This exploratory study investigated the strategies that eight older New Zealanders use to enable participation in day-to-day occupations that they need or want to do, in their homes and the community. The types of strategies older people use to overcome barriers to participation and manage limitations are not widely known or reported. Exploring strategies for participation employed by older people is important because the majority of older New Zealanders live in the community and their numbers are growing, and projected to reach 25% of the total population by the year 2051 (Ministry of Health, 2002). New Zealand’s Positive Ageing Strategy (Minister for Senior Citizens, 2001), advocates for a society where people can age positively, where they are highly valued and their participation encouraged. The literature relating to occupation, participation and health was explored, and provided some evidence that older people are developing strategies and, with some education, are able to manage their own health conditions. The assumption underpinning this study is that they are equally able to manage strategies for participation, particularly those devised by older people themselves. A qualitative descriptive methodology was used. The participants were selected following a presentation to a group of older adults and snowball recruitment. They were aged between 73 and 98 years old and were receiving assistance to live in community, which was taken to indicate they had experienced some limitation in, or barrier to their everyday activities, in response to which they might have discovered or developed coping strategies. Interviews were conducted in the participants’ homes, and analysed using a general inductive approach. Four main categories emerged; strategies for keeping me safe, strategies for recruiting and accepting help, strategies for meeting biological needs, and strategies for conserving resources. Overarching themes of managing and getting on with it, sprinkled with a sense of humour by some participants was present in the attitudes of many participants. The study revealed that this group of older people can and do use strategies to enable occupation in their everyday lives, which differ from those recommended by occupational therapists and other health professionals. This finding suggests that health professionals, policy makers and educators have much to learn from older people. The provision of help to older adults should take into consideration the importance of social interactions, not just the physical needs. There is a need for transport to be more readily available and affordable for older people to attend occupations that meet social needs. Health professionals complement the strategies developed by older people, and finding ways to combine the strategies should be developed. Listening to older adults’ current ways of managing and working with them to develop alternate, yet acceptable methods will provide a challenge. Health professionals should take a greater role in advocating for the social and transport needs of older adults. A self-management approach in education for older people, using peers and making use of existing education groups in the community and health system, is suggested. Education of those who engage with older people, such as carers, family, health professionals and community groups should include developing their skills in assisting older people to identify their strategies and developing strategies for the future.

This exploratory study investigated the strategies that eight older New Zealanders use to enable participation in day-to-day occupations that they need or want to do, in their homes and the community. The types of strategies older people use to overcome barriers to participation and manage limitations are not widely known or reported. Exploring strategies for participation employed by older people is important because the majority of older New Zealanders live in the community and their numbers are growing, and projected to reach 25% of the total population by the year 2051 (Ministry of Health, 2002). New Zealand’s Positive Ageing Strategy (Minister for Senior Citizens, 2001), advocates for a society where people can age positively, where they are highly valued and their participation encouraged. The literature relating to occupation, participation and health was explored, and provided some evidence that older people are developing strategies and, with some education, are able to manage their own health conditions. The assumption underpinning this study is that they are equally able to manage strategies for participation, particularly those devised by older people themselves. A qualitative descriptive methodology was used. The participants were selected following a presentation to a group of older adults and snowball recruitment. They were aged between 73 and 98 years old and were receiving assistance to live in community, which was taken to indicate they had experienced some limitation in, or barrier to their everyday activities, in response to which they might have discovered or developed coping strategies. Interviews were conducted in the participants’ homes, and analysed using a general inductive approach. Four main categories emerged; strategies for keeping me safe, strategies for recruiting and accepting help, strategies for meeting biological needs, and strategies for conserving resources. Overarching themes of managing and getting on with it, sprinkled with a sense of humour by some participants was present in the attitudes of many participants. The study revealed that this group of older people can and do use strategies to enable occupation in their everyday lives, which differ from those recommended by occupational therapists and other health professionals. This finding suggests that health professionals, policy makers and educators have much to learn from older people. The provision of help to older adults should take into consideration the importance of social interactions, not just the physical needs. There is a need for transport to be more readily available and affordable for older people to attend occupations that meet social needs. Health professionals complement the strategies developed by older people, and finding ways to combine the strategies should be developed. Listening to older adults’ current ways of managing and working with them to develop alternate, yet acceptable methods will provide a challenge. Health professionals should take a greater role in advocating for the social and transport needs of older adults. A self-management approach in education for older people, using peers and making use of existing education groups in the community and health system, is suggested. Education of those who engage with older people, such as carers, family, health professionals and community groups should include developing their skills in assisting older people to identify their strategies and developing strategies for the future.

