perspectives of participants: A qualitative study.

AIMS AND OBJECTIVES: This qualitative study examined the appropriateness and acceptability of 14-week modified tai chi and yoga programmes in an Australian residential aged care (RAC) setting by exploring experiences and perspectives of frail older residents and staff participants. BACKGROUND: Older persons in RAC have limited opportunities for physical activity. Tai chi and yoga are mindfulness-based exercise interventions that have been used to promote physical and psychological health of older adults in community settings. While research on tai chi and yoga interventions in community settings is promising, there is limited research regarding the interventions' appropriateness and acceptability for frail older residents in residential care settings in Australia. DESIGN: Descriptive and qualitative component of a mixed-methods study. METHODS: All residents who participated in the modified yoga and tai chi interventions and staff who supported them were invited. A total of 19 individuals comprising 16 residents and three staff members participated in three focus group interviews. The interviews were audio-recorded, transcribed and analysed thematically using a qualitative descriptive approach. RESULTS: Nine themes that reflected the uniqueness of the programmes' mind-body approach are presented: (a) novel, new and exciting; (b) smoothness, rhythm and flow; (c) slow and mindful; (d) gentle but rewarding; (e) moving whole body; (f) perceived benefits; (g) worthwhile; (h) feeling alive; and (i) calming and relaxing. CONCLUSIONS: The modified programmes of tai chi and yoga was acceptable, appropriate, enjoyable and helpful. Both tai chi and yoga appear to provide appropriate physical exercise and opportunities for older persons to enhance their quality of life through interaction of physical, emotional and intellectual wellness domains. RELEVANCE TO CLINICAL PRACTICE: The 14-week modified programmes of tai chi and yoga could be applied to frail older RAC population to promote health and active ageing.

Analysis of the Empathic Concern Subscale of the Emotional Response Questionnaire in a Study Evaluating the Impact of a 3D Cultural Simulation.

Abstract Background Empathic concern has been found to decline in health professional students. Few effective educational programs and a lack of validated scales are reported. Previous analysis of the Empathic Concern scale of the Emotional Response Questionnaire has reported both one and two latent constructs. Aim To evaluate the impact of simulation on nursing students' empathic concern and test the psychometric properties of the Empathic Concern scale. Methods The study used a one group pre-test post-test design with a convenience sample of 460 nursing students. Empathic concern was measured pre-post simulation with the Empathic Concern scale. Factor Analysis was undertaken to investigate the structure of the scale. Results There was a statistically significant increase in Empathic Concern scores between pre-simulation 5.57 (SD = 1.04) and post-simulation 6.10 (SD = 0.95). Factor analysis of the Empathic Concern scale identified one latent dimension. Conclusion Immersive simulation may promote empathic concern. The Empathic Concern scale measured a single latent construct in this cohort.

Survivors' quality of life after cardiopulmonary resuscitation: an integrative review of the literature.

BACKGROUND: The incidence of cardiac arrest and cardiopulmonary resuscitation continues to increase worldwide largely due to greater awareness of the symptoms of cardiac events and increased attention to cardiopulmonary resuscitation training in the community. Globally, predicted survival rates after cardiopulmonary resuscitation have remained at 10% for decades and although patient outcome remains unpredictable, there is a positive trend in life expectancy. For a resuscitation attempt to be classed as successful, not only survival but also quality of life has to be evaluated. AIM: The aim of this review was to examine literature that explores the quality of life (QOL) for survivors' after CPR and the influence cognitive impairment, anxiety, depression and post-traumatic stress disorder (PTSD) has had on their QOL. REVIEW METHODS: This review follows Whittemore and Knafl's framework for an integrative literature review. Electronic databases EBSCO, Ovid, PubMed and EMBASE were searched. After application of the inclusion and exclusion criteria, thirty-six papers published from January 2000 to June 2015 were included in this review. RESULTS: These papers represent a broad spectrum of research evaluating quality of life for survivors of cardiopulmonary resuscitation. The heterogeneous research methods and vast number of different research tools make it challenging to compare the findings. The majority of papers concluded that quality of life for survivors of cardiac arrest and cardiopulmonary resuscitation was generally acceptable. However, studies also described survivors' experience of anxiety, depression, post-traumatic stress and cognitive dysfunction. CONCLUSION: A majority of papers reported an acceptable quality of life if the patient survived to hospital discharge. The heterogeneity in quantitative papers was noticeable and indicates a marked variance in patient outcomes. This review highlights the absence of specialized tools used to investigate survivors' experience of the event. Further exploration of the impact cardiopulmonary resuscitation has on the individual may improve ongoing rehabilitation and quality of life levels for survivors.

