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Morgan T, Wiles J, Morgan K, Williams L, Black S, Koh A, Fanueli E, Moeke-Maxwell T, Xu J, Goodwin H, Gott M. Older people's views on loneliness during COVID-19 lockdowns. Aging Ment Health 2024; 28:142-150. [PMID: 37178140 DOI: 10.1080/13607863.2023.2211549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND AND OBJECTIVES There have been growing concerns that social distancing and stay-at-home mandates have exacerbated loneliness for older people. Empirical evidence about older people's experiences of loneliness and COVID-19 have quantified this phenomena without considering how older people themselves define and understand loneliness. This paper explores how older New Zealanders conceptualized and experienced loneliness under 'lockdown' stay-at-home measures. METHODS This multi-methods qualitative study combines data from letters (n = 870) and interviews (n = 44) collected from 914 people aged over 60 and living in Aotearoa, New Zealand during the COVID-19 pandemic. We conducted a reflexive thematic analysis to conceptualise this data. FINDINGS We identify three interconnected ways in which older people conceptualised and experienced loneliness: (1) feeling disconnected relating to lack of emotional closeness to another often resulting from being physically separated from others and not being able to touch; (2) feeling imprisoned relating to separation from preferred identities and activities and was frequently associated with boredom and frustration; and (3) feeling neglected which often related to feeling let down by generalised and idealised forms of support, such as one's neighbourhood and health care system. DISCUSSION Older New Zealanders experienced lockdown loneliness in three interconnected ways rather than as a stable and homogenous experience. Māori, Pacific, Asian and New Zealand European older people often discussed loneliness in different ways; attesting to loneliness being a culturally-mediated concept shaped by expectations around desirable social interaction. We conclude the paper with implications for research and policy.
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Affiliation(s)
- Tessa Morgan
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Janine Wiles
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Kathryn Morgan
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lisa Williams
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Stella Black
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Anne Koh
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Elizabeth Fanueli
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jing Xu
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Hetty Goodwin
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Taylor E, Moeke-Maxwell T, Anderson NE. Māori end-of-life care in the intensive care unit: A qualitative exploration of nursing perspectives. Aust Crit Care 2024; 37:106-110. [PMID: 38036383 DOI: 10.1016/j.aucc.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Although goals of care for intensive care patients are typically focussed on restoration of health, 8-15% of patients will die in the intensive care unit (ICU), or soon after transfer to a ward. Early recognition of the need for end-of-life care is vital to identify and support the wishes of the patient and needs of their family. In Aotearoa, New Zealand, Māori are over-represented in admissions to ICUs. Enabling nursing staff to provide culturally safe care to Māori patients and whānau (family, including extended family, kin) at the end of life is critical to upholding Te Tiriti o Waitangi requirements and providing equitable care. This qualitative study explores the experiences of both Māori and non-Māori intensive care nurses, in providing end-of-life care for Māori patients and their whānau. OBJECTIVES The objective of this study was to characterise nursing experiences of end-of-life care for Māori in the ICU, identify barriers to and facilitators of confident, competent culturally responsive care, and highlight opportunities to improve preparation and support. METHODS Qualitative semistructured interviews were undertaken with nine intensive care nurses (four Māori and five non-Māori) with experience ranging from novice to expert. Data collection and analysis was underpinned by reflexive thematic analysis strengthened by Kaupapa Māori Research values and tikanga best practice. FINDINGS Participants described positive and negative experiences in caring for Māori at the end of life. Culturally responsive end-of-life care for Māori in intensive care appears dependent on the acknowledgement and inclusion of whānau as members of the multidisciplinary team. Participants identified a need for high-quality education, supportive unit end-of-life care guidelines and hospital policies, and cultural resources to confidently provide quality end-of-life care. CONCLUSION Improved understanding of Māori culture, critical awareness of systems of power and privilege, and the availability of cultural liaisons may increase the confidence and competence of ICU nurses providing care to Māori whānau.
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Affiliation(s)
- Ellie Taylor
- School of Nursing, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- School of Nursing, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Natalie E Anderson
- School of Nursing, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand; Auckland Emergency Department, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand.
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Robinson J, Raphael D, Moeke-Maxwell T, Parr J, Gott M, Slark J. Implementing interventions to improve compassionate nursing care: A literature review. Int Nurs Rev 2023. [PMID: 37975578 DOI: 10.1111/inr.12910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Abstract
AIM To identify strategies which support the implementation of interventions to promote compassionate nursing care with a focus on interventions designed to support improved patient outcomes and/or patient experience in acute hospitals. METHODS An integrative review using the PRISMA guidelines and a 5-stage framework consisting of problem identification, literature search, data evaluation, data analysis and presentation. CINAHL, Embase, Medline, PsychInfo and Web of Science were systematically searched using key search terms. Hand searches were conducted of the reference lists of eligible articles and searching key journals. RESULTS Six articles met the inclusion criteria with six different interventions described. A thematic analysis of the findings identified three key themes relating to the implementation of interventions which promote compassionate nursing care: (1) the importance of evidence; (2) support for nursing development; and (3) planning for and leading implementation. CONCLUSION Compassionate care improves quality of life, the hospital experience and overall recovery. Strong nursing leadership and a supportive team environment are facilitators for delivery of compassionate care in acute settings. Excessive workload, overly rigid reporting and organisational indifference are barriers to delivery of compassionate care. IMPLICATIONS FOR NURSING POLICY Health policy is used to inform the systematic implementation and delivery of patient care informed by best evidence. Health setting, environment and culture are important facets of the implementation of a compassionate care framework. Furthermore, nurse engagement, teamwork and nurse leadership are key facilitators for delivery of compassionate care in acute hospital settings. These findings need to be taken into consideration by policy makers and nursing leaders when designing and implementing compassionate care interventions. IMPLICATIONS FOR NURSING POLICY Implementing interventions to improve compassionate nursing care can be challenging. This review identified the factors which should be considered by policy makers when implementing these interventions systematically throughout the healthcare system.
