Abuse of women by male partners is a significant social problem in New Zealand. Ten participating women, whose experiences span more than fifty years, provided interviews focused on their recovery from partner abuse but including the broader context of their lives. Grounded Theory methodology with a feminist perspective was applied in conjunction with Grounded Theory methods. The study identifies GROWING THROUGH ADVERSITY as the basic psychosocial process of recovery from an abusive relationship. GROWING THROUGH ADVERSITY has three inter-related core categories: FINDING A PATH BEYOND ABUSE concerns experiencing abuse and finding safety; GETTING A LIFE is about interactions with the social world; and BECOMING MYSELF involves personal growth and development. In the first of five phases, FALLING FOR LOVE, women commit to the relationship with unexamined, traditional beliefs in gender ideals. When the partner becomes abusive stereotyped meanings of relationship require compliance as the price of 'love', or result in shame and self-blame. In phase two, TAKING CONTROL, coping strategies of resistance and compliance fail. Seeking help for themselves, or the relationship, results in finding other perspectives and new contexts of meaning, prompting participants to overcome personal, social, and safety constraints to separation. Phase three includes the distress and difficulty of SECURING A BASE. In the fourth phase, MAKING SENSE OF IT, participants seek both explanation and meaning for their experience. By the fifth phase, BEING MYSELF, participants have constructed new meaning systems and integrated into wider social contexts. They have become women who live by their own values, without partner abuse. Analysis of participants' experience highlights the changing purpose of help-seeking, The paradox of shame and self blame, and processes of meaning-making and coping are clarified. Victim-blaming is identified as a social sanction that supports abuse. Personal growth processes are conceptualised by integrating several developmental theorists.

This study explores the day-to-day lived experience of eight novice hospital play specialists in New Zealand, during the early months following their appointment. Hospital play specialists come from a background in early childhood teaching and work as members of paediatric healthcare teams to support development and coping in hospitalised children and young people. Participants' stories were gathered in face-to-face interviews and were then analysed using an interpretive approach informed by Heideggerian hermeneutic phenomenology. Throughout the reflective process of the study, I have sought to show the vividness of the participants’ unique experiences whilst revealing the deeper understandings that lie below. This study shows that experiences as a novice matter to the subsequent development of professional identity as a hospital play specialist. The participants' early impressions of tile world of a hospital are shown in the findings to be those of strangers arriving in a foreign country, struggling to survive and to achieve a sense of belonging. Despite initially feeling lost and vulnerable, they are revealed as resourcefU1 in coping with change, and resilient in acquiring new skills, finding support, building relationships, and adapting their practice. Inclusion within healthcare teams, and recognition of their knowledge and skills by the participants and by their healthcare colleagues, contribute to participants' successful transitions from novice to competent practitioners. There are implications in this study for team leaders, managers and hospital play specialists regarding recruitment and support, such as ensuring that those employed show the flexibility needed for this role and are the11 provided with suitable early information and induction programmes Alongside this is the need for a focus on professional development and improved processes of communication, and inclusion of new staff members within the healthcare team.

Human and financial costs generated by nurse shortages, within a context of increasing numbers of patients requiring nursing care, demonstrate the potential significance of this study which aims to identify work related factors contributing to New Zealand nurses' intent to leave the job. Two hundred and seventy five usable paper and pencil surveys (Response rate = 68.8%) from a random sample of 400 nurses employed in one New Zealand District Health Board were used to explore intent to leave the job. Three research questions directed the description of levels of job satisfaction, job stress, and burnout found in nurse participants, correlations between the three variables, and the identification of variables predicting intent to leave the job through regression analyses. Levels of job satisfaction were high, job stress was low, and burnout was average. Specifically, lack of opportunity to participate in organisational decision making, control over work conditions, control over what goes on in the work setting (key Magnet Hospital characteristics) were not evident, and with pay rates, were the main sources of job dissatisfaction. Workload was the most frequently experienced source of stress by nurse participants. Twenty-five per cent of nurse participants reported high levels of intent to leave the job. Correlations suggested that reductions in job satisfaction influenced increases in job stress and burnout. Job stress was associated with increases in emotional exhaustion. Emotional exhaustion was influenced by eight job satisfaction, job stress, and burnout subscales. Five subscales (professional opportunities, praise and recognition, interaction opportunities, extrinsic rewards, lack of support) explained 26.2% of the variance in nurse participant's intent to leave. Issues of power and control were associated with job dissatisfaction, job stress and burnout in nursing practice. However, predictors of intent to leave the job suggest a growing realisation by nurse participants that postgraduate education and nursing research may provide the tools to create positive change in the health care environment and make nursing visible, valued and appropriately rewarded.