Home care packages: insights into the experiences of older people leading up to the introduction of consumer directed care in Australia.

This paper reports phase one, conducted from March to June 2015, of a two-phase, qualitative descriptive study designed to explore the perceptions and experiences of older people before and after the introduction of consumer directed care (CDC) to home care packages (HCP) in Australia. Eligible consumers with a local HCP provider were mailed information about the study. Data collection occurred before the introduction of CDC and included face-to-face, in-depth interviews, summaries of interviews, field notes and reflective journaling. Semi-structured questions and 'emotional touchpoints' relating to home care were used to guide the interview conversation. Line-by-line data analysis, where significant statements were highlighted and clustered to reveal emergent themes, was used. Five older people, aged 81 to 91 years, participated in the study. The four emergent themes were: seeking quality and reciprocity in carer relationships; patchworking services; the waiting game; and technology with utility. Continuity of carers was central to the development of a trusting relationship and perceptions of care quality among older consumers. Care coordinators and workers should play a key role in ensuring older people receive timely information about CDC and their rights and responsibilities. Participants' use of contemporary technologies suggests opportunities to improve engagement of HCP clients in CDC.

Australian nursing students' stories of end-of-life care simulation.

Because nurses are at the forefront of end-of-life care, it is imperative that nursing students are prepared for this role upon graduation. Research suggests that many nursing students are unprepared to deliver compassionate and quality end-of-life care. There have been many attempts to address this need; one emerging method is end-of-life care simulation. This paper explores the experiences of 18 undergraduate nursing students of end-of-life care simulation. Participants' stories were obtained via observation during end-of-life care simulation, audio-recorded post simulation debriefing, and semi-structured interviews. Using Clandinin and Connolly's three dimensions of Narrative Inquiry (temporality, spatiality, and sociality) participants' stories reflected convergence of time, place, and person. Findings revealed three distinct plotlines along a time continuum, specifically surrounding time of death: (i) "The privilege of end-of-life care;" (ii) "Witnessing death as surreal;" and (iii) "The honor of providing after-death care." Participants' narratives suggest that end-of-life care simulation is an important means of preparing students for clinical end-of-life care experiences. This has implications for nursing educators wishing to consider simulation in end-of-life care education.

Living within stories: Exploring the experiences of people with transient ischemic attack.

A transient ischemic attack (TIA) significantly increases a person's risk of ischemic stroke. However, little is known about the experiences of these people or what influences their decision to access care. This article explores the stories of three people who experienced a TIA. All participants were interviewed after receiving a diagnosis of TIA by a specialist neurologist. By utilizing a framework of narrative inquiry, several storylines were revealed across temporal, social, and geographical landscapes. The main storylines include: bodily disruption, time stasis, altered temporal perceptions, the roles of others, and help-seeking behavior. The primary author also reflects upon his own origin and explores how this inquiry has influenced his perceptions, career, and nursing practice. This inquiry may assist healthcare workers to gain insight into the experiences of people with TIA and suggests how involvement of significant others is beneficial when educating people at risk of TIA.

Measuring the impact of a 3D simulation experience on nursing students' cultural empathy using a modified version of the Kiersma-Chen Empathy Scale.