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Affiliation(s)
- Jackie Robinson
- Faculty of Medical Health Sciences, School of Nursing, University of Auckland, Auckland, New Zealand
| | - Deborah Raphael
- Faculty of Medical Health Sciences, School of Nursing, University of Auckland, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- Faculty of Medical Health Sciences, School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jenny Parr
- Te Whatu Ora Health New Zealand Counties Manukau, Auckland, New Zealand
| | - Merryn Gott
- Faculty of Medical Health Sciences, School of Nursing, University of Auckland, Auckland, New Zealand
| | - Julia Slark
- Faculty of Medical Health Sciences, School of Nursing, University of Auckland, Auckland, New Zealand
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French M, Hansford L, Moeke-Maxwell T. Reflecting on choices and responsibility in palliative care in the context of social disadvantage. Palliat Care Soc Pract 2023; 17:26323524231193037. [PMID: 37654731 PMCID: PMC10467305 DOI: 10.1177/26323524231193037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/21/2023] [Indexed: 09/02/2023] Open
Abstract
There is a need to understand how to improve palliative care provision for people impacted by social inequity. Social inequity, such as that related to socioeconomic circumstances, has profound impacts on experiences of death and dying, posing personal and professional challenges for frontline professionals tasked to ensure that everyone receives the best standard of care at the end of their lives. Recent research has highlighted an urgent need to find ways of supporting healthcare professionals to acknowledge and unpack some of the challenges experienced when trying to deliver equitable palliative care. For example, those involved in patient or person-centred activities within health settings often feel comfortable focusing on individual choice and responsibility. This can become ethically problematic when considering that inequities experienced towards the end of life are produced and constrained by socio-structural forces beyond one individual's control. Ideas and theories originating outside palliative care, including work on structural injustice, cultural safety and capabilities approach, offer an alternative lens through which to consider roles and responsibilities for attending to inequities experienced at the end of life. This paper draws upon these ideas to offer a new way of framing individual responsibility, agency and collective action that may help palliative care professionals to support patients nearing their end of life, and their families, in the context of socioeconomic disadvantage. In this paper, we argue that, ultimately, for action on inequity in palliative care to be effective, it must be coherent with how people understand the production of, and responsibility for, those inequities, something that there is limited understanding of within palliative care.
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Affiliation(s)
- Maddy French
- International Observatory on End of Life Care, Lancaster University, Health Innovation Campus, Sir John Fisher Drive, Lancaster LA1 4YW, UK
| | - Lorraine Hansford
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
| | - Tess Moeke-Maxwell
- Te A-rai Palliative Care and End of Life Research Group, University of Auckland, Auckland, New Zealand
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Morgan T, Gott M, Williams L, Naden J, Wang Y, Smith B, Fanueli E, Budi Setyawati M, Morgan K, Robinson J, Anderson N, Carey M, Moeke-Maxwell T. A bad time to die? Exploring bereaved families/wha-nau experiences of end-of-life care under COVID-19 restrictions: a qualitative interview study. Palliat Care Soc Pract 2023; 17:26323524231189525. [PMID: 37584059 PMCID: PMC10424543 DOI: 10.1177/26323524231189525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/05/2023] [Indexed: 08/17/2023] Open
Abstract
Background There have been international concerns raised that, during the COVID-19 pandemic, there was an absence of good palliative care resulting in poor end-of-life care experiences. To date, there have been few studies considering the pandemic's impact on people dying from non-COVID-19 causes and their families and friends. In particular, there has been very less empirical research in relation to end-of-life care for Indigenous, migrant and minoritised ethnic communities. Objectives To explore bereaved next-of-kin's views and experiences of end-of-life care under COVID-19 pandemic regulations. Design This qualitative study involved in-depth one-off interviews with 30 ethnically diverse next-of-kin who had a family member die in the first year of the pandemic in Aotearoa, New Zealand. Methods Interviews were conducted by ethnically matched interviewers/interviewees. A reflexive thematic analysis was used to explore and conceptualise their accounts. Results A key finding was that dying alone and contracting COVID-19 were seen as equally significant risks by bereaved families. Through this analysis, we identified five key themes: (1) compromised connection; (2) uncertain communication; (3) cultural safety; (4) supported grieving and (5) silver linings. Conclusion This article emphasises the importance of enabling safe and supported access for family/whanau to be with their family/wha-nau member at end-of-life. We identify a need for wider provision of bereavement support. We recommend that policy makers increase resourcing of palliative care services to ensure that patients and their families receive high-quality end-of-life care, both during and post this pandemic. Policy makers could also promote a culturally-diverse end-of-life care work force and the embedding of culturally-safety practices across a range of institutions where people die.
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Affiliation(s)
- Tessa Morgan
- Applied Social Science Group, Department of Public Health and Primary Care, The University of Cambridge, Forvie Site, Cambridge CB2 0SR, UK
| | - Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lisa Williams
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Joe Naden
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Yingmin Wang
- School of Foreign Studies and School of International Culture, South China Normal University, Guangzhou, China
| | - Brianna Smith
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Elizabeth Fanueli
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Martyarini Budi Setyawati
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Kathryn Morgan
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jackie Robinson
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Natalie Anderson
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Melissa Carey
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Snelling J, Young J, Beaumont S, Diesfeld K, White B, Willmott L, Robinson J, Moeke-Maxwell T. Health care providers' early experiences of assisted dying in Aotearoa New Zealand: an evolving clinical service. BMC Palliat Care 2023; 22:101. [PMID: 37480024 PMCID: PMC10362551 DOI: 10.1186/s12904-023-01222-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 07/05/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND In November 2021, assisted dying (AD) became lawful in Aotearoa New Zealand. A terminally ill person may now request, and receive, pharmacological assistance (self-administered or provided by a medical practitioner/nurse practitioner) to end their life, subject to specific legal criteria and processes. Exploring the experiences of health providers in the initial stage of the implementation of the End of Life Choice Act 2019 is vital to inform the ongoing development of safe and effective AD practice, policy and law. AIM To explore the early experiences of health care providers (HCPs) who do and do not provide AD services seven months after legalisation of AD to provide the first empirical account of how the AD service is operating in New Zealand's distinctive healthcare environment and cultural context. DESIGN Qualitative exploratory design using semi-structured individual and focus group interviewing with a range of HCPs. RESULTS Twenty-six HCPs participated in the study. Through a process of thematic analysis four key themes were identified: (1) Difference in organisational response to AD; (2) challenges in applying the law; (3) experiences at the coal face; and (4) functionality of the AD system. CONCLUSION A range of barriers and enablers to successful implementation of AD were described. Adoption of open and transparent organisational policies, ongoing education of the workforce, and measures to reduce stigma associated with AD are necessary to facilitate high quality AD service provision. Future research into the factors that influence responses to, and experience of AD; the impact of institutional objection; and the extent to which HCP perspectives evolve over time would be beneficial. In addition, further research into the integration of AD within Māori health organisations is required.
