Julia Slark

Objective: To describe and compare ethics and governance approval timelines for the Quality in Acute Stroke Care (QASC) Australasia Trial (2021–present) and Triage, Treatment, and Transfer of Patients with Stroke in Emergency Departments (T3) Trial (2012–2014), benchmarking against national and international targets. Methods: Retrospective, descriptive analysis of approval timelines for ethics, Site-Specific Assessment (SSA), Clinical Trials Research Agreements (CTRA), and Public Health Act (PHA) application (Queensland hospitals). Results: The QASC Australasia Trial involved 52 Australian and 8 New Zealand hospitals. In Australia, lead ethics approval took 30 days. SSA approvals took a median of 91 days (interquartile range (IQR) 52–144). CTRA execution required a median of 56 days (IQR 38–105). PHA approval was required at 10 sites, with a median of 34 days (IQR 29–52). In New Zealand, ethics approval took 53 days. SSA approvals and CTRA execution took medians of 121 days (IQR 73–152) and 133 days (IQR 84–146), respectively. The T3 Trial involved 26 Australian hospitals. Lead ethics approval took 76 days. SSA approvals (n = 22) took a median of 132 days (IQR 106–175). Since the T3 Trial, Australian lead ethics approval times decreased by 61% and SSA approvals decreased by 31%. Only 33% of Australian QASC Australasia Trial and 5% of T3 Trial SSA approvals met the 60-day national benchmark. Conclusions: Multicentre trial governance processes remain lengthy, particularly for New Zealand. CTRA and jurisdiction requirements delayed SSA approval. Streamlined processes are needed to optimise resources and accelerate evidence translation.

Māori, the Indigenous people of Aotearoa New Zealand, experience higher rates of mental health admissions, seclusions and poorer outcomes. Current mental health services are largely based on Western models of care and do not address the needs of Māori. This integrative review aimed to identify, critically appraise and synthesise evidence on Māori models of inpatient mental health services. Whittemore and Knafl's integrative review procedure was used. Pubmed, PsycINFO, EMBASE, CINAHL, Proquest and Google were searched for records published between 2014 and 2024 in English or the Māori language. Included studies had to refer to Māori models of adult inpatient mental health services or aspects of such services relevant to Māori. Studies were critically appraised using the Joanna Briggs tools and evaluated for Māori responsiveness using the Te Ara Tika Guidelines. This review is consistent with the PRISMA guidelines. Twenty‐five publications were included and comprised qualitative and quantitative studies, reviews and policy articles. Eight studies used kaupapa Māori research methods. One hundred and nine Māori participants were included across the studies, of which 21 were service users, three were family members and the remainder were healthcare professionals. The current evidence base on Māori models of care for inpatient mental health services in Aotearoa New Zealand is very limited. Four main themes were identified, which included an urgent need to transform inpatient mental health services for Māori, to embed cultural processes and values throughout such services, to involve service users and family in the co‐design of services and to increase Māori research on inpatient mental health services.