Physiotherapists in New Zealand are increasingly learning and practicing Western acupuncture. Western acupuncture as a new and different tool is enhancing and yet challenging physiotherapists practice. This study explores the meaning behind Western acupuncture practice to further understand the implications of its development and possible future direction.Hermeneutic methodology was used because it facilitates the exploration between that which is familiar and that which is unfamiliar. Seven New Zealand physiotherapists qualified to practise Western acupuncture were interviewed about their practice experiences. The data in relation to the phenomenon of inquiry was analysed thematically.The findings revealed a complex array of tensions within physiotherapy because of the differences Western acupuncture brings to physiotherapists' practice. Western acupuncture is a new and useful tool in the physiotherapists 'toolbox'. It is congruent with other physiotherapy practices in that it shares the same scientific neurophysiological foundation. However, the association of Western acupuncture with traditional Chinese acupuncture causes it to be viewed as a complementary medical practice and thus, not completely legitimate as a part of physiotherapy. These tensions are further confounded because the technical rationalist paradigm, upon which physiotherapy is based, values evidence-based practices. The best evidence is perceived to be that gained from the randomised controlled trial. I argue that the randomised controlled trial is poorly suited to the evaluation of complex practices such as Western acupuncture. Such insights also challenge physiotherapy, as a whole, because the available 'evidence' does not acknowledge the complexities of practice involving individual practitioners, their colleagues, the profession, other healthcare professions, patients and the public.The tensions encountered in physiotherapy and Western acupuncture practice have led to a number of recommendations in education, practice, research and legislation. Overall, they suggest a need to develop a more inclusive model of practice development. Western acupuncture is a potentially valuable tool. In order to maximise use of this tool physiotherapy practice understandings need to be extended. This in turn, will assist development of the profession as a whole.

Neck manipulation is commonly used in the management of some musculoskeletal disorders to reduce pain and improve movement. There is, however, little understanding about the underlying mechanism. Recent research has alluded to a neurophysiological mechanism mediated through supraspinal pathways in the central nervous system, that may alter motor activity. The purpose of this study was to determine the effect of neck manipulation on the excitability of cortical motoneurons by means of activating corticospinal pathways to the flexor carpi radialis (FCR) muscle in an active motor system using the transcranial magnetic stimulation (TMS) technique.Motor evoked potentials (MEPs) were elicited by TMS and recorded in 20 normal subjects using established procedures. The peak-to-peak amplitude of MEPs were measured both before and after C6/7 manipulation and before and after neck positioning. Both interventions were applied to the normal subjects in random order on two different days. MEPs were recorded immediately after the intervention, then seven minutes and 14 minutes later to assess the time course of the effect. Five neck pain subjects participated in the manipulation experiments. The effects of manipulation, resulting in joint cavitation, were also explored. Two trials were undertaken before the intervention and these served as control measures. MEP data was represented in two ways. Firstly, 40 MEPs were averaged over 120 seconds; secondly, 15 MEPs were average over 60 seconds. A percentage change calculation was used to express the data relative to the baseline. Alterations in cortical excitability before and after manipulation were analysed by repeated measure analysis of variance (ANOVA) on the MEP data, and percentage change scores.Cortical neurons projecting to FCR were significantly facilitated up to 60 seconds after the manipulation of the non-painful segment, relative to baseline values and the positioning control. A small but significant latent increase in excitability was also observed 15 minutes after manipulation. The response to manipulation of the painful cervical segment was significantly different from that of the non-painful segment. When manipulation of the painful segment did not result in joint cavitation, an inhibitory effect was observed. In contrast, however, cortical motoneurons were facilitated when joint cavitation was associated with manipulation.In conclusion, motor activity is enhanced with neck manipulation when cortical motoneuron excitability is measured by TMS in human subjects performing a voluntary contraction. This may explain the clinically observed improvement in spinal motion and motor control with spinal manipulation. Further, joint cavitation may be important in signifying the success of the joint manipulation. The excitatory effect on cortical motoneurons is probably mediated through a transcortical pathway by means of the activation of muscle afferents with the manipulative thrust.These findings assist in understanding the neurophysiological mechanism underlying the effect of spinal manipulation.