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Affiliation(s)
| | - Jessica Young
- Te Herenga Waka – Victoria University of Wellington, Wellington, New Zealand
| | - Sophie Beaumont
- Te Herenga Waka – Victoria University of Wellington, Wellington, New Zealand
| | - Kate Diesfeld
- Auckland University of Technology, Auckland, New Zealand
| | - Ben White
- Queensland University of Technology, Brisbane, Australia
| | - Lindy Willmott
- Queensland University of Technology, Brisbane, Australia
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Burholt V, Peri K, Awatere S, Balmer D, Cheung G, Daltrey J, Fearn J, Gibson R, Kerse N, Lawrence AM, Moeke-Maxwell T, Munro E, Orton Y, Pillai A, Riki A, Williams LA. Improving continence management for people with dementia in the community in Aotearoa, New Zealand: Protocol for a mixed methods study. PLoS One 2023; 18:e0288613. [PMID: 37463158 PMCID: PMC10353819 DOI: 10.1371/journal.pone.0288613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/23/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The number of people living with dementia (PLWD) in Aotearoa New Zealand (NZ) was estimated at 96,713 in 2020 and it is anticipated that this number will increase to 167,483 by 2050, including an estimated 12,039 Māori (indigenous people of NZ) with dementia. Experiencing urinary incontinence (UI) or faecal incontinence (FI) is common for PLWD, particularly at the later stages of the disease. However, there is no robust estimate for either prevalence or incidence of UI or FI for PLWD in NZ. Although caregivers rate independent toilet use as the most important activity of daily living to be preserved, continence care for PLWD in the community is currently not systematised and there is no structured care pathway. The evidence to guide continence practice is limited, and more needs to be known about caregiving and promoting continence and managing incontinence for PLWD in the community. This project will seek to understand the extent of the challenge and current practices of health professionals, PLWD, caregivers and family; identify promising strategies; co-develop culturally appropriate guidelines and support materials to improve outcomes; and identify appropriate quality indicators so that good continence care can be measured in future interventions. METHODS AND ANALYSIS A four-phase mixed methods study will be delivered over three years: three phases will run concurrently, followed by a fourth transformative sequential phase. Phase 1 will identify the prevalence and incidence of incontinence for PLWD in the community using a cohort study from standardised home care interRAI assessments. Phase 2 will explore continence management for PLWD in the community through a review of clinical policies and guidance from publicly funded continence services, and qualitative focus group interviews with health professionals. Phase 3 will explore experiences, strategies, impact and consequences of promoting continence and managing incontinence for PLWD in the community through secondary data analysis of an existing carers' study, and collecting new cross-sectional and longitudinal qualitative data from Māori and non-Māori PLWD and their caregivers. In Phase 4, two adapted 3-stage Delphi processes will be used to co-produce clinical guidelines and a core outcome set, while a series of workshops will be used to co-produce caregiver resources.
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Affiliation(s)
- Vanessa Burholt
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Wales, United Kingdom
| | - Kathryn Peri
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sharon Awatere
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Deborah Balmer
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Gary Cheung
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Julie Daltrey
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jaime Fearn
- School of Psychology, Massey University, Palmerston North, New Zealand
| | - Rosemary Gibson
- School of Psychology, Massey University, Palmerston North, New Zealand
| | - Ngaire Kerse
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Tess Moeke-Maxwell
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Erica Munro
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Yasmin Orton
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Avinesh Pillai
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Arapera Riki
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lisa Ann Williams
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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8
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Satchell E, Carey M, Dicker B, Drake H, Gott M, Moeke-Maxwell T, Anderson N. Family & bystander experiences of emergency ambulance services care: a scoping review. BMC Emerg Med 2023; 23:68. [PMID: 37316865 DOI: 10.1186/s12873-023-00829-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Emergency ambulance personnel respond to a variety of incidents in the community, including medical, trauma and obstetric emergencies. Family and bystanders present on scene may provide first aid, reassurance, background information or even act as proxy decision-makers. For most people, involvement in any event requiring an emergency ambulance response is a stressful and salient experience. The aim of this scoping review is to identify and synthesise all published, peer-reviewed research describing family and bystanders' experiences of emergency ambulance care. METHODS This scoping review included peer-reviewed studies that reported on family or bystander experiences where emergency ambulance services responded. Five databases were searched in May 2022: Medline, CINAHL, Scopus, ProQuest Dissertation & Theses and PsycINFO. After de-duplication and title and abstract screening, 72 articles were reviewed in full by two authors for inclusion. Data analysis was completed using thematic synthesis. RESULTS Thirty-five articles reporting heterogeneous research designs were included in this review (Qualitative = 21, Quantitative = 2, Mixed methods = 10, Evidence synthesis = 2). Thematic synthesis developed five key themes characterising family member and bystander experiences. In an emergency event, family members and bystanders described chaotic and unreal scenes and emotional extremes of hope and hopelessness. Communication with emergency ambulance personnel played a key role in family member and bystander experience both during and after an emergency event. It is particularly important to family members that they are present during emergencies not just as witnesses but as partners in decision-making. In the event of a death, family and bystanders want access to psychological post-event support. CONCLUSION By incorporating patient and family-centred care into practice emergency ambulance personnel can influence the experience of family members and bystanders during emergency ambulance responses. More research is needed to explore the needs of diverse populations, particularly regarding differences in cultural and family paradigms as current research reports the experiences of westernised nuclear family experiences.
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Affiliation(s)
- Eillish Satchell
- Te Ārai Palliative & End of Life Research Group, School of Nursing University of Auckland , Private Bag 92019, Auckland, 1142, New Zealand
| | - Melissa Carey
- Te Ārai Palliative & End of Life Research Group, School of Nursing University of Auckland , Private Bag 92019, Auckland, 1142, New Zealand
| | - Bridget Dicker
- Paramedicine Research Unit, Auckland University of Technology, Auckland, New Zealand
- St John, New Zealand (Hato Hone Aotearoa), Auckland, New Zealand
| | - Haydn Drake
- St John, New Zealand (Hato Hone Aotearoa), Auckland, New Zealand
| | - Merryn Gott
- Te Ārai Palliative & End of Life Research Group, School of Nursing University of Auckland , Private Bag 92019, Auckland, 1142, New Zealand
| | - Tess Moeke-Maxwell
- Te Ārai Palliative & End of Life Research Group, School of Nursing University of Auckland , Private Bag 92019, Auckland, 1142, New Zealand
| | - Natalie Anderson
- Te Ārai Palliative & End of Life Research Group, School of Nursing University of Auckland , Private Bag 92019, Auckland, 1142, New Zealand.
- Adult Emergency Department, Auckland City Hospital, Auckland Mail Centre, Private Bag 92024, Auckland, 1142, New Zealand.