This study aimed to understand the inpatient experiences of people accessing healthcare who identify as Indian in an acute care hospital in Aotearoa New Zealand, using the Fundamentals of Care Framework as a point of care theory. Specifically, the study aimed to explore their experiences of communication, respect, personal care, and self-care, four areas identified for improvement in a previous internal organisational review of care. The study used a qualitative descriptive approach which aligns with critical theory aiming to understand how different participants perceive reality within dynamic contexts. The study was conducted with ten participants who identified as Indian and had been patients in an acute care hospital. Directed content analysis was applied to the data from the interviews using the four previously identified categories. These categories included communication, respect, personal, and self-care. Content drawn from within these categories was then analysed using relational caregiver (nurse) actions as described in the Fundamentals of Care Framework. The results demonstrated that nurses’ actions lacked a relational approach in many of the care episodes particularly concerning communication, respect, and self-care. However, this approach aligned with the participant’s expectations of what nurses can deliver due to the busyness of their work; they seemingly picked up this burden of nursing busyness. Participants did not express any perceived differences in care relating to their culture or ethnicity. The diversity of the workforce reflective of themselves, was a welcoming factor, highlighting the benefits of a globally mobile workforce. Te Reo Māori Translation: He rangahau ine kounga o ngā wheako o ngā tūroro Īnia mō te horanga taurima taketake i tētahi hōhipera māuiui tārūrū: Ngā Ariā Matua Ko te aronga o tēnei rangahau he whai kia mārama ki ngā wheako o ngā tāngata e kī nei he Īnia rātou ina urutomo ki ngā tautiakitanga hauora i tētahi hōhipera taurima māuiui tārūrū i Aotearoa, mā te whakamahi i te Anga Tikanga Taurima Taketake hei pūtahi mō ngā ariā taurima. Inarā, ko te whai a te uiuinga kia tūhuratia ō rātou wheako mō te whakawhiti kōrero, mō te whakarangatira i te tangata, te tiaki whaiaro, me te tiaki i a rātou anō, ēnei katoa i tautohutia i tētahi arotake taurima whakaroto o te whakahaere. Ka whakamahia e tēnei rangahau tētahi ara ine kounga whakamārama e hāngai ana ki ngā ariā tātari e whai nei kia mārama he pēhea te kite a tēnā tangata whai wāhi, a tēnā tangata whai wāhi, i ngā horopaki rerekē. I kawea tēnei uiuinga i te taha o ētahi tāngata whai wāhi tekau i kī he Īnia rātou, ā, kua noho hei tūroro i tētahi hōhipera taurima māuiui tārūrū. I hoatu he tātari whakawhāiti aronga ki ngā mōhiotanga i tāpaetia mai i roto i ngā uiui. I tātaritia ngā kitenga mā te whakamahi kāwai i takea mai i tētahi arotake tō mua o ngā wheako o ngā tūroro o te taurima taketake i taua wāhi tonu o te rangahau mā te whakamahi i ngā kāwai e whā kua whakamāmatia ake nei. Ka uru ki tēnei kāwai ko te whakawhiti, ko te whakaute, ko te āhua whaiaro, me te taurima a te tangata i te tangata anō. I tātaritia ngā kai i takea mai i ēnei kāwai nā te whakamahi i ngā mahi a te kaitaurima (tapuhi) tūtata, e ai ki tōna tūtohutanga i roto i te Anga Tikanga Taurima Taketake. Kei ngā hua ka kitea i te ngaro tētahi tatanga tūturu i roto i ngā tūponotanga taurima maha, otirā mō te whakawhiti kōrero, mō te whakaute, me te taurima a te tangata i te tangata anō, i tino kitea. Ahakoa tērā, i hāngai tēnei ara ki ngā tūmanako o ngā tāngata whai wāhi mō ngā mea ka taea te hora e ngā tapuhi nā te waipuke mai o ngā mahi; i rongo rā rātou i te taumahatanga o te waipuke o te mahi tapuhi. Kāore ngā tāngata whai wāhi mai i tino kōrero mō tētahi makihuhunu, nā tō rātou ahurea, tō rātou momo iwi rānei. I mihi anō rātou ki te āhua o te noho mai o ētahi tapuhi nō tō rātou ao anō, me te mihi ki te āhua o te rere noa o ngā tapuhi ki ngā wāhi maha o te ao, mahi ai.

Relational practice is the basis for human connection and is linked to enhanced healthcare experiences and involvement with healthcare services. Although the nurse‐patient relationship is typically built around behavioural communication skills, relational practice requires developing awareness, connectedness and responsiveness to others. The task‐oriented ways of working have eroded these attributes. This study explored how Indigenous values and practices can transform relational practice in a publicly funded acute hospital in Aotearoa, New Zealand. Kaupapa Māori (Māori philosophy and practice) and grounded theory were used to generate and analyse data from interviews with Māori staff and consumers. Three culturally informed processes culminated in the culturally grounded theory of achieving a culture of whanaungatanga (belonging and inclusion): tikanga mahi (work ethic), whakawhanaungatanga (developing kinships) and manaakitanga (cultural and social responsibility). The study highlights the necessity of developing and maintaining relationships and creating an environment that enables relational practice. Findings show that developing a sound work ethic supported by solid and committed leadership and espousing Māori values is the catalyst for change. Applying an Indigenous mentoring model like the tuakana‐teina (leader–learner) model may create an environment supporting organisational culture change.

