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Shankar Sankaran,
Tim Kenealy,
Allan Adair,
Vivienne Adair, Heather Coster,
Noeline Whitehead,
Nicolette Sheridan,
Matthew Parsons,
Elaine Marshall,
Leslie Bailey,
Catherine Price,
Dwayne Crombie,
Harry Rea
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ABSTRACT: To describe an intervention supporting Aged Related Residential Care (ARRC) and to report an initial evaluation.
The intervention consisted of: medication review by a multidisciplinary team; education programmes for nurses; telephone advice 'hotlines' for nursing and medical staff; Advance Care Planning; and implementing existing community programmes for chronic care management and preventing acute hospital admissions. Semi-structured interviews were conducted with members of the multidisciplinary team, rest home nurses and caregivers. Quantitative data were collected on medication changes, hotline use, use of education opportunities and admissions to hospital.
Medications were reduced by 21%. Staff noted improvements in the physical and mental state of residents. There was no significant reduction in hospital admissions. Nurses were unable to attend the education offered to them, but it was taken up and valued by caregivers. There was minimal uptake of formal acute and chronic care programmes and Advance Care Planning during the intervention. Hotlines were welcomed and used regularly by the nurses, but not the GP.
The provision of high status specialist support on site was enthusiastically welcomed by ARRC staff. The interventions continue to evolve due to limited uptake or success of some components in the pilot.
The New Zealand medical journal 01/2010; 123(1308):41-53.
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ABSTRACT: The present paper investigates what keeps doctors 'in place' in New Zealand rural communities and what prompts their departure from practice. The study is based on in-depth interviews conducted with nine overseas-trained medical practitioners within rural areas in New Zealand during 2004. A thematic analysis was undertaken. The resulting narratives reveal the unintended circumstances under which respondents often arrived in their rural communities, as well as some of the 'pull' factors which a more relaxed rural lifestyle offers. Recurring themes relating to the attractiveness of place include community loyalty and the enjoyment of 'fully practicing medicine'. Themes which corroded the attractiveness of place included 'entrapment', lack of choice in secondary schooling, restricted spousal employment opportunities, the lack of cultural and entertainment activities, and difficulties accessing continuing medical education. The authors conclude that addressing the question of what makes 'place' attractive to overseas-trained general practitioners in rural New Zealand requires an understanding of place as context rather than mere location.
Health & Social Care in the Community 12/2006; 14(6):532-40. · 0.86 Impact Factor
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ABSTRACT: Beyond their educational function, schools are frequently a focal point for community life. We argue that this latter role was compromised in New Zealand by a decade of neoliberal realignments within education policy. During the 1990s the abolition of school zones, the commodification of education, and the drive for efficiency in the allocation of educational resources undermined the place of school in community life. In this paper we explore the impacts of a school closure on an urban neighbourhood in Invercargill, New Zealand. We present and interpret narratives gathered during an interview-based study of the closure of Surrey Park Primary School. Our analysis highlights parents' perspectives on the role of the educational bureaucracy in the closure debate, the ambiguous role assigned to 'community' within the restructured system, the impact of the closure for low-income families, and the place of schools in contributing to the neighbourhood social cohesion. Our analysis concurs with international research suggesting that breaking links between schools and communities has potentially significant educational impacts on children.
Environment and Planning C Government and Policy 01/2003; 21(2):203-223. · 1.16 Impact Factor