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Parke R, Bates S, Carey M, Cavadino A, Ferguson A, Hammond N, Joyce F, Kirby S, Moeke-Maxwell T, Nona F, Mason K. Bullying, discrimination, and sexual harassment among intensive care unit nurses in Australia and New Zealand: An online survey. Aust Crit Care 2023; 36:10-18. [PMID: 36210282 DOI: 10.1016/j.aucc.2022.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Bullying, discrimination, and sexual harassment are significant problems within healthcare organisations but are often under-reported. Consequences of these behaviours within a healthcare setting are wide ranging, affecting workplace environments, personal well-being, and patient care and leading to increased staff turnover and quality of patient care and outcomes. Whilst there has been some work undertaken in the general nursing workforce, there is a dearth of evidence regarding the extent and impact of these behaviours on the nursing workforce in intensive care units (ICUs) in Australia and New Zealand. OBJECTIVE We aimed to determine self-reported occurrences of bullying, discrimination, and sexual harassment amongst ICU nurses in Australia and New Zealand. METHODS A prospective, cross-sectional, online survey of ICU nurses in Australia and New Zealand was undertaken in May-June 2021, distributed through formal colleges, societies, and social media. Questions included demographics and three separate sections addressing bullying, sexual harassment, and discrimination. RESULTS In 679 survey responses, the overall reported occurrences of bullying, discrimination, and sexual harassment in the last 12 months were 57.1%, 32.6%, and 1.9%, respectively. Perpetrators of bullying were predominantly nurses (59.6%, with 57.9% being ICU nurses); perpetrators of discrimination were nurses (51.7%, with 49.3% being ICU nurses); and perpetrators of sexual harassment were patients (34.6%). Respondents most commonly (66%) did not report these behaviours as they did not feel confident that the issue would be resolved or addressed. CONCLUSIONS Determining the true extent of bullying, discrimination, and sexual harassment behaviours within the ICU nursing community in Australia and New Zealand is difficult; however, it is clear a problem exists. These behaviours require recognition, reporting, and an effective resolution, rather than normalisation within healthcare professions and workplace settings in order to support and retain ICU nursing staff.
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Affiliation(s)
- Rachael Parke
- School of Nursing, The University of Auckland, Auckland, New Zealand; Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, New Zealand, Auckland, New Zealand.
| | - Samantha Bates
- Dept of Intensive Care, Anaesthesia, Pain & Perioperative Medicine, Western Health, Melbourne, Australia; Centre for Integrated Critical Care, Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | - Melissa Carey
- School of Nursing, The University of Auckland, Auckland, New Zealand; School of Nursing, University of Southern Queensland, Australia
| | - Alana Cavadino
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Adele Ferguson
- ICU/ED, Bay of Plenty District Health Board, New Zealand
| | - Naomi Hammond
- Critical Care Division, The George Institute for Global Health and UNSW Sydney, Sydney, NSW, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Fiona Joyce
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, New Zealand, Auckland, New Zealand
| | - Steve Kirby
- Critical Care Complex, Middlemore Hospital, Auckland, New Zealand
| | | | - Francis Nona
- School of Public Health, The University of Queensland, Australia
| | - Kathleen Mason
- School of Nursing, The University of Auckland, Auckland, New Zealand
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Gott M, Wiles J, Mason K, Moeke-Maxwell T. Creating 'safe spaces': A qualitative study to explore enablers and barriers to culturally safe end-of-life care. Palliat Med 2022; 37:520-529. [PMID: 36415017 PMCID: PMC10074738 DOI: 10.1177/02692163221138621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Internationally, efforts are being made to promote equity in palliative and end-of-life care for Indigenous peoples. There is a need to better understand the experiences of Indigenous service users and staff. AIM To explore the views of Māori health practitioners and whānau (family group) caregivers regarding barriers and enablers to culturally safe palliative and end-of-life care. DESIGN A Kaupapa Māori qualitative study. SETTING/PARTICIPANTS Interviews were conducted with 103 participants from four areas of the North Island of Aotearoa New Zealand. Participants comprised bereaved whānau (family) of Māori with a life limiting illness and Māori health practitioners. RESULTS Māori health practitioners undertake cultural and connecting work to promote culturally safe palliative and end-of-life care for Māori patients and their whānau. This work is time-consuming and emotionally and culturally demanding and, for most, unpaid and unrecognised. Non-Māori staff can support this work by familiarising themselves with te reo Māori (the Māori language) and respecting cultural care customs. However, achieving culturally safe end-of-life care necessitates fundamental structural change and shared decision-making. CONCLUSIONS Our findings indicate that efforts to support equitable palliative care for Indigenous people should recognise, and support, the existing efforts of health practitioners from these communities. Colleagues from non-Indigenous populations can support this work in a range of ways. Cultural safety must be appropriately resourced and embedded within health systems if aspirations of equitable palliative and end-of-life care are to be realised.
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Affiliation(s)
- Merryn Gott
- Te Ārai Palliative Care and End of Life Research Group, The School of Nursing, The University of Auckland, Grafton, Auckland, New Zealand
| | - Janine Wiles
- Te Ārai Palliative Care and End of Life Research Group, The School of Population Health, The University of Auckland, Grafton, Auckland, New Zealand
| | - Kathleen Mason
- Te Ārai Palliative Care and End of Life Research Group, The School of Nursing, The University of Auckland, Grafton, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- Te Ārai Palliative Care and End of Life Research Group, The School of Nursing, The University of Auckland, Grafton, Auckland, New Zealand
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Affiliation(s)
- Natalie Elizabeth Anderson
- School of Nursing, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Jackie Robinson
- School of Nursing, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- School of Nursing, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
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Morgan T, Wiles J, Moeke-Maxwell T, Black S, Park HJ, Dewes O, Williams LA, Gott M. 'People haven't got that close connection': meanings of loneliness and social isolation to culturally diverse older people. Aging Ment Health 2020; 24:1627-1635. [PMID: 31256631 DOI: 10.1080/13607863.2019.1633619] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Social isolation and loneliness among older people are known to have negative effects on health and wellbeing. Few studies, however, have enabled older people to define these concepts in their own terms. This paper based on research in Aotearoa, New Zealand is the first to comparatively outline the meanings of loneliness and social isolation from the perspective of four ethnically diverse groups of older adults (Māori, Pacific, Asian, and NZ European).Method: We interviewed 44 older people and conducted three focus groups with 32 older people. We used thematic and narrative analyses.Results: Loneliness and social isolation were conceptualized as interconnected concepts described as a 'look and feel', a 'state of mind' and as a 'lack of desired companionship'. Participants conveyed sophisticated understandings of the structural underpinnings of both loneliness and social isolation as multi-dimensional, complex, and situated.Conclusions: Older people describe complex and culturally- nuanced understanding and experience of social isolation and loneliness. More culturally appropriate services, greater mental-health support and more service provision on weekends and evenings are needed.
