Julie M. Boddy

Feelings of Abandonment and Quality of Life Among Older Persons in Rural Northeast Thailand

The purpose of this study was to determine the extent to which older persons in rural Northeast Thailand felt abandoned by the emigration of their children and the impact this may have on their quality of life. A cross sectional survey, consisting of 113 questions including the 26-item WHOQOL-BREF and the 24-item WHOQOL-OLD was administered to 212 participants. Participants ranged in age from 60 to 107 with a mean age of 71. While only 9% were found to live alone, 20% stated that they felt abandoned to some degree. A one-way between groups MANOVA was conducted to determine if those who felt abandoned differed from those who did not on a single-item question of Overall QOL and the total scores for the WHOQOL-BREF and WHOQOL-OLD. A statistically significant difference was found between the groups on the combined dependent variable [F (3, 208) = 4.75, p = .003; Wilks’ Lambda = .94]. When the results for each of the dependent variables were considered separately, statistically significant differences were found on the WHOQOL-BREF [F (1, 210) = 13.61, p < .001] and the WHOQOL-OLD [F (1, 210) = 9.85, p = .001] only.

Culturally specific process measures to improve mental health clinical practice: indigenous focus

Objective: In New Zealand and Australia, a renewed emphasis on equity and efficiency in the provision of mental health care has seen outcomes-focused, culturally appropriate clinical practice become essential within mental health services. Ascertaining the degree to which quality improvement and monitoring systems are enhancing professional practice and patient outcomes, however, is hindered by the difficulty of measuring the process of quality care delivery. Method: This paper argues that it is the process of care delivery (i.e. what clinicians do to, and for, patients) that is critical to the effectiveness of treatment and the degree to which treatment either inhibits or promotes an improvement in mental health recovery. Identification of the underlying causes of poor achievement of process factors is likely to positively impact on things such as readmission rates, shared care initiatives, and ultimately patient recovery. Such attention could be the difference between low-quality service provision and a high-quality service provision with positive recovery outcomes for patients. Results: Ascertaining the degree to which quality improvement and monitoring systems are enhancing professional practice and patient outcomes for indigenous people, however, is hindered by the difficulty of measuring such concepts. Australia has indeed embraced ‘culturally appropriate’ practice in recent years, but this appears to be piecemeal when compared with New Zealand. Certainly, there are inconsistent and variable approaches to cultural practices with indigenous people when comparing the two countries. Conclusions: Using evidence from a bicultural mental health nursing study that developed and validated generic and Mâori-specific (indigenous) clinical indicators for mental health nursing standards of practice in New Zealand, it is argued that the process of care delivery is equally as important as outcome measures when ascertaining the effectiveness of nursing care. Second, this paper contends that accurate process measures must be culturally responsive to indigenous and other ethnic groups.

The New Zealand development and trial of mental health nursing clinical indicators—a bicultural study

This paper describes the development and validation of bicultural clinical indicators that measure achievement of mental health nursing practice standards in New Zealand (ANZMCHN, 1995, Standards of practice for mental health nursing in New Zealand. ANZCMHN, Greenacres). A four-stage research design was utilised including focus groups, Delphi surveys, a pilot, and a national field study, with mental health nurses and consumers as participants. During the national field study, consumer files (n=327) from 11 District Health Boards, and registered nurses (n=422) completed an attitude questionnaire regarding the regularity of specific nursing and service activities. Results revealed a variation in the mean occurrence of the clinical indicators in consumer case notes of 18.5-89.9%. Five factors with good internal consistency, encompassing domains of mental health nursing required for best practice, were derived from analysis of the questionnaire. This study presents a research framework for developing culturally and clinically valid, reliable measures of clinical practice.

Achieving Harmony: Moving from Experiencing Social Disgust to Living with Harmony in People with HIV/AIDS in the Thai Context

This chapter discusses the ways Thai people living with HIV/AIDS come to terms with their diagnosis and learn to manage their lives in the context of stigma and discrimination. The chapter draws on the results of two grounded theory studies which were conducted in the South and Northeast of Thailand, respectively. Data were gathered from 33 participants with HIV/AIDS in the South and 30 in the Northeast through in-depth interviews and participant observations. Interviews were tape-recorded and then transcribed verbatim.