Among the main topics addressed at the conference were: active and ambient assisted living (AAL); eHealth education; electronic patient and health records; ethical legal and economic aspects of eHealth; ICT for integrated treatment, research and personalized medicine; patient portals and personal health records; semantic interoperability of information systems; and visualization of clinical or epidemiological data".

http://ebooks.iospress.nl/volume/ehealth2015-health-informatics-meets-ehealth-innovative-health-perspectives-personalized-health

Hayn, D., et al. (Eds.). eHealth2015 – Health Informatics Meets eHealth. Studies in Health Technology and Informatics, 212.

The authors conclude that the findings "... indicate that the use of a simple, low-cost communication strategy for patient care is associated with improvements in clinician and carer experience with potential implications for patient safety. Minimally, TOP 5 represents ‘good practice’ with a low risk of harm for patients".

Now available to read in free full text at: http://dx.doi.org/10.1093/intqhc/mzv026 

Luxford, K., et al. (2015). Improving clinician–carer communication for safer hospital care: A study of the ‘TOP 5’ strategy in patients with dementia. International Journal for Quality in Health Care, 27(3), 175 - 182

"While participants acknowledged that patients could play a role in preventing infections while in hospital, that role was largely associated with maintaining their own personal hygiene ... Some participants said that they would feel comfortable and happy to engage with staff, while others voiced concerns. Some about not wanting to ‘cause trouble or start fires’ and therefore would not tell staff members to perform hand hygiene [or] articulated a fear that their care may be negatively affected if they directly engaged or confronted clinicians about their behaviours". The authors discuss the implications of these findings.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1177/1757177415588378 or contact your DHB library, or organisational or local library for assistance.

Seale, H., et al. (2015). ‘I don’t want to cause any trouble’: The attitudes of hospital patients towards patient empowerment strategies to reduce healthcare-acquired infections. Journal of Infection Prevention, 31 May [Epub before print]

Thirty-eight articles were included. "Overwhelmingly, tele-emergency studies reported positive findings especially in terms of technical quality and user satisfaction. There were also positive findings reported for clinical processes and outcomes, throughput, and disposition, but the rigor of studies using these measures was limited. Studies of economic outcomes are particularly limited".

The authors conclude that tele-emergency has potential for small and rural hospitals that may see infrequent but emergency situations requiring specialist care and could also contribute to expanding use of minor treatment clinics to address access issues in remote areas and overcrowding in urban emergency departments.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1016/j.ijmedinf.2015.05.009 or contact your DHB library, or organisational or local library for assistance.

Ward, M.M., et al. (2015). Systematic review of telemedicine applications in emergency rooms. International Journal of Medical Informatics, 22 May [Epub before print]

In this systematic review, the authors aimed to define the target domains of culture-improvement interventions, assess their impact on surgical culture and whether they led to better patient outcomes and improved healthcare efficiency.

To find out more, go to:  http://www.anzca.edu.au/fellows/special-interest-groups/anaesthetists-in-management/the-12th-annual-combined-communication-education.html

To read the report, go to:  http://www.safetyandquality.gov.au/wp-content/uploads/2015/03/Engaging-Patients-in-Communication-at-Transitions.pdf

Australian Commission on Safety and Quality in Health Care. (2015). Engaging patients in communication at transitions of care. Prepared by a consortium from Deakin and Griffith Universities. Sydney: ACSQHC.

HIIRC identified this research via the Ministry of Health Library's Grey Matter newsletter.

This systematic review aimed to identify the five most important elements of inpatient end-of-life care for patients with palliative care needs and their families.

The most common distractions came from external staff, followed by case-irrelevant conversations. The authors that:

• case-irrelevant conversations were associated with poorer team performance.
• irrelevant conversations initiated by surgeons were associated with lower teamwork in surgeons  and anesthesiologists.
• equipment-related distractions were related with higher stress and lower teamwork in nurses.
• acoustic distractions were related with higher stress in surgeons and higher workload for anesthesiologists.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1097/SLA.0000000000001051 or contact your DHB library, or organisational or local library for assistance.

Wheelock, A., et al. (2015). The impact of operating room distractions on stress, workload, and teamwork. Annals