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Affiliation(s)
- Tessa Morgan
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Janine Wiles
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Stella Black
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Hong-Jae Park
- School of Social Sciences and Psychology, Western Sydney University, Penrith, Australia
| | - Ofa Dewes
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lisa Ann Williams
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Moeke-Maxwell T, Mason K, Williams L, Gott M. Digital story-telling research methods: Supporting the reclamation and retention of indigenous end-of-life care customs in Aotearoa New Zealand. Progress in Palliative Care 2020. [DOI: 10.1080/09699260.2019.1704370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | - Lisa Williams
- School of Nursing, University of Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, University of Auckland, New Zealand
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14
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Wiles J, Morgan T, Moeke-Maxwell T, Black S, Park HJ, Dewes O, Williams LA, Gott M. Befriending Services for Culturally Diverse Older People. J Gerontol Soc Work 2019; 62:776-793. [PMID: 31296128 DOI: 10.1080/01634372.2019.1640333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 06/09/2023]
Abstract
Befriending services may address loneliness and social isolation amongst older people. However social diversity is rarely reported in investigations of befriending services. The views of non-users are also rarely explored. In this research, we explored older adults' experiences of, and attitudes towards, a befriending service, among service users and non-service users, drawing on interviews and focus groups with 76 older adults, 10 volunteer visitors, and 20 service providers. Participants agreed that the befriending service helped alleviate social isolation and loneliness and that supportive services to foster connection are needed. Barriers to engagement included lack of knowledge, appropriateness of services and feeling undeserving. The befriending service was most successful when a match went beyond a transactional 'professional-client' relationship to resemble genuine friendship, underpinned by mutual interests and norms of reciprocity and reliability. We also identified five clear ideas about what characterizes an ideal supportive service; supported opportunities for getting out, genuine and reciprocal relationships, reliability, visitor characteristics, and connecting people to their culture. Befriending adds to social networks, and enhances connectedness to the community. Loneliness is alleviated when mutually beneficial and genuinely reciprocal relationships develop. However, group interventions or connections to community groups may be more appropriate for some.
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Affiliation(s)
- Janine Wiles
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland , Auckland , New Zealand
| | - Tessa Morgan
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland , Auckland , New Zealand
| | - Tess Moeke-Maxwell
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland , Auckland , New Zealand
| | - Stella Black
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland , Auckland , New Zealand
| | - Hong-Jae Park
- School of Social Sciences and Psychology, Western Sydney University , Penrith , NSW , Australia
| | - Ofa Dewes
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland , Auckland , New Zealand
| | - Lisa Ann Williams
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland , Auckland , New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland , Auckland , New Zealand
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Gott M, Robinson J, Moeke-Maxwell T, Black S, Williams L, Wharemate R, Wiles J. 'It was peaceful, it was beautiful': A qualitative study of family understandings of good end-of-life care in hospital for people dying in advanced age. Palliat Med 2019; 33:793-801. [PMID: 31027476 DOI: 10.1177/0269216319843026] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hospitals are important sites of end-of-life care, particularly for older people. A need has been identified to understand best practice in hospital end-of-life care from the service-user perspective. AIM The aim of this study was to identify examples of good care received in the hospital setting during the last 3 months of life for people dying in advanced age from the perspective of bereaved family members. DESIGN A social constructionist framework underpinned a qualitative research design. Data were analysed thematically drawing on an appreciative enquiry framework. SETTING/PARTICIPANTS Interviews were conducted with 58 bereaved family carers nominated by 52 people aged >80 years participating in a longitudinal study of ageing. Data were analysed for the 21 of 34 cases where family members were 'extremely' or 'very' satisfied with a public hospital admission their older relative experienced in their last 3 months of life. RESULTS Participants' accounts of good care aligned with Dewar and Nolan's relation-centred compassionate care model: (1) a relationship based on empathy; (2) effective interactions between patients/families and staff; (3) contextualised knowledge of the patient/family; and (4) patients/families being active participants in care. We extended the model to the bicultural context of Aotearoa, New Zealand. CONCLUSION We identify concrete actions that clinicians working in acute hospitals can integrate into their practice to deliver end-of-life care with which families are highly satisfied. Further research is required to support the implementation of the relation-centred compassionate care model within hospitals, with suitable adaptations for local context, and explore the subsequent impact on patients, families and staff.
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Affiliation(s)
- Merryn Gott
- 1 School of Nursing, University of Auckland, Auckland, New Zealand.,2 Te Ārai Palliative Care and End of Life Research Group, University of Auckland, Auckland, New Zealand
| | - Jackie Robinson
- 1 School of Nursing, University of Auckland, Auckland, New Zealand.,2 Te Ārai Palliative Care and End of Life Research Group, University of Auckland, Auckland, New Zealand.,3 Auckland District Health Board, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- 1 School of Nursing, University of Auckland, Auckland, New Zealand.,2 Te Ārai Palliative Care and End of Life Research Group, University of Auckland, Auckland, New Zealand
| | - Stella Black
- 1 School of Nursing, University of Auckland, Auckland, New Zealand.,2 Te Ārai Palliative Care and End of Life Research Group, University of Auckland, Auckland, New Zealand
| | - Lisa Williams
- 1 School of Nursing, University of Auckland, Auckland, New Zealand.,2 Te Ārai Palliative Care and End of Life Research Group, University of Auckland, Auckland, New Zealand
| | - Rawiri Wharemate
- 2 Te Ārai Palliative Care and End of Life Research Group, University of Auckland, Auckland, New Zealand
| | - Janine Wiles
- 2 Te Ārai Palliative Care and End of Life Research Group, University of Auckland, Auckland, New Zealand.,4 School of Population Health, University of Auckland, Auckland, New Zealand
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16
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Moeke-Maxwell T, Wharemate R, Black S, Mason K, Wiles J, Gott M. Toku toa, he toa rangatira: A qualitative investigation of New Zealand Māori end of life care customs. IJIH 2018. [DOI: 10.32799/ijih.v13i2.29749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Informal end of life caregiving will increase over the next 30 years in line with the anticipated increase in older Māori deaths. Of concern, New Zealand’s neo-colonial trajectory (loss of lands, cultural disenfranchisement, urban migration, ethnic diversity, global diaspora and changing whānau (family, including extended family) compositions) has restricted some indigenous whānau from retaining their end of life care customs. This article reports on a qualitative pilot study on Māori whānau end of life care customs undertaken to explore how those care customs contribute towards strengthening whānau resilience and bereavement. Five whānau, including thirteen individuals from diverse iwi (tribes), took part in one of six face to face interviews. Kaupapa Māori research methods informed the analysis. The findings report a high level of customary caregiving knowledge among older whānau carers as well as a cohesive whānau collective support system for this group. Tribal care customs were handed down via 1) enculturation with tribal principles, processes and practices 2) observing kaumātua processes and practices and 3) being chosen and prepared for a specific care role by kaumātua. Younger participants had strong cultural care values but less customary care knowledge. The pilot concluded the need for a larger systematic qualitative study of Māori tikanga (customs) and kawa (guidelines) as well as the development of participant digital stories to support a free online educational resource to increase understanding among whānau, indigenous communities and the health and palliative care sectors.