AIMS AND OBJECTIVES: To determine the effect of immersive 3D cultural simulation on nursing students' empathy towards culturally and linguistically diverse patients. BACKGROUND: Accelerated globalisation has seen a significant increase in cultural diversity in most regions of the world over the past forty years. Clinical encounters that do not acknowledge cultural factors contribute to adverse patient outcomes and health care inequities for culturally and linguistically diverse people. Cultural empathy is an antecedent to cultural competence. Thus, appropriate educational strategies are needed to enhance nursing students' cultural empathy and the capacity to deliver culturally competent care. DESIGN: A one-group pretest, post-test design was used for this study. The simulation exposed students to an unfolding scene in a hospital ward of a developing county. METHODS: A convenience sample of second-year undergraduate nursing students (n = 460) from a semi-metropolitan university in Australia were recruited for the study. Characteristics of the sample were summarised using descriptive statistics. T-tests were performed to analyse the differences between pre- and post simulation empathy scores using an eight item modified version of the Kiersma-Chen Empathy Scale. RESULTS: Students' empathy towards culturally and linguistically diverse patients significantly improved after exposure to the 3D simulation experience. The mean scores for the Perspective Taking and Valuing Affective Empathy subscales also increased significantly postsimulation. CONCLUSIONS: The immersive 3D simulation had a positive impact on nursing students' empathy levels in regards to culturally and linguistically diverse groups. Research with other cohorts and in other contexts is required to further explore the impact of this educational approach. RELEVANCE TO CLINICAL PRACTICE: Immersive cultural simulation experiences offer opportunities to enhance the cultural empathy of nursing students. This may in turn have a positive impact on their cultural competence and consequently the quality of care they provide to culturally and linguistically diverse patients.

Nurses' stories of a 'Fairy Garden' healing haven for sick children.

AIMS AND OBJECTIVES: To report on the stories of registered nurses and nurse administrators in a Thai hospital that recently constructed a healing haven environment called a 'Fairy Garden' to support the formal and informal activities of sick children. BACKGROUND: While there has been some research into healing environments in health for adults, there has been no qualitative research into healing environments such as natural gardens for children. DESIGN: Narrative inquiry was selected to capture the holistic notion of the participant's experience. Clandinin's narrative inquiry framework involving three dimensions sociality, space and temporality was used to analyse the data. METHODS: Eight nurses (including two head nurses, three ward nurses and three nurse administrators) were interviewed in three separate focus groups between November 2011-June 2012. RESULTS: Findings included storylines/threads of happiness, relaxation and calmness, imagination, spirituality and cooperation in reporting observed responses of sick children to the 'Fairy Garden'. Importantly, play was seen as a distractor from the children's pain and illness, with the children's ward no longer viewed as simply a clinical hospital site. Rather the opportunities that were afforded to children to interact with the 'Fairy Garden' environment expanded their hospital experience to include play, social interaction and educational activities. CONCLUSION: The Nurses' stories capture numerous storylines and threads in which the 'Fairy Garden' becomes an environment beyond the constraints of the hospital ward. Storylines indicate increased acceptance and adherence to treatment as the 'Fairy Garden' opens up alternatives for children, especially those children long term in the hospital. Children exhibit behaviours that suggest the 'Fairy Garden' supports psycho-social and physical benefits that improve their hospital stay and provide potential for improved clinical outcomes. RELEVANCE TO CLINICAL PRACTICE: Designed hospital environments need to consider the addition of natural and activity spaces to support sick children and their families. Reports from nurses caring for children indicate benefits of the natural environment outside the clinical area.

Nutrition and hydration in dying patients: the perceptions of acute care nurses.

AIMS AND OBJECTIVES: To explore the perceptions of nurses regarding the provision and nonprovision of medical nutrition and hydration during the end stage of life when death is imminent in the acute care setting. BACKGROUND: When people are dying, they often experience a loss of appetite and desire for drinking which are natural processes at this time. The cessation of eating and drinking challenges both family members and clinical staff. This article builds on previous studies that describe the perceptions of medical doctors and palliative care nurses regarding medical nutrition and hydration during the end stage of life when death is imminent. DESIGN: Qualitative descriptive design. METHODS: This study included three focus group meetings with ten nurses in an acute care setting in medical, oncology and haematology units. An interview schedule was used to guide the discussions. RESULTS: The main theme to emerge from this study was 'finding a comfort space/ambiguous spaces of unrest' that included four subthemes: (1) limited involvement in decision-making, (2) comfort vs. discomfort, (3) uncertainty and (4) the comfort of withdrawing treatment. Finding a comfort space captures the challenges nurses faced when speaking about the concerns of patients and family. In this space, there were ambiguities that created unease and unrest: a reluctance to talk about death; a reluctance to engage with the patient and the family. CONCLUSIONS: Acute care nurses need to be more cognisant of the palliative approach to care and become more engaged with decision-making during the end stage of life when death is imminent. RELEVANCE TO CLINICAL PRACTICE: Nurses in acute care settings need to be involved in decision-making and advocate for patients and family during the dying phase. Nurses in acute care need better understanding about the palliative approach to care and nutrition and hydration for people who are dying.