This qualitative, descriptive study explored physiotherapists' experience of participating in peer review in public and private health services in New Zealand. Peer review is a professional activity where one health practitioner evaluates the practice of another. Accordingly, much professional effort has been expended on developing peer review systems and implementing review processes, yet the benefits of peer review are uncertain. A changing legislative environment where producing evidence of ongoing professional development is required, has provided impetus for this study given the limited research to support the use of peer review in this context. While the literature identifies competing focuses on professional development and accountability, there is lack of clarity about which model of peer review is being implemented in this country and which might serve the profession better. This study is a first step in clarifying the issues by identifying the personal, professional and organisational factors that influence health professionals' participation in peer review. The methodology consisted of a qualitative descriptive approach situated within a post positivist paradigm. Seven physiotherapists working in the New Zealand health system who had participated in a peer review process within the last 3 years participated in this study. Semi structured interviews were conducted, guided by broad questions relating to central themes identified during an extensive literature review. Interviews were then audio taped and transcribed verbatim to form the data. Transcripts were analysed by assigning content labels to units of text that seemed to encapsulate one complete thought or idea. The labelled groups were analysed into sub themes. Finally, the general themes that arose were described. Findings indicate that while peer review systems have been developed and are carried out as prescribed, therapists lack clarity about the intended outcomes. While recognising the benefits of receiving feedback on practice, many manage the review process to maintain positive working relationships and ensure their practice is favourably reviewed. The strategies they employ and the consequences of managing peer review in these ways are described. Current peer review processes in New Zealand do not provide reliable information about competence to practice. Neither do they fully achieve their potential as a professional development tool. Therefore, the professional emphasis and effort on peer review needs to be revisited. The findings highlight the need for consultation amongst individual physiotherapists, physiotherapy managers, physiotherapy professional organisations, and the registration board, to negotiate whether regulatory or professional development needs will drive peer review processes in New Zealand in the future.

This qualitative, descriptive study explored physiotherapists' experience of participating in peer review in public and private health services in New Zealand. Peer review is a professional activity where one health practitioner evaluates the practice of another. Accordingly, much professional effort has been expended on developing peer review systems and implementing review processes, yet the benefits of peer review are uncertain. A changing legislative environment where producing evidence of ongoing professional development is required, has provided impetus for this study given the limited research to support the use of peer review in this context. While the literature identifies competing focuses on professional development and accountability, there is lack of clarity about which model of peer review is being implemented in this country and which might serve the profession better. This study is a first step in clarifying the issues by identifying the personal, professional and organisational factors that influence health professionals' participation in peer review. The methodology consisted of a qualitative descriptive approach situated within a post positivist paradigm. Seven physiotherapists working in the New Zealand health system who had participated in a peer review process within the last 3 years participated in this study. Semi structured interviews were conducted, guided by broad questions relating to central themes identified during an extensive literature review. Interviews were then audio taped and transcribed verbatim to form the data. Transcripts were analysed by assigning content labels to units of text that seemed to encapsulate one complete thought or idea. The labelled groups were analysed into sub themes. Finally, the general themes that arose were described. Findings indicate that while peer review systems have been developed and are carried out as prescribed, therapists lack clarity about the intended outcomes. While recognising the benefits of receiving feedback on practice, many manage the review process to maintain positive working relationships and ensure their practice is favourably reviewed. The strategies they employ and the consequences of managing peer review in these ways are described. Current peer review processes in New Zealand do not provide reliable information about competence to practice. Neither do they fully achieve their potential as a professional development tool. Therefore, the professional emphasis and effort on peer review needs to be revisited. The findings highlight the need for consultation amongst individual physiotherapists, physiotherapy managers, physiotherapy professional organisations, and the registration board, to negotiate whether regulatory or professional development needs will drive peer review processes in New Zealand in the future.