The incidence of stroke in younger adults is rising, especially among women. This study aims to explore the experiences of younger women who have had a stroke to understand their experience and support needs. This study used a qualitative description approach, recruiting eligible women through a snowball method. A focus group discussion was conducted to collect data, which was then analysed using thematic analysis. The five participants were 18 to 64 years old when they experienced their stroke and six to 18 years post-stroke when they participated in a focus group discussion in 2021. Four themes and 11 sub-themes emerged during the data analysis: 1) impacts of stroke (stroke onset and early experiences, physical and psychosocial effects, and changes to their roles and careers); 2) women’s reproductive health (pregnancy, on the contraceptive pill, and effect of anticoagulants on menstruation); 3) self-management (being a woman, healthcare monitoring, and self-care); and 4) support (internal and external support). The younger woman’s burden after stroke is complex due to their risk factors, symptoms, and recovery needs. Therefore, developing specific long-term rehabilitation strategies for younger women are needed for more effective stroke rehabilitation and recurrent stroke prevention. TE REO MĀORI TRANSLATION: Ngā wheako o ngā wāhine taitamariki o te roro ikura: He rangahau whakaahua kounga: Ngā Ariā Matua E piki haere ana te pānga o te roro ikura i waenga i ngā pakeke āhua taitamariki, otirā he tino pērā mō te wahine. E whai ana tēnei rangahau kia tūhuratia ngā wheako o ngā wāhine taitamariki kua pāngia e te roro ikura kia mārama kē atu ō rātou wheako me ō rātou hiahia tautoko. I whakamahia e tēnei rangahau tētahi ara whakamārama whakaahua kounga, nā te rapu haere i ngā wāhine āhei mā tētahi huarahi torotoro tangata. I whakahaeretia tētahi hui whakawhiti kōrero hei kohikohi raraunga, ā, ka tātaritia i muri mā te tātari ā-tāhuhu. Ko te pakeke o te hunga whakauru kei waenga i te 18 ki te 64 tau i te pānga o tō rātou roro ikura, ā, e ono ki te tekau mā waru tau i muri i te roro ikura ka whai wāhi ki te hui whakawhiti kōrero, i te tau 2021. E whā ngā tāhuhu, 11 hoki ngā tāhuhu whāiti i puta i roto i te tātaritanga raraunga: 1) ko ngā pānga o te roro ikura (te ekenga mai o te roro ikura me ngā wheako tuatahi, ngā pānga ā-tinana, ā-wairua, ā-hinengaro hoki, ngā panonitanga ki ō rātou tūranga mahi, ara mahi hoki); 2) te hauora whakaputa uri o ngā wāhine (te hapūtanga, te pire ārai hapū, te pānga o ngā rongoā whakakūtere toto ki te ikura wahine); 3) te whakahaere i a ia anō (te noho hei wahine, te aroturuki manaakitanga hauora, te taurima a te tangata i a ia anō); me te 4) tautoko (whakaroto, whakawaho anō hoki). He matatini ngā āhuatanga o ngā kawenga mō te wahine taitamariki i muri i te ikura, nā ngā āhuatanga tūraru, ngā tohu o te mate, me ngā hiahia mātūtū. Nā reira, me whakatupu rautaki whakamātūtū mō te wā roa mō ngā wāhine taitamariki, e kaha ake ai te whai hua o ngā mahi whakaora i muri i te roro ikura, me te ārainga i te pānga anō o te roro ikura. Ngā kupu matua: ngā wheako roro ikura; ngā pānga roro ikura; te whakamātūtūtanga i muri i te roro ikura; ngā tūraru roro ikura; mōrehu nō te roro ikura; ngā wāhine taitamariki