Awakening to the other: reflections on developing intercultural competence through an undergraduate study tour.

For the past 4 years, undergraduate students from the Faculty of Health, University of Newcastle, Newcastle, Australia, have undertaken a two week cultural study tour in Thailand, being exposed to a broad range of cultural interactions, health settings in rural and remote areas, and health-treatment approaches, including traditional and complementary therapies. Student evaluations and reflections were collected after the 2010 and 2011 study tours. This paper reports on findings following thematic analysis of the data, which identified central themes, including connectivity to others, "awakenings", "embodiment", and looking to the future. Findings included a recognition by students of a growth in awareness and change in perspective, which they felt would impact on their future approach in caring for patients from culturally- and linguistically-diverse backgrounds. We conclude that the study tour provided an effective way of sensitizing students to cultural differences and promoting cross-cultural awareness.

A student's perspective of managing data collection in a complex qualitative study.

AIM: To highlight from a doctoral student's perspective some of the unexpected and challenging issues that may arise when collecting data in a complex, qualitative study. BACKGROUND: Using a qualitative approach to undertaking a PhD requires commitment to the research topic, the acquisition of a variety of research skills and the development of expertise in writing. Despite close research supervision and guidance, the first author of this paper experienced unexpected hurdles when collecting data. This article highlights these hurdles and compares them with similar and dissimilar challenges raised by a social researcher with 30 years' experience (White 2012). DATA SOURCES: The first author's experience of field research during her PhD candidature. REVIEW METHODS: Informed by a critical theoretical perspective, a snowballing technique was used to examine issues related to data collection by a doctoral student in a qualitative research study. DISCUSSION: The first author found the logistics of qualitative data collection, concerns about transparency, role confusion and power differentials with participants, and the effective use of video recording technology, unexpectedly challenging. Many of these issues are highlighted in the literature and/or during research supervision. However, the student researcher remains a novice when entering the field. It is often only on reflection after encountering the hurdle that the student recognises future pre-emptive or alternative methods of data collection. CONCLUSION: The challenges faced as a doctoral student managing the data collection phase of the study concurred with White's discussion of some of the 'real life challenges that novice researchers might face' (2012). Specific guidance and prudence are needed by research students to know when enough data have been collected for manageable analysis within the limits of candidature. Use of reflexivity and mindfulness practised by the student during this phase assisted the ability to reflect, respond and learn from issues as they arose and aim for a harmonious work, study and life balance. IMPLICATIONS FOR PRACTICE/RESEARCH: This paper highlights these issues and offers suggestions for other research higher degree students facing similar challenges when collecting data in a complex qualitative study.

The influence of tai chi and yoga on balance and falls in a residential care setting: A randomised controlled trial.

Abstract Falls amongst older people is a global public health concern. Whilst falling is not a typical feature of ageing, older people are more likely to fall. Fall injuries amongst older people are a leading cause of death and disability. Many older people do not do regular exercise so that they lose muscle tone, strength, and flexibility which affect balance and predispose them to falls. The management of falls in residential care settings is a major concern with strategies for prevention and monitoring a focus in this setting. Yoga and tai chi have shown potential to improve balance and prevent falls in older adults. They also have potential to improve pain and quality of life. The aim of this study was to determine the feasibility of conducting a three-arm randomised controlled trial (RCT) with frail older people in a residential care setting to test the hypothesis that a 14-week modified tai chi or yoga programme is more effective than usual care activity in improving balance function, quality of life, pain experience and in reducing number of falls. There were no statistically significant differences between the three groups in the occurrence of falls. Yoga demonstrated a slight decrease in fall incidence; quality of life improved for the tai chi group. Only the yoga group experienced a reduction in average pain scores though not statistically significant. The findings of the study suggest it is possible to safely implement modified yoga and tai chi in a residential care setting and evaluate this using RCT design. They show positive changes to balance, pain and quality of life and a high level of interest through attendance amongst the older participants. The results support offering tai chi and yoga to older people who are frail and dependent with physical and cognitive limitations.