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Wiles J, Moeke-Maxwell T, Williams L, Black S, Trussardi G, Gott M. Caregivers for people at end of life in advanced age: knowing, doing and negotiating care. Age Ageing 2018; 47:887-895. [PMID: 30165558 DOI: 10.1093/ageing/afy129] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 07/21/2018] [Indexed: 11/14/2022] Open
Abstract
Background the need for palliative and end of life care for the oldest old is growing rapidly. Family carers often report they do not feel well supported; for better practice and policy, we need better understanding of their experiences and how to support them. Design and setting people in the LiLACS NZ longitudinal study of advanced age identified a carer to be interviewed after their death. Nominated caregivers were contacted 3-6 months after an older person's death and invited to take part in the current study. Subjects fifty-eight interviews were conducted with carers of 52 people in advanced age, 20 Māori and 32 non-Māori. The majority of the 58 carers were in their 60 s and were women. Methods guided-conversation interviews covered end of life preferences and experiences, needs and gaps in support, arrangements after death, and experiences of bereavement. Rigorous data analysis included multiple researchers identifying and interrogating themes across and within the transcripts, and feedback and discussion with participants. Results we identify a typology of nine categories of care, and argue that the support and care provided by family should be understood as going beyond simple task-based transactions. We present a model of end of life care describing and explaining inter-related aspects of knowing, doing and negotiating care tasks. Conclusions this work furthers current understandings of care, as multifaceted and negotiated. This has very practical implications for thinking about how best to support the complex end of life caregiving work of people caring for a person in advanced age.
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Affiliation(s)
- Janine Wiles
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lisa Williams
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Stella Black
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gabriella Trussardi
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Williams LA, Moeke-Maxwell T, Wiles J, Black S, Trussardi G, Kerse N, Gott M. How family caregivers help older relatives navigate statutory services at the end of life: A descriptive qualitative study. Palliat Med 2018; 32:1124-1132. [PMID: 29667475 DOI: 10.1177/0269216318765853] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: A key challenge in meeting the palliative care needs of people in advanced age is the multiple healthcare and social service agencies typically involved in their care. The ‘patient navigator’ model, originally developed in cancer care, is the professional solution most often recommended to address this challenge. However, little attention has been paid, or is known, about the role that family carers play in enabling their dying relatives to negotiate service gaps. Aim: To explore the role family caregivers play in helping people dying in advanced old age navigate health services at the end of life. Design: Qualitative study using semi-structured interviews and analysed via thematic analysis. Setting/participants: A total of 58 interviews were conducted in New Zealand with the family caregivers of 52 deceased older relatives who had been participants in Life and Living in Advanced Age: a Cohort Study in New Zealand. Results: Fragmentation of services was the key concern, causing distress both for the older person and their family caregivers. Carers identified and engaged with appropriate services in order to facilitate care and treatment. Their involvement was not always met by healthcare professionals with respect or regard to their knowledge of the older person’s needs. Conclusion: Family caregivers are trying to help their older relatives overcome the limitations of fragmented health systems at the end of life. They are doing so at times by stepping in to perform patient navigator tasks usually conceptualised as a role for statutory services to carry out. Programmes and services need to be implemented that will better support family carers who are acting as care navigators.
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Affiliation(s)
- Lisa Ann Williams
- 1 School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- 1 School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Janine Wiles
- 2 School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Stella Black
- 1 School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gabriella Trussardi
- 1 School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- 2 School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- 1 School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Williams L, Trussardi G, Black S, Moeke-Maxwell T, Frey R, Robinson J, Gott M. Complex contradictions in conceptualisations of 'dignity' in palliative care. Int J Palliat Nurs 2018; 24:12-21. [PMID: 29368556 DOI: 10.12968/ijpn.2018.24.1.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Internationally, increasing attention is being paid to understanding patient experiences of health care. Within palliative care, the Views of Informal Carers - Evaluation of Services (VOICES) questionnaire is commonly used for this purpose. Among its objectives is to ask family members if their relatives were treated with dignity at the end of life. This is regarded as useful for understanding the quality of the health care received. AIM To highlight the differences between family members' reports of dignity in the care provided to their relatives at the end of life, as reported in the VOICES questionnaire, and their narratives about the care their relatives received. METHODS A total of 21 cognitive interviews were conducted during a New Zealand pilot of the VOICES questionnaire. RESULTS Discrepancies between ratings of dignity and the lived experience of care suggest that lay understandings of dignity may not be congruent with that of health care providers. CONCLUSIONS Bereaved family members' self-reports of dignity in end-of-life care captured using survey methods alone are inadequate to understand the complex ways in which individuals conceptualise and experience dignity within a health care context. The authors advocate consideration of multiple, complementary approaches to gathering consumer experiences of end-of-life care, as well as research which enables service users to interrogate what dignity in care means in an end-of-life context.
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Affiliation(s)
- Lisa Williams
- Research Fellow; School of Nursing, Faculty of Medical and Health Sciences, the University of Auckland, New Zealand
| | - Gabriella Trussardi
- Research Assistant; School of Nursing, Faculty of Medical and Health Sciences, the University of Auckland, New Zealand
| | - Stella Black
- Research Assistant; School of Nursing, Faculty of Medical and Health Sciences, the University of Auckland, New Zealand
| | - Tess Moeke-Maxwell
- Research Fellow; School of Nursing, Faculty of Medical and Health Sciences, the University of Auckland, New Zealand
| | - Rosemary Frey
- Research Fellow; School of Nursing, Faculty of Medical and Health Sciences, the University of Auckland, New Zealand
| | - Jackie Robinson
- Senior Lecturer; School of Nursing, Faculty of Medical and Health Sciences, the University of Auckland, New Zealand
| | - Merryn Gott
- Professor of Health Sciences; School of Nursing, Faculty of Medical and Health Sciences, the University of Auckland, New Zealand
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Gott M, Wiles J, Moeke-Maxwell T, Black S, Williams L, Kerse N, Trussardi G. What is the role of community at the end of life for people dying in advanced age? A qualitative study with bereaved family carers. Palliat Med 2018; 32:268-275. [PMID: 29130405 DOI: 10.1177/0269216317735248] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND New public health approaches to palliative care prioritise the role of community at end of life. However, little is known about community support for the increasing numbers of people dying in advanced age. AIM To explore the role of community at end of life for people dying in advanced age from the perspective of their bereaved family caregivers. DESIGN A constructionist framework underpinned a qualitative research design. Data were analysed using critical thematic analysis. SETTING/PARTICIPANTS A total of 58 participants (19 Māori and 39 non-Māori) who cared for 52 family members who died at >80 years of age participated in semi-structured interviews. RESULTS A reduction in the social networks and community engagement of the older person was identified in the end-of-life period. Numerous barriers to community engagement in advanced age were identified, including poor health (notably dementia), moving into an aged care facility and lack of access due to transport difficulties. An active withdrawal from community at end of life was also noted. Carers felt limited support from community currently, but identified that communities could play a particular role in reducing social isolation and loneliness among people of advanced age prior to death. CONCLUSION Our study provides strong support for public health approaches to palliative care that advocate building social networks around people who are dying and their family carers. However, it also indicates that strategies to do so must be flexible enough to be responsive to the unique end-of-life circumstances of people in advanced age.
