One of us: Stories from two New Zealand rest homes.

In this article we explore the ways in which two aged residential care facilities in New Zealand construct and present themselves through the stories told by those who live and work in them. Ethnographic field notes and interviews were analysed using an immersion/crystallization method consistent with a narrative gerontology framework. Woven into residents' stories about their lives in the facility were tales of earlier lives and identities, immigration, occupations, marriage, tragedies and medical emergencies. Care workers, nursing staff and managers talked about vocation, the ethos and values of the institution and the importance that both staff and residents felt a sense of belonging and 'being one of us.' These stories, 'talk into reality' the aged residential care facility as a particular kind of rest home, in which residents feel 'at home'. In addition, as researchers who brought our own stories to the project, we actively contributed to the construction of each institution as a certain kind of facility.

The impact of a rural scanner in overcoming urban versus rural disparities in the utilisation of computed tomography.

OBJECTIVE: In 2008, Oamaru Hospital became the second rural hospital in New Zealand to install a computed tomography (CT) scanner. This article assesses the impact of this on local CT scanning rates. DESIGN: Observational: review of radiology department data. SETTING: Rural hospital imaging services. PARTICIPANTS: CT scanning patients residing in Otago region during the study period. INTERVENTIONS: There is no intervention in this observational study. MAIN OUTCOME MEASURES: CT scanning rates and waiting times before and after the introduction of the rural scanner. RESULTS: Prior to the scanner being commissioned, there was a significant urban versus rural disparity in CT utilisation. Residents in the neighbouring urban centre were 1.4 times more likely to access CT (33.2 (95% confidence interval (CI) 32.2-34.2) versus 23.0 (95% CI 21.0-25.1) scans per 1000 residents per annum). Twenty months after the scanner was commissioned, the rate for the rural community had almost doubled to 45.6 (95% CI 43.0-48.2) and was 1.2 times greater than for the urban community. This difference was not sustained, and rural and urban communities had similar CT scanning rates in 2011 and 2012. Mean waiting time for residents in the rural community fell from 21.1 (95% CI 17.1-25.2) days prior to the scanner to 6.7 (95% CI 5.6-7.8) days after the scanner was commissioned. CONCLUSIONS: On-site CT increased the rural scanning rate, corrected the rural-urban disparity and reduced waiting times without apparent over servicing.

Perspectives on psychosocial and spiritual cancer support services in New Zealand.

In New Zealand, support services have been developed in response to patient need but are variable. The benefits of psycho-social-spiritual care in reducing distress and enhancing quality of life for people with cancer and their families are well established yet unmet needs continue to feature. This project aimed to examine how health care professionals assessed for psycho-social-spiritual distress and unmet need, decisions on appropriate support, and identification of barriers in the referral process. A mixed-methods approach was used for this research. The qualitative phase entailed semistructured interviews with health care professionals working in cancer care. The quantitative phase was an online survey of oncologists and nurses. Thematic analysis was carried out by performing a side-by-side analysis of both sets of data. Nurses were most likely to assess for psycho-social-spiritual need and to refer to support services. Despite a clear mandate to provide regular psycho-social-spiritual assessment, there is no consistency of assessment and referral across New Zealand. There are clearly unmet psycho-social-spiritual needs among people affected by cancer in New Zealand, with health care professionals in this study noting structural impediments to adequate supportive care. There is a mismatch between the importance placed on such care and the capacity that is currently available. The results of this study provide evidence that can be used to argue for improvements in the infrastructure, funding allocation and policy that would allow for better psycho-social-spiritual care within the challenging context of increasing numbers of those affected by cancer.

The use of nurses in community palliative care.

This qualitative study uses a phenomenological life world perspective to examine the utilization of nurses in community palliative care for people with noncancer conditions with a life expectancy of 2 years. Sited in Otago, New Zealand, while there was a number of health professionals involved in providing palliative care in the community for people with malignant conditions, none of the participants with nonmalignant disease were receiving specialist palliative care at the time of interview. Support services used a rehabilitative model of care that was not always appropriate in meeting the needs of the people who were dying and their families.

Facing uncertainty: the lived experience of palliative care.

OBJECTIVE: This qualitative research study listens to the narratives of people experiencing the dying process who attended the Otago Community Hospice, Dunedin, New Zealand. METHODS: Ten people, aged between 51 and 65, were approached; two declined and one died sooner than expected. All were women (although this was not part of the original design) and all had carcinoma. Data for the study was sought through qualitative research interviews, considering the development of each participant's illness in relation to her perception of her embodiment in the palliative care setting, and concluding with questions about what she wants the people who care for and about her to learn from her experience. Consistent with this phenomenological approach, the method of analysis was thematic and interpretive. RESULTS: The main theme was the uncertainty that all participants felt throughout the diagnostic process and during treatment. Uncertainty, too, was a factor in how they managed their day, whether they would be able to sustain an outing or an activity or not and whether they would be pain free. None were afraid of dying but hoped that when they did die, they would do so comfortably. The relationship with their general practitioners varied. Where fatigue or the effects of medication were not an issue, they could think clearly, but their bodies were experienced as letting them down and limiting their activities. The ideal of "living until you die" was not able to be fulfilled. The increasing approach of social death as they withdrew from their employment and social responsibilities affected them. SIGNIFICANCE OF RESULTS: Whether one has a "good death" or not is determined not only by the progression and management of the disease process by health professionals, but also by the way in which one is perceived, by self and others. There are no guidelines for the dying role; everybody dies differently and individually.

Facing uncertainty: the lived experience of palliative care.

OBJECTIVE: This qualitative research study listens to the narratives of people experiencing the dying process who attended the Otago Community Hospice, Dunedin, New Zealand. METHODS: Ten people, aged between 51 and 65 years old, were approached; two declined and one died sooner than expected. All were women (although this was not part of the original design), and all had carcinoma. Data for the study were sought through qualitative research interviews, considering the development of each participant's illness in relation to her perception of her embodiment in the palliative care setting, and concluding with questions about what she wants the people who care for and about her to learn from her experience. Consistent with this phenomenological approach, the method of analysis was thematic and interpretive. RESULTS: The main theme was the uncertainty that all participants felt throughout the diagnostic process and during treatment. Uncertainty, too, was a factor in how they managed their day, whether they would be able to sustain an outing or an activity or not, and whether they would be pain free. None were afraid of dying but hoped that when they did die, they would do so comfortably. The relationship with their general practitioners varied. Where fatigue or the effects of medication were not an issue, they could think clearly, but their bodies were experienced as letting them down and limiting their activities. The ideal of "living until you die" was not able to be fulfilled. The increasing approach of social death as they withdrew from their employment and social responsibilities affected them. SIGNIFICANCE OF RESULTS: Whether one has a "good death" or not is determined not only by the progression and management of the disease process by health professionals, but also by the way in which one is perceived, by self and others. There are no guidelines for the dying role; everybody dies differently and individually.