Considering Aboriginal palliative care models: the challenges for mainstream services.

This review discusses palliative care and end-of-life models of care for Aboriginal people in the Australian state New South Wales, and considers Aboriginal palliative care needs by reflecting on recent literature and lessons derived from Aboriginal consultation. Aboriginal people in Australia account for a very small proportion of the population, have poorer health outcomes and their culture demonstrates a clear resistance to accessing mainstream health services which are viewed as powerful, isolating and not relevant to their culture, way of life, family and belief systems. Aboriginal people regard their land as spiritual and their culture dictates that an Aboriginal person needs to know their origins, emphasising the value placed on kin and also demonstrating a strong desire to remain within their own country. Currently Aboriginal people tend to not access palliative care services in mainstream facilities; and there is very little data on Aboriginal admissions to palliative care centres. Over the last two decades only two models of palliative care focusing on and developed in Aboriginal communities have been implemented. The seminal contribution to Aboriginal Palliative Care was in the form of a resource kit developed to support palliative care providers to examine their practice for cultural appropriateness for Aboriginal and Torres Strait Islanders. The 'living model' coming from this project is adaptive and flexible, enabling implementation in different Aboriginal country as a participative process with community input. The Australian government's National Indigenous Palliative Care Needs Study similarly indicated that Australian empirical research on Aboriginal palliative care service provision is in its infancy, and comprehensive data on the rates of Aboriginal access to palliative care services did not exist. What literature does exist is drawn together in an argument for the development and need for culturally specific Aboriginal palliative care models, which are culturally appropriate, locally accessible and delivered in collaboration and partnership with Aboriginal controlled health services. This is essential because Aboriginal people are a minority cultural group who are disconnected from mainstream health service delivery, and have a sense of cultural isolation when accessing mainstream services. It is preferable that palliative care is delivered in a collaboration between Aboriginal Controlled Health Service and mainstream palliative care services to ensure a dignified end of life for the Aboriginal person. These collaborations and partnerships are fundamental to ensure that a critical mass of Aboriginal clinicians are trained and experienced in end of life care and palliation. Developing palliative care programs within Aboriginal communities and training Aboriginal Health Workers, promoted and developed in partnership with the Aboriginal community, are important strategies to enhance palliative care service provision. Further partnerships should be championed in this collaborative process, acknowledging a need for palliative care models that fit with Aboriginal peoples' community values, beliefs, cultural/ spiritual rituals, heritage and place.

Complementary therapies in rehabilitation: stroke patients' narratives. Part 2.

AIMS AND OBJECTIVES: To document the narratives of nursing staff and patients in a Thailand Rehabilitation Centre where complementary therapies are used and to discuss perceived progress of these stroke patients. Specific complementary therapies used at this Rehabilitation Centre include Thai massage and herbal therapies. BACKGROUND: Whilst there has been a small amount of quantitative research on stroke patients and complementary therapies there has been no qualitative research on the experience of stroke patients and the use of complementary therapies. DESIGN: Qualitative pilot study using narrative inquiry and discourse analysis framed by poststructural theory. METHOD: Six stroke patients were interviewed about their involvement in complementary therapy practice and treatments and their experiences of these therapies in rehabilitation. RESULTS: This study represents a reflective mining of patients' stories and captures the main theme of changes in stroke patients' embodiment and a main discourse of attending to and enabling progress. Throughout the storylines there are many other discourses such as hope, desire, helplessness, despair, fear, motivation, gratefulness, gladness and fragility. CONCLUSION: Threaded throughout the stroke patients' stories of their rehabilitation there is a layering of discourses involving tensions and a longing to overcome their disability. There are twists and detours in their stories that show the complexity of the illness experience. Progress is not straightforward with a quick recovery. Many contexts or variables influence progress such as spatiality, temporality and people. RELEVANCE TO CLINICAL PRACTICE: What is offered here is the reality of the rehabilitation process for stroke patients. Through the use of narrative inquiry the contexts of people, spatiality (environment) and temporality (time) are an important part of rehabilitation process.