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Affiliation(s)
- Merryn Gott
- 1 School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Janine Wiles
- 2 School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- 2 School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Stella Black
- 2 School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Lisa Williams
- 1 School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- 2 School of Population Health, The University of Auckland, Auckland, New Zealand
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Gott M, Frey R, Wiles J, Rolleston A, Teh R, Moeke-Maxwell T, Kerse N. End of life care preferences among people of advanced age: LiLACS NZ. BMC Palliat Care 2017; 16:76. [PMID: 29258480 PMCID: PMC5738169 DOI: 10.1186/s12904-017-0258-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/01/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Understanding end of life preferences amongst the oldest old is crucial to informing appropriate palliative and end of life care internationally. However, little has been reported in the academic literature about the end of life preferences of people in advanced age, particularly the preferences of indigenous older people, including New Zealand Māori. METHODS Data on end of life preferences were gathered from 147 Māori (aged >80 years) and 291 non- Māori aged (>85 years), during three waves of Te Puawaitangi O Nga Tapuwae Kia Ora Tonu, Life and Living in Advanced Age (LiLACs NZ). An interviewer-led questionnaire using standardised tools and including Māori specific subsections was used. RESULTS The top priority for both Māori and non-Māori participants at end of life was 'not being a burden to my family'. Interestingly, a home death was not a high priority for either group. End of life preferences differed by gender, however these differences were culturally contingent. More female Māori participants wanted spiritual practices at end of life than male Māori participants. More male non-Māori participants wanted to be resuscitated than female non- Māori participants. CONCLUSIONS That a home death was not in the top three end of life priorities for our participants is not consistent with palliative care policy in most developed countries where place of death, and particularly home death, is a central concern. Conversely our participants' top concern - namely not being a burden - has received little research or policy attention. Our results also indicate a need to pay attention to diversity in end of life preferences amongst people of advanced age, as well as the socio-cultural context within which preferences are formulated.
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Affiliation(s)
- Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rosemary Frey
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Janine Wiles
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Anna Rolleston
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ruth Teh
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Williams L, Gott M, Moeke-Maxwell T, Black S, Kothari S, Pearson S, Morgan T, Wharemate MR, Hansen WW. Can digital stories go where palliative care research has never gone before? A descriptive qualitative study exploring the application of an emerging public health research method in an indigenous palliative care context. BMC Palliat Care 2017; 16:46. [PMID: 28870189 PMCID: PMC5584042 DOI: 10.1186/s12904-017-0216-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 06/23/2017] [Indexed: 11/23/2022] Open
Abstract
Background The World Health Organization (WHO) has called for global approaches to palliative care development. Yet it is questionable whether one-size-fits-all solutions can accommodate international disparities in palliative care need. More flexible research methods are called for in order to understand diverse priorities at local levels. This is especially imperative for Indigenous populations and other groups underrepresented in the palliative care evidence-base. Digital storytelling (DST) offers the potential to be one such method. Digital stories are short first-person videos that tell a story of great significance to the creator. The method has already found a place within public health research and has been described as a useful, emergent method for community-based participatory research. Methods The aim of this study was to explore Māori participants’ views on DST’s usefulness, from an Indigenous perspective, as a research method within the discipline of palliative care. The digital storytelling method was adapted to include Māori cultural protocols. Data capturing participant experience of the study were collected using participant observation and anonymous questionnaires. Eight participants, seven women and one man, took part. Field notes and questionnaire data were analysed using critical thematic analysis. Results Two main themes were identified during analyses: 1) issues that facilitated digital storytelling’s usefulness as a research method for Māori reporting on end of life caregiving; and 2) issues that hindered this process. All subthemes identified: recruitment, the pōwhiri process, (Māori formal welcome of visitors) and technology, related to both main themes and are presented in this way. Conclusion Digital storytelling is an emerging method useful for exploring Indigenous palliative care issues. In line with a Health Promoting Palliative Care approach that centres research in communities, it helps meet the need for diverse approaches to involve underrepresented groups.
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Affiliation(s)
- Lisa Williams
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Stella Black
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Shuchi Kothari
- Media and Communication, School of Social Sciences, Faculty of the Arts, University of Auckland, Auckland, New Zealand
| | - Sarina Pearson
- Media and Communication, School of Social Sciences, Faculty of the Arts, University of Auckland, Auckland, New Zealand
| | - Tessa Morgan
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Matua Rawiri Wharemate
- Kaumātua, Te Ārai: Palliative Care and End of Life Research Group, School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Whaea Whio Hansen
- Kaumātua, Te Ārai: Palliative Care and End of Life Research Group, School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Gott M, Moeke-Maxwell T, Morgan T, Black S, Williams L, Boyd M, Frey R, Robinson J, Slark J, Trussardi G, Waterworth S, Wharemate R, Hansen W, Smith E, Kaka K, Henare K, Henare E, Poto M, Tipene-Carter E, Hall DA. Working bi-culturally within a palliative care research context: the development of the Te Ārai Palliative Care and End of Life Research Group. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/13576275.2016.1216955] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Merryn Gott
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Tessa Morgan
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Stella Black
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Lisa Williams
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Rosemary Frey
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Jackie Robinson
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Julia Slark
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Gabriella Trussardi
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Susan Waterworth
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Rawiri Wharemate
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Whio Hansen
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Eliza Smith
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Kiripai Kaka
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Kohi Henare
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Eileen Henare
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Manaaki Poto
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Eliza Tipene-Carter
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Devi-ann Hall
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
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Gardiner C, Allen R, Moeke-Maxwell T, Robinson J, Gott M. Methodological considerations for researching the financial costs of family caregiving within a palliative care context. BMJ Support Palliat Care 2016; 6:445-451. [PMID: 27118370 DOI: 10.1136/bmjspcare-2015-001046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/27/2016] [Accepted: 04/04/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND The financial impact of family caregiving in a palliative care context has been identified as an issue which requires further research. However, little is known about how research should be conducted in this area. OBJECTIVE The aim of this study was to explore the opinions of family caregivers in New Zealand regarding the need to conduct research relating to the financial costs of family caregiving and to explore their perspectives on acceptable and feasible methods of data collection. METHODS A qualitative study design was adopted. Semistructured interviews were conducted with 30 family caregivers who were either currently caring for a person with palliative care needs or had done so in the past year. RESULTS All participants felt that research relating to the costs of family caregiving within a palliative care context was important. There was little consensus regarding the most appropriate methods of data collection and administration. Online methods were preferred by many participants, although face-to-face methods were particularly favoured by Ma¯ori participants. Both questionnaires and cost diaries were felt to have strengths and weaknesses. CONCLUSIONS Prospective longitudinal designs are likely to be most appropriate for future research, in order to capture variations in costs over time. The lack of consensus for a single preferred method makes it difficult to formulate specific recommendations regarding methods of data collection; providing participants with options for methods of completion may therefore be appropriate.