Preterm birth is one of the leading causes of neonatal mortality and morbidity in New Zealand and overseas. Neonatal intensive care is the most expensive item in the national health budget. The human cost to the child and the family is significant. In the last twenty five years there has been no reduction in the preterm birth rate despite major advances in neonatal and obstetric care. The aim of this study is to describe and explore the experience of women who had received traditional Chinese acupuncture treatment for threatened preterm labour. I explore the perception of acupuncture as an effective treatment to stop preterm labour, prolong the pregnancy or prevent preterm birth in a subsequent pregnancy, where risk factors are present. This is a descriptive and exploratory case study using a multiple case study design. A purposive sample was selected of five retrospective cases of women who had had a previous preterm birth experience and who had used acupuncture for threatening preterm labour in a subsequent pregnancy. Data was collected from the women using interviews, observations and review of midwifery and acupuncture case notes. The data was analysed using content and thematic analysis and also principles based on the philosophy of traditional Chinese medicine. The key finding of the study is that the five women at risk all completed a full-term pregnancy. They all noticed that the signs and symptoms usually associated with threatening preterm labour went away when they had acupuncture. They also experienced a number of significant improvements to their general health and wellbeing. All five were totally happy with the outcomes and the entire acupuncture experience. When intervention is required, acupuncture based on the principles of traditional Chinese medicine appears effective as a treatment strategy in preterm labour. Few studies have been done in this area. Further research is needed so that women can be offered choices and healthcare professionals can have confidence in acupuncture as a treatment strategy for threatening preterm labour.

As the population ages, older adults managing chronic conditions and associated functional impairments will turn to family members and friends to obtain assistive help as informal caregivers. Formal services are often commissioned to provide additional care to complex older adults, creating a network that requires effective information sharing and communication in order to provide optimal care. Unfortunately, important formal-informal care relationships are often not formed and care is not coordinated as effectively as possible. As we enter the information age, services that were once only offered within the community, such as banking and support groups, are now available online. Services now exist to facilitate care coordination for informal caregivers in a shared network of care. Using these tools may show additional benefit if service providers are invited to contribute. Although these tools are currently used by some service providers, there are barriers to gaining widespread user buy-in to this model of use. This study used focus group interviews to conduct a qualitative study on the potential to improve care using an online network to connect informal caregivers and service providers. Case managers, service providers, and informal caregivers were interviewed in order to determine perceptions towards an online network to facilitate communication between caregivers, as well as barriers to supporting online network use by service providers. Interview participants felt that online networks had the potential to improve care delivery through better communication and information sharing, specifically for complex clients who have larger, more complicated care networks. Barriers to the implementation of online networks included the perception that network use would be time-consuming, communication restrictions set by regulating bodies, and the potential for privacy, security, and information ownership issues. Additionally, logistical issues would need to be addressed before the network can be adopted by home care agencies. Widespread inclusion of service providers in online network services will hinge on support from informal caregivers, home care agencies, and regulating organizations. A future pilot study could explore the potential roles and impacts of using online networks to link formal care providers and informal caregivers.