Complementary therapies in rehabilitation: nurses' narratives. Part 1.

AIMS AND OBJECTIVES: To document the narratives of nursing staff in a Thai rehabilitation centre where complementary therapies are used and to discuss perceived progress of these complementary therapies on stroke patients. Specific complementary therapies used at this rehabilitation centre include Thai massage and herbal therapies. BACKGROUND: In Thailand, there is cultural acknowledgement of a range of traditional therapies (including complementary therapies) widely used in Thai health care. For example, meditation enjoys wide acceptance in Thai culture and attracts strong participation from visitors to Thai Buddhist centres because of growing interest in developing a personal health regime for future preventative health problems. DESIGN: Qualitative study using narrative inquiry and discourse analysis framed by poststructural theory. METHOD: Six nursing staff and six stroke patients were interviewed about their involvement in complementary therapy practice and treatments and their experiences of these therapies in rehabilitation. This paper reports the six nurses' narratives of their involvement with patients and complementary therapies. RESULTS: The overall findings revealed two strong themes: nurses' professional landscape and changes in stroke patients' embodiment. These two themes were interwoven in a main discourse of nurses attending to and enabling holistic care. CONCLUSION: The contexts of temporality, spatiality and other people influencing the progress of patients' recovery are significant in this study. In particular, the findings illustrate the importance of the nurses' discourse in preparing stroke patients for a state of readiness to heal. RELEVANCE TO CLINICAL PRACTICE: The nurses' role becomes much more significant in health care as demonstrated through these stories. Their part in establishing a holistic approach through motivating, advising, educating, calming and imparting a sense of family enables a strong connection with mind, body and spirit potentiating recovery for stroke patients.

Rehabilitation of stroke patients using traditional Thai massage, herbal treatments and physical therapies.

OBJECTIVE: To determine quantitatively if a unique rehabilitation program using traditional Thai massage, herbal treatments and physical therapies could improve activities of daily living, mood and sleep patterns, and pain intensity of stroke patients over time. METHODS: This was a prospective cohort study, conducted over a three-month period. Patients were recruited from a 42-bed rehabilitation centre in Northern Thailand, which admits mainly stroke, head injury and spinal patients for rehabilitation. RESULTS: There were 62 patients enrolled in the study, with 55% being male. The average age of patients was 59 years and 63% were married. The average time since the initial stroke was 15 months. At baseline, the average Barthel Index score was 50.7, and the average emotion, pain and sleep scores were 2.6, 3.1, and 3.2, respectively. After adjusting for age, gender and time since initial stroke in the longitudinal model, the Barthel Index significantly improved by 6.1 points after one month (P<0.01) and by 14.2 points after three months (P<0.01); emotion significantly improved by 0.7 points after one month (P<0.01) and by 0.9 points after three months (P<0.01); pain significantly improved by 0.5 points after one month (P<0.01) and by 0.5 points after three months (P<0.01); sleep significantly improved by 0.5 points after one month (P<0.01) and by 0.6 points after three months (P<0.01). CONCLUSION: This unique stroke rehabilitation program has produced significant improvements in activities of daily living, mood, pain and sleep patterns of stroke patients. These findings warrant the need for further research to compare patients undergoing this program of rehabilitation with patients undergoing more conventional rehabilitation programs.

Death and dying in Australia: perceptions of a Sudanese community.

AIMS: The aims of this study were to obtain information to support Palliative Care healthcare workers to meet the needs of the Sudanese population in death, dying, and bereavement. BACKGROUND: Australia is a multicultural society and healthcare workers are faced with increasing numbers and diversity of immigrants to whom healthcare professionals strive to provide quality health care. METHODS: A qualitative interpretive approach was used with data collected from a sample of 15 participants during focus group discussions. Data were collected in 2008-2009, transcribed and analysed. RESULTS: The main themes and ideas identified in the dialogues were analysed under five main headings--Communication issues including disclosure and consent; Concepts of disease and illness; Attitudes towards medical treatments; Customs surrounding death, dying and bereavement; and Spiritual and religious issues. CONCLUSION: The cultures and traditions of African countries vary widely; this study provides a snapshot of the views of a Sudanese African community about death and dying in Australia.