A qualitative descriptive approach was undertaken to explore the leadership experience of seven first line nurse managers working in the Cook Islands. For the purposes of this study first line nurse managers are those nurses working as a charge nurse in a hospital, nursing supervisors, chief public health nurse, and nurses working autonomously in the outer islands of the Cook Islands. Nurses in these roles are in key positions to influence the practice of others and set the standard of practice and culture of a unit. The participants were recruited if they were currently employed in any of these positions. The seven participants were all Cook Islands women who received their undergraduate nursing education in the Cook Islands. The purpose of the study was to describe their leadership experience, to raise an awareness of their role, and to make recommendations to support and improve the preparation of nurses for leadership roles in the Cook Islands. Through face-to-face interviews, the participants' stories were audio taped and transcribed verbatim. Six of the seven transcripts required translation from Cook Islands Maori to English and this was conducted by the researcher who is fluent in both languages. Content and thematic analysis of the data revealed a spiritual, emotive and intuitive theme in the participants' leadership experience. The findings of the study revealed the self confidence of these nurses to manage in this role despite being challenged by management issues and the lack of preparedness for the role. The supportive network established within their staff, their family and the people around them has provided the impetus to continue to 'serve' their people. The findings also revealed that these nurses recognised the need to continue to learn and develop themselves and their staff. The findings of this study have significance for nurses aspiring to be nurse leaders in the Cook Islands or other Pacific Islands and rural communities. A key stakeholder in this study is the Cook Islands Ministry of Health, as insights and awareness gained can contribute to an appropriate preparation and support programme for nurses working in its organisation.

Good sexual and reproductive health is fundamental to the overall health status of Māori communities. In 2001, the Ministry of Health reported that New Zealand was facing a Chlamydia epidemic. This epidemic has not abated as rates of Chlamydia have increased significantly in the past five years, with disproportionately high rates in young Māori women compared to non-Māori women. Despite significant sexual health disparities, young Māori have had limited opportunities to participate in research focussed on sexual health and voice their opinions and concerns on sexual health issues. This qualitative descriptive study has used a Māori inquiry paradigm and approached the research from a Kaupapa Māori perspective. The primary research question asked what the knowledge, attitudes and reported behaviours of young urban Māori women were in regards to sexual health and in particular, the sexually transmitted infection Chlamydia. Secondary aims were to ascertain the sources of information used and accessibility of sexual health services, as well as identifying resilience factors associated with protection against Chlamydia infection. The data was collected from semi-structured interviews with 16 young Māori women living in the Auckland region. Data analysis involved the inductive approach of categorical content analysis to identify major categorical themes to answer the specific questions posed. The main conclusion was that there are a number of barriers to accessing quality sexual health information and services for young Māori women. Participants’ level of knowledge varied reflecting their personal experiences and many were unaware that Chlamydia is asymptomatic and that delayed diagnosis can lead to fertility problems. The main sources of sexual health information accessed were whānau, peers, school, and contact with health professionals. Racism was identified as one of the barriers to sexual healthcare services. The young women expressed a clear preference for sexual health services to be delivered by Māori. Most importantly, for sexual health interventions to be successful it is essential that Māori communities, including young people and their whānau, are an integral part of creating positive solutions. Resilience factors that may help protect young women from contracting chlamydia characteristic of this group were having a strong connection with a caring adult or friend and parents who viewed sexuality as a normal part of adolescent development. In addition, having a positive Māori cultural identity with an ability to understand bicultural differences was strongly associated with participants accessing sexual healthcare services despite identified barriers.

Little is known about social work at psychiatric institutions in Canada. This research looks at patient records at Selkirk Mental Health Centre (SMHC) from 1947-1979 at Selkirk, Manitoba. Qualitative descriptive methods are employed to examine patient records (N=132) for the function and form of social work. A random selection of patient records at SMHC was performed where qualitative themes of social work related activities were identified and collected. Additional data included archival records of provincial and federal reports to provide context for the findings. Social work emerged from practice, becoming increasingly sophisticated as SMHC evolved and degreed social workers entered the field. Findings show that social work was an essential profession for SMHC to address a rising patient census as well as manage the transition to community located mental health care. While some social work related activities are performed by other staff, there is a qualitative difference when a social worker performs these. Findings also showed that social work has a relationship with severe and persistent mental illness as a population served at SMHC. Future historical research can benefit from this study as it includes a developed method for future patient record research. Future research could be in various professional disciplines as well as contribute to the growing knowledge around social work practice in Canada. Findings show that social work is a relevant and important role that has a historic connection in the field of mental health. This study contributes to the growing literature on the history of social work in Canada. / October 2015