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Affiliation(s)
- Clare Gardiner
- School of Nursing & Midwifery, The University of Sheffield, Sheffield, UK
| | | | | | - Jackie Robinson
- School of Nursing, University of Auckland, Auckland, New Zealand.,Auckland District Health Board, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand
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Gott M, Moeke-Maxwell T, Williams L, Black S, Trussardi G, Wiles J, Mules R, Rolleston A, Kerse N. Te Pākeketanga: living and dying in advanced age--a study protocol. BMC Palliat Care 2015; 14:74. [PMID: 26691519 PMCID: PMC4687083 DOI: 10.1186/s12904-015-0073-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 12/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of people dying in advanced old age is increasing rapidly and building the evidence base regarding end - of - life care for older people has been identified as an international policy priority. The unique opportunity to link longitudinal studies of ageing with studies exploring the end of life circumstances of older people remains under-exploited internationally. Very little is known about the specific circumstances, cultural needs and care preferences of indigenous older people, including Māori, at end - of - life and the needs of their whānau/ extended family carers. METHODS We will use rigorous qualitative methods to conduct post-bereavement interviews with bereaved whānau and family of 50-60 people who died >80 years; approximately half of participants will be Maori. The older decedents were participants in the first longitudinal study of older people involving a specific indigenous cohort internationally: Te Puāwaitanga O Ngā Tapuwae Kia Ora Tonu, Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ). Prior to death, they completed a questionnaire regarding their end-of-life preferences and nominated a family or whānau member to participate in this separate study exploring end-of-life circumstances of those in advanced age. DISCUSSION Recommendations to improve care will be formulated in collaboration with participants and their local hapū (sub-tribe). Ultimately this study has the potential to inform better outcomes for the growing numbers of people dying in advanced old age both in New Zealand and internationally, as well as their whānau and family caregivers. It also highlights the ability to generate an in-depth understanding of end-of-life circumstances by appending studies of palliative and end-of-life care onto existing longitudinal studies.
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Affiliation(s)
- Merryn Gott
- School of Nursing, University of Auckland, Boyle Building, 85 Park Road, Auckland, New Zealand.
| | - Tess Moeke-Maxwell
- School of Nursing, University of Auckland, Boyle Building, 85 Park Road, Auckland, New Zealand
| | - Lisa Williams
- School of Nursing, University of Auckland, Boyle Building, 85 Park Road, Auckland, New Zealand
| | - Stella Black
- School of Nursing, University of Auckland, Boyle Building, 85 Park Road, Auckland, New Zealand
| | - Gabriella Trussardi
- School of Nursing, University of Auckland, Boyle Building, 85 Park Road, Auckland, New Zealand
| | - Janine Wiles
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Rangimarie Mules
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Anna Rolleston
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
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Gott M, Allen R, Moeke-Maxwell T, Gardiner C, Robinson J. 'No matter what the cost': A qualitative study of the financial costs faced by family and whānau caregivers within a palliative care context. Palliat Med 2015; 29:518-28. [PMID: 25680378 PMCID: PMC4441882 DOI: 10.1177/0269216315569337] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND There has been significant attention paid in recent years to the economic costs of health service provision for people with palliative care needs. However, little is known about the costs incurred by family caregivers who typically provide the bulk of care for people at the end of life. AIM To explore the nature and range of financial costs incurred by family caregiving within a palliative care context. DESIGN In-depth qualitative interviews were conducted with 30 family/whānau caregivers who were currently caring for someone with a life-limiting illness or had done so within the preceding year. Narrative analysis was used to identify impacts and costs at the personal, interpersonal, sociocultural and structural levels. SETTING Auckland, New Zealand. FINDINGS Costs of caregiving were significant and, for participants, resulted in debt or even bankruptcy. A range of direct (transport, food and medication) and indirect costs (related to employment, cultural needs and own health) were reported. A multi-level qualitative analysis revealed how costs operated at a number of levels (personal, interpersonal, sociocultural and structural). The palliative care context increased costs, as meeting needs were prioritised over cost. In addition, support from statutory service providers to access sources of financial support was limited. CONCLUSION Families incur significant financial costs when caring for someone at the end of life. Research is now needed to quantify the financial contribution of family and whānau caregiving within a palliative care context, particularly given attempts in many countries to shift more palliative care provision into community settings.
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Affiliation(s)
- Merryn Gott
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Ruth Allen
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | | | - Clare Gardiner
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Jackie Robinson
- School of Nursing, The University of Auckland, Auckland, New Zealand
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Williams L, Moeke-Maxwell T, Kothari S, Pearson S, Gott M, Black S, Frey R, Wharemate R, Hansen W. PA12 Is digital storytelling ka pai for new zealand māori? using digital storytelling as a method to explore whānau end of life caregiving experiences: a pilot study. BMJ Support Palliat Care 2015; 5 Suppl 1:A23. [PMID: 25960498 DOI: 10.1136/bmjspcare-2015-000906.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Māori regard stories as a preferred method for imparting knowledge through waiata (song), moteatea (poetry), kauwhau (moralistic tale), pakiwaitara (story) and purakau (myths). Storytelling is also an expression of tinorangatiratanga (self-determination); Māori have the right to manage their knowledge, which includes embodiment in forms transcending typical western formulations. Digital storytelling is a process by which 'ordinary people' create short autobiographical videos. It has found application in numerous disciplines including public health and has been used to articulatethe experiences of those often excluded from knowledge production. AIM To explore the use of digital storytelling as a research method for learning about whānau (family) experiences providing end of life care for kaumātua (older people). METHODS Eight Māori and their nominated co-creators attended a three-day digital story telling workshop led by co-researchers Shuchi Kothari and Sarina Pearson. They were guided in the creation of first-person digital stories about caring for kaumātua. The videos were shared at a group screening, and participants completed questionnaires about the workshop and their videos. A Kaupapa Māori narrative analysis was applied to their stories to gain new perspectives on Māori end of life caregiving practices. (Kaupapa Maori research privileges Maori worldviews and indigenous knowledge systems.) RESULTS Digital storytelling is an appropriate method as Māori is an oral/aural society. It allows Māori to share their stories with others, thus promoting community support at the end of life, befitting a public health approach. CONCLUSION Digital storytelling can be a useful method for Māori to express their experiences providing end of life caregiving.
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Moeke-Maxwell T. What whānau need at the end of life. Nurs N Z 2014; 20:12-14. [PMID: 24946406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
Within the health research context, indigenous people globally have a commitment to provide their own solutions. Māori, the indigenous people of Aotearoa (New Zealand) value the traditional Pōwhiri process of engagement and participation in mental health research. The practices and protocols within the Pōwhiri process (use in the Doctorate of Philosophy (2010) and Auckland University) are premised on the notion of respect and positive relationships between the tangata whenua (hosts or research participants) and manuwhiri (guests or researchers). This paper briefly describes the Pōwhiri process, which may be a model applicable to research with other indigenous cultures.
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