Aim and Objectives This study aimed to explore inpatient healthcare delivery experiences of Māori (New Zealand's Indigenous people) patients and their whānau (extended family network) at a large tertiary hospital in New Zealand to (a) determine why Māori are less satisfied with the relational and psychosocial aspects of fundamental care delivery compared to other ethnic groups; (b) identify what aspects of care delivery are most important to them; and (c) contribute to the refinement of the Fundamentals of Care framework to have a deeper application of Indigenous concepts that support health and well-being. Background Bi-annual Fundamentals of Care audits at the study site have shown that Māori are more dissatisfied with aspects of fundamental care delivery than other ethnic groups. Design Retrospective analysis of narrative feedback from survey data using an exploratory descriptive qualitative approach. Methods Three hundred and fifty-four questionnaires containing narrative patient experience feedback were collected from the study site's patient experience survey reporting system. Content analysis was used to analyse the data in relation to the Fundamentals of Care framework and Māori concepts of health and well-being. The research complies with the SRQR guidelines for reporting qualitative research. Results Four themes were identified: being treated with kindness and respect; communication and partnership; family is the fundamental support structure; and inclusion of culture in the delivery of care. Conclusion The current iteration of the Fundamentals of Care framework does not reflect in depth how indigenous groups view health and healthcare delivery. The inclusion of an Indigenous paradigm in the framework could improve healthcare delivery experiences of Indigenous peoples. Relevance to clinical practice Research around the application and relevance of the Fundamentals of Care framework to Indigenous groups provides an opportunity to refine the framework to improve health equity, and healthcare delivery for Indigenous people.

Stroke has the highest global burden of any neurological disease. Many studies investigate secondary stroke prevention strategies, but the outcomes remain poor, and the rates of recurrent stroke st...

Objective: The patient experience of gout flares is multidimensional, with several contributing factors including pain intensity, duration, and frequency. There is currently no consistent method for reporting gout flare burden in long-term studies. This study aimed to determine which factors contribute to patient perceptions of treatment efficacy in long-term studies of gout flare prevention.Methods: This study involved face-to-face interviews with people with gout using visual representations of gout flare patterns. Participants were shown different flare scenarios over a hypothetical 6-month treatment period that portrayed varying flare frequency, pain intensity, and flare duration. The participants were asked to indicate and discuss which scenario they believed was most indicative of successful treatment over time. Quantitative data relating to the proportion of participants selecting each scenario were reported using descriptive statistics. A qualitative descriptive approach was used to code and categorize the data from the interview transcripts.Results: Twenty-two people with gout participated in the semistructured interviews. All 3 factors of pain intensity, flare duration, and flare frequency influenced participants’ perception of treatment efficacy. However, a shorter flare duration was the most common indicator of successful treatment, with half of participants (n = 11, 50%) selecting the scenario with a shorter flare duration over those with less painful flares.Conclusion: Flare duration, flare frequency, and pain severity are all taken into account by patients with gout when considering treatment efficacy over time. Long-term studies of gout should ideally capture all these factors to better represent patients’ experience of treatment success.

Aims and objectives: Identify the key concepts, principles and values embedded within Indigenous Māori models of health and wellbeing; and determine how these could inform the development of a Māori‐centred relational model of care.Background: Improving health equity for Māori, similar to other colonised Indigenous peoples globally, requires urgent attention. Improving the quality of health practitioners’ engagement with Indigenous Māori accessing health services is one area that could support improving Māori health equity. While the Fundamentals of Care framework offers a promising relational approach, it lacks consideration of culture, whānau or family, and spirituality, important for Indigenous health and wellbeing.Design and methods: A qualitative literature review on Māori models of health and wellbeing yielded nine models to inform a Māori‐centred relational model of care. We followed the PRISMA guidelines for reporting literature reviews.Results: Four overarching themes were identified that included dimensions of health and wellbeing; whanaungatanga (connectedness); whakawhanaungatanga (building relationships); and socio‐political health context (colonisation, urbanisation, racism, and marginalisation). Health and wellbeing for Māori is a holistic and relational concept. Building relationships that include whānau (extended family) is a cultural imperative.Conclusions: This study highlights the importance and relevance of relational approaches to engaging Māori and their whānau accessing health services. It signals the necessary foundations for health practitioners to build trust‐based relationships with Māori. Key elements for a Māori‐centred model of relational care include whakawhanaungatanga (the process of building relationships) using tikanga (cultural protocols and processes) informed by cultural values of aroha (compassion and empathy), manaakitanga (kindness and hospitality), mauri (binding energy), wairua (importance of spiritual wellbeing).Relevance to clinical practice: Culturally‐based models of health and wellbeing provide indicators of important cultural values, concepts and practices and processes. These can then inform the development of a Māori‐centred relational model of care to address inequity.