Introduction: Mobility is critical for independence, social engagement and quality of life, which for many seniors equates with driving. Driving cessation has been associated with depression, isolation and decreased social and community engagement. However, apart from a few studies in the United States, research on the impacts of driving cessation and transportation use in general has been restricted to community dwelling seniors. It is estimated that 40,000 seniors in Ontario alone currently live in retirement facilities; a number expected to increase. Purposes: The aim of the wider project is to gain a better understanding of the transportation patterns and needs of older adults living in retirement homes. The specific aims of this study, which focused on residents who recently stopped driving (in the past two years), were to examine: 1) events leading to driving cessation, impacts (including depression), and possible associations with relocation; 2) transportation use, including how frequently they left the Village; and 3) connections with family and friends, and activity engagement in and outside the Villages. Methods: A survey of residents from four retirement Villages in Southern Ontario was conducted to examine driving status and use of other modes of transportation. An in-depth study was then conducted with a sample of 20 residents (9 men and 11 women, age 86.45 ± 5.16), recruited via letters, pamphlets, booths and door-to-door. The study involved both quantitative (questionnaires, scales on depression and balance confidence, activity checklists) and qualitative methods (small group discussions). Participants were also asked to complete travel diaries over two weeks for all trips outside the Village (purpose and mode of travel). Results: The transportation survey (N=407; 56% response rate) showed that 68% of residents had stopped driving (N=273), over half within 12 months of relocation. In the in-depth study, 36.8% had stopped driving before the move (average of 3.43±1.72 months, range 1 to 6), 42.1% after the move (average of 27.38±13.51 months, range 2 to 46), and 21.2% within the same month. While the quantitative data indicates a relationship between these transitions, this connection was often not made by residents themselves. Several mentioned health problems as the main reason they quit driving; two had lost their licenses. Regardless, most felt the decision to quit driving was voluntary and done at the “right time”. Except for a few people, this sample did not have depression symptoms and had adjusted to no longer driving. The majority (85%) had relatives in the area and most stayed connected to relatives and friends living outside the Village through visits and phone calls. Nearly all the residents (90%, n=18) received rides from others, most commonly from their daughters (70%), followed by friends outside the Village (60%). Half the sample said they used public buses occasionally, and those who did had significantly higher balance confidence scores on the ABC scale (73.33±18.50) compared to those who did not (49.44±21.02) (t=-2.69 p=0.015). Confidence scores, however, did not differ for those who used the Village shuttle (80%) and those who did not (20%). Based on their travel diaries, 76.5% of the residents (13/17) made at least one trip outside the Village over a two week period (average of 7.00±4.93, range 1 to 18), most often as a passenger in a private vehicle (58%). Recreation and social trips were the most common (44.2%), followed by: medical appointments (18%), shopping (17%), errands (15.3%) and religious activities (5.4%). The sample also took advantage of services and amenities inside the Village, including: meals in the dining room (95%), the café (90%), general store (80%), salon (65%), library (65%), laundry facilities as well as services of health professionals. They also participated in Village programs, including: music, concerts, movies (80%), physical activities (65%), games (55%) and religious services (50%). Conclusions: Seniors who can afford to live in upscale retirement homes may not suffer the adverse effects of driving cessation often found in community seniors. Despite advanced age and mobility restrictions (85% used a walker outdoors), these individuals remained connected to the outside community. This sample, at least, took advantage of the services and amenities in their Villages which may reduce their need for travel outside the Village. They do not appear to have unmet transportation needs, given that most had relatives in the area as well as other people to drive them when needed. More studies are needed on this growing segment of the senior population, particularly on other types of retirement facilities which may not offer as many services (such as shuttle buses or vans) for residents.

There is a strong push in public health for multi-faceted partnerships to develop practice-relevant evidence that effectively address complex risk factors like tobacco use. Consequently, new partnership structures that cross-cut different social groups are emerging to harness their distinct knowledge and generate actionable breakthroughs. Little is known about these structures, particularly informal ones that hinge on voluntary group membership like Communities of Practice (CoPs). Specifically, little is known about the factors/processes that enable people representing different social groups to translate their knowledge across group boundaries and co-create knowledge that informs action in these informal structures. Calls to develop/test theories, frameworks, and models are made to enlighten these gaps. This study responded to these calls by developing and testing a conceptual framework. The framework asserts that a shared identity, member identification / sense of belonging, social capital and psychological safety contribute to diverse people cohering into a collective, which was deemed important to enable knowledge to translate across group boundaries. The study examined how each factor influenced and inter-related to influence the use of CoP-related knowledge and its different types (with an emphasis on conceptual and instrumental uses). The study also examined what factors contributed to or detracted from these relationships in the context of the Program Training and Consultation Centre’s tobacco control specific Learning through Evidence and Action Reflection Network (LEARN) Community of Practice (CoP) project. Following a pragmatist orientation, a two-phased quant-QUAL sequential, explanatory mixed-methods embedded case study design was employed. The LEARN CoP project formed the case study and two CoPs that comprised that project formed the embedded units. Phase I of the study involved a quantitative survey that was completed by 35 of 58 eligible LEARN CoP members. The Phase II dominant qualitative study involved ~90 minute audio-recorded telephone interviews of 14 LEARN CoP members (seven per embedded unit) who comprised a subset of Phase I survey respondents (nested sampling approach). CoP documents (meeting minutes, audio-recorded meetings, Community Charters and Learning Agendas, WebEx™ discussion posts) served as supplementary data sources. Phase I quantitative analyses examined whether each factor of interest predicted knowledge use using simple and multiple linear regression, tested an analytic model that proposed shared identity led to knowledge use via the mediators member identification, social capital and psychological safety using Baron & Kenny’s (1986) mediation approach and Goodman’s Test (1960) for confirmation. As a prelude to the Phase II qualitative study, descriptive statistics, t-tests and ANOVA were conducted to discern how the LEARN CoP and more specifically each of its embedded units (CoP A and CoP B) were developing with respect to the factors of interest and what differences existed between the two communities. Phase I findings loosely informed the focus of the Phase II qualitative study and data were coded and analysed using open, axial and selective coding procedures (Strauss & Corbin, 1990). Phase I and Phase II data were compared and contrasted in the discussion, with greater emphasis placed on the qualitative findings. Overall findings revealed that in the LEARN CoP case, each factor in the conceptual framework influenced how members used knowledge gained in the CoP. These factors also inter-related in ways that helped diverse members to cohere in ways that influenced knowledge use. Shared identity, member identification / sense of belonging and psychological safety were related to conceptual types of knowledge use (increased awareness, learning as a result of CoP knowledge). Social capital was the only factor that was related to both conceptual and instrumental types of CoP knowledge use (e.g., knowledge gained from the CoP was used to inform decision making or applied in some fashion in practice). However, member identification / sense of belonging emerged as an important theme that motivated members to interact and build social capital which in turn led to instrumental types of knowledge use. A superordinate identity (shaped by a common and actionable purpose) helped members to jel together despite representing different social groups by serving as an anchor point for member identification / sense of belonging. The CoP’s ‘alignment’ with the philosophies, culture and priorities of important entity’s that shaped the CoP’s work (e.g., government and the organizations that members represented) also influenced the use of CoP knowledge. Other factors including relevant knowledge, leadership (including member roles), and a variety of mechanisms that enabled interaction (i.e., in-person meetings, WebEx, teleconferences, structured time for practice sharing, working groups) contributed to or detracted from the relationships found in the study. Solving complex problems like tobacco-related chronic diseases necessitates building multi-faceted partnership structures that connect different configurations of an existing or desired system and their respective knowledge. This is not an easy task because it requires bringing together people representing potentially different social identities that possess their own ways of thinking and doing, which can limit knowledge use. This study sought to understand how factors that help diverse people to cohere into a collective enhance knowledge use. The study highlights the need to understand identity-based issues at play when people from different social groups are brought together in partnership structures like the formally instituted, voluntary CoP examined. Cultivating a shared identity and sense of belonging can bridge silos and motivate people to engage in behaviours that build rich pools of social capital. These factors together can enhance the co-creation and use of evidence and collective action that can save lives.

Objective: The purpose of this investigation was to examine the effect of implementation intentions on physical activity in older adults with stronger and weaker executive control resources (ECRs). Methods: One hundred and ten community dwelling older adults (Mage=74.42) were randomly assigned to receive either a physical activity implementation intention intervention, a control intervention, or no-treatment. Three ECR facets (inhibition, task-switching, working memory), baseline behaviour and baseline intentions were assessed during the initial laboratory session. During 4 weekly follow-up telephone interviews, participants reported physical activity behaviour for the previous week, and refreshed implementation intentions for each upcoming week. Results: A main effect of treatment condition on 1-month self-reported physical activity was observed, with those in the experimental group reporting significantly higher physical activity than those in the control or no-treatment conditions. In addition, a significant 2-way (intention strength by treatment condition) interaction emerged, with the experimental group showing higher intention-behaviour correspondence than the control and no-treatment groups. A marginal 2-way interaction of intention and behavioural inhibition was also detected; those with stronger behavioural inhibition had higher intention-behaviour correspondence relative to those with weaker behavioural inhibition across all three treatment conditions. Conclusions: Implementation intentions are effective in facilitating physical activity in healthy older adults. The findings also indicate that behavioural inhibition may be important for the moderation of intention-behaviour relationships in the context of physical activity, regardless of goal setting strategy.