Jacquie Kidd

Patients' engagement in primary care: powerlessness and compounding jeopardy. A qualitative study

Primary health care does not adequately respond to populations known to have high needs such as those with compounding jeopardy from chronic conditions, poverty, minority status and age; as such populations report powerlessness.

Mental Illness in the Nursing Workplace: A Collective Autoethnography

Abstract Many nurses are burned out, exhausted and have a high intent to leave their jobs. These factors, when experienced over a period of time, are consistent with the development of mental illness. This study takes a collective autoethnographical approach to mental illness in the nursing workplace by focusing on the stories of nurses who have experienced mental illness in clinical practice. It highlights three ways in which nursing and mental illness are connected; the nurse who is vulnerable to mental illness prior to entering the profession, the nurse who develops mental illness that is independent of her work but is nevertheless impacted by it, and the nurse who develops mental illness as a result of her work and/or role. This paper explores the hyphenated lives and bullying these nurses experience, and recommends strategies that the profession, employing organisations, and individuals can adopt to reduce nurses’ progression from stress to distress and mental illness.

Mental health nursing in New Zealand primary health care

Abstract International literature and New Zealand health policy is giving increased emphasis to the role of the primary health care sector in responding to mental health issues. These issues include the need for health promotion, improved detection and treatment of mild to moderate mental illness, and provision of mental health care to some of those with severe mental illness who traditionally receive care in secondary services. These developments challenge specialist mental health nurses to develop new roles which extend their practice into primary health care. In some parts of New Zealand, this process has been under way for some time in the form of shared care projects. However developments currently are ad hoc. There is room for considerable development of specialist mental health nursing roles, including roles for nurse practitioners in primary mental health care.

Implementing and Maintaining Nurse-Led Healthy Living Programs in Forensic Inpatient Settings: An Illustrative Case Study

BACKGROUND: Healthy living programs (HLPs) within the context of mental health units are an applied response to the concerns of metabolic syndrome and the associated physical illnesses to which people with serious mental illness are susceptible. OBJECTIVE: To illustrate how nurses, with other health professionals and service users, have established and maintained HLPs in two locked forensic mental health units in New Zealand. DESIGN: This illustrative case study adopts a multimodal approach to data collection and analysis. Across two programs, interviews were undertaken with service users (n = 15) and staff (n = 17), minutes of meetings were analyzed for major decision points, and clinical notes were reviewed to identify which service-user health status measures (body mass index, glucose tolerance test results, blood pressure, and medication use) were recorded. RESULTS: Similarities were identified in the way the HLPs were implemented and maintained by champions who advocated for change, challenged staff attitudes, secured funding, and established new systems and protocols. Successful implementation depended on involvement of the multidisciplinary team. Each program operated within a different physical environment and adopted its own philosophical approach that shaped the style of the program. The HLPs had an impact on nurses, other staff, and on the culture of the institutions. The programs raised dilemmas about restrictions and risk versus autonomy and self-management. CONCLUSION: Understanding the effects of the clinical and philosophical contexts in which HLPs are established and the way challenges and benefits are affected by context has practical significance for the future development of health programs in forensic settings, prisons, and general mental health units.

DEVELOPING A KAUPAPA MĀORI FRAMEWORK FOR WHĀNAU ORA

The use of whānau ora (healthy families) to represent individual health while also encompassing the collective of family means there is a need to address connectedness that goes beyond wider family structures to include health, education and social service providers. The views of kaumātua (Māori elders) were sought through a series of hui (meetings) to develop an understanding of the term “whānau ora” and its practical application. The hui highlighted that whānau ora has many interconnecting facets, including some tension around the notions of interdependent whānau and individual health care needs. Te Korowai has been developed from seven interconnecting themes raised by kaumātua. Te Korowai represents the concepts and practicalities of whānau ora.

A whanau ora journey of Maori men with chronic illness: A Te Korowai analysis

The Oranga Tāne Māori research project explored the views of tāne Māori (Māori men) with a chronic disease or cancer, and their whānau (families), to discover how they experienced their health care in relation to whānau ora (healthy families). The first phase of developing this research involved developing a local whānau ora framework called Te Korowai. Interviews were undertaken with 47 tāne Māori with chronic disease or cancer and 15 support people. The men had received or were currently receiving care for one or more chronic diseases. Data were analysed using Te Korowai as a conceptual framework. Findings included the foundational importance of “being Māori” as an enabler for health decision-making and service engagement, and whakamā (shyness, embarrassment) as a barrier to effective service provision. Health professionals are urged to look to how they can re-engage individuals and whānau, and to prioritize relationship building and respectful engagement.