According to several studies, there have been improvements in adolescent sexual behaviour; declining adolescent pregnancies, fewer adolescents having more than one sexual partner, and an increasing numbers of adolescents using contraceptives. Notwithstanding these improvements, there are concerns regarding adolescents’ sexual health including adolescents’ limited knowledge of sexual health issues, high rates of sexually transmitted infections and the need to eliminate barriers to adolescent sexual health services. The purpose of this study was to explore adolescents’ perceptions of the facilitators and barriers to the promotion of healthy sexuality of adolescents living in PEI. A qualitative descriptive design guided by CST and a socio-ecological framework was used to explore participants’ perceptions. Six female high school students, 16-18 years of age, participated in a face-to-face semi-structured interview followed by a second face-to-face follow up interview. Seven themes emerged from the data that was analyzed through thematic analysis: The Illusion of Accessible Resources; Risky Behaviours; Peer Pressure Alive and Well in High School; Cyberbullying; Parental Influence on Adolescent Decision Making; Inefficient and Underutilized School Health Resources; and Inefficient and Underutilized Community Health Resources. While it is evident that some promotion of healthy sexuality of adolescents is occurring in PEI, more investigation and development is needed to better support adolescents with comprehensive school services including guidance and education. The results of this study can be used to guide this future development.

A qualitative descriptive approach was undertaken to explore the leadership experience of seven first line nurse managers working in the Cook Islands. For the purposes of this study first line nurse managers are those nurses working as a charge nurse in a hospital, nursing supervisors, chief public health nurse, and nurses working autonomously in the outer islands of the Cook Islands. Nurses in these roles are in key positions to influence the practice of others and set the standard of practice and culture of a unit. The participants were recruited if they were currently employed in any of these positions. The seven participants were all Cook Islands women who received their undergraduate nursing education in the Cook Islands. The purpose of the study was to describe their leadership experience, to raise an awareness of their role, and to make recommendations to support and improve the preparation of nurses for leadership roles in the Cook Islands. Through face-to-face interviews, the participants' stories were audio taped and transcribed verbatim. Six of the seven transcripts required translation from Cook Islands Maori to English and this was conducted by the researcher who is fluent in both languages. Content and thematic analysis of the data revealed a spiritual, emotive and intuitive theme in the participants' leadership experience. The findings of the study revealed the self confidence of these nurses to manage in this role despite being challenged by management issues and the lack of preparedness for the role. The supportive network established within their staff, their family and the people around them has provided the impetus to continue to 'serve' their people. The findings also revealed that these nurses recognised the need to continue to learn and develop themselves and their staff. The findings of this study have significance for nurses aspiring to be nurse leaders in the Cook Islands or other Pacific Islands and rural communities. A key stakeholder in this study is the Cook Islands Ministry of Health, as insights and awareness gained can contribute to an appropriate preparation and support programme for nurses working in its organisation.

Good sexual and reproductive health is fundamental to the overall health status of Māori communities. In 2001, the Ministry of Health reported that New Zealand was facing a Chlamydia epidemic. This epidemic has not abated as rates of Chlamydia have increased significantly in the past five years, with disproportionately high rates in young Māori women compared to non-Māori women. Despite significant sexual health disparities, young Māori have had limited opportunities to participate in research focussed on sexual health and voice their opinions and concerns on sexual health issues. This qualitative descriptive study has used a Māori inquiry paradigm and approached the research from a Kaupapa Māori perspective. The primary research question asked what the knowledge, attitudes and reported behaviours of young urban Māori women were in regards to sexual health and in particular, the sexually transmitted infection Chlamydia. Secondary aims were to ascertain the sources of information used and accessibility of sexual health services, as well as identifying resilience factors associated with protection against Chlamydia infection. The data was collected from semi-structured interviews with 16 young Māori women living in the Auckland region. Data analysis involved the inductive approach of categorical content analysis to identify major categorical themes to answer the specific questions posed. The main conclusion was that there are a number of barriers to accessing quality sexual health information and services for young Māori women. Participants’ level of knowledge varied reflecting their personal experiences and many were unaware that Chlamydia is asymptomatic and that delayed diagnosis can lead to fertility problems. The main sources of sexual health information accessed were whānau, peers, school, and contact with health professionals. Racism was identified as one of the barriers to sexual healthcare services. The young women expressed a clear preference for sexual health services to be delivered by Māori. Most importantly, for sexual health interventions to be successful it is essential that Māori communities, including young people and their whānau, are an integral part of creating positive solutions. Resilience factors that may help protect young women from contracting chlamydia characteristic of this group were having a strong connection with a caring adult or friend and parents who viewed sexuality as a normal part of adolescent development. In addition, having a positive Māori cultural identity with an ability to understand bicultural differences was strongly associated with participants accessing sexual healthcare services despite identified barriers.