Citizens un-interrupted: Practices of inclusion by mental health service users

ABSTRACT Inclusion, participation, and the recognition as being an equal is important for the well-being and resilience of all citizens. The notion of homo occupacio describes the persona of the citizen as the self-directed, self-initiated occupational human who takes possession of his or her world through a repertoire of occupations located within the rules and norms of society. For those in society who have been labelled with a psychiatric diagnosis, the ability to participate and exercise the rights and responsibilities as citizens can be conditional, often interrupted and, at times, denied. Once labelled, service users report that they are regarded as the marginalised and excluded immanent Other; their status is then relegated to subject rather than citizen and political actor. Thus positioned on the margins of the democratic processes of the state, service users enter the state of exception as homo sacer, regarded as the outcast, the banned and dangerous Other, whereby the personal power of the citizen no longer seems to hold. This paper presents service users’ stories of distressing exclusion that interrupted their rights to occupational justice, and marginalised them from occupation. The paper also presents the practices of inclusion that service users engaged in that restored their rights and responsibilities as occupied and active citizens. The successful stories of inclusion are framed within one of Isin’s four domains of his citizenship theory: the extent of citizenship, and the rules and norms of inclusion and exclusion.

Treatment and survival disparities by ethnicity in New Zealand women with stage I–III breast cancer tumour subtypes

PurposeThis study aims to look at the distribution of different subtypes of stage I–III breast cancer in Māori and Pacific versus non-Māori/Pacific women, and to examine cancer outcomes by ethnicity within these different subtypes.MethodThis study included 9,015 women diagnosed with stage I–III breast cancer between June 2000 and May 2013, recorded in the combined Waikato and Auckland Breast Cancer Registers, who had complete data on ER, PR and HER2 status. Five ER/PR/HER2 subtypes were defined. Kaplan–Meier method and Cox proportional hazards model were used to examine ethnic disparities in breast cancer-specific survival.ResultsOf the 9,015 women, 891 were Māori, 548 were Pacific and 7,576 others. Both Māori and Pacific women were less likely to have triple negative breast cancer compared to others (8.6, 8.9 vs. 13.0%). Pacific women were more than twice as likely to have ER−, PR− and HER2+ cancer than Māori and others (14.2 vs. 6.0%, 6.7%). After adjustment for age, year of diagnosis, stage, grade and treatment, the hazard ratios of breast cancer-specific mortality for Māori and Pacific women with ER+, PR+ and HER2− were 1.52 (95% CI 1.06–2.18) and 1.55 (95% CI 1.04–2.31) compared to others, respectively. Māori women with HER2+ cancer were twice more likely to die of their cancer than others.ConclusionsOutcomes for Māori and Pacific women could be improved by better treatment regimens especially for those with HER2+ breast cancer and for women with ER+, PR+ and HER2− breast cancer.

Doing it together: a story from the co-production field

Purpose – Co-production in the context of mental health research has become something of a buzzword to indicate a project where mental health service users and academics are in a research partnership. The notion of partnership where one party has the weight of academic tradition on its side is a contestable one, so in this paper the authors “write to understand” (Richardson and St Pierre, 2005) as the purpose of this paper is to examine the experiences of working in a co-produced research project that investigated supported housing services for people with serious mental health problems. Design/methodology/approach – The authors set out to trouble the notion of co-produced research though a painfully honest account of the project, while at the same time recognising it as an idea whose time has come and suggesting a framework to support its implementation. Findings – Co-production is a useful, albeit challenging, approach to research. Originality/value – This paper is particularly relevant to researchers w...

Cultural health literacy: the experiences of Māori in palliative care:

Abstract: Health literacy is a concept that is frequently applied to the patient’s ability to find and comprehend health information. However, recent literature has included the skill of the health professional and the accessibility of health resources as important factors in the level of health literacy achieved by individuals and populations. In 2014 a qualitative study undertaken in Aotearoa New Zealand, investigated the context of health literacy for Māori in a palliative care setting (Māori are the indigenous people of Aotearoa New Zealand). The study included the experiences of patients, whānau (families), and health professionals. Method: Individual semi-structured interviews were held with 21 patients, whānau and six key informants: a medical specialist, a service leader involved in developing culturally specific responses to patients, two Māori service managers, and two Māori health team leaders. Focus groups were held with a total of 54 health professionals providing palliative care services. Data analysis: A thematic analysis was undertaken using a general inductive approach. The trustworthiness and reliability of the analysis was supported by sharing analysis of the transcripts among the research team. Member checking or respondent validation was used in seeking confirmation of the interim findings at five hui (meetings) with the research communities involved. Findings: This study found that the shock and grief that attends a life-limiting illness made hearing and processing health information very difficult for patients and whānau. Further, ‘hard conversations’ about moving from active treatment to palliative care were often avoided by health professionals, leaving patients and whānau distressed and confused about their choices and prognosis. Finally, poor cultural health literacy on the part of organisations has likely impacted on late access to or avoidance of palliative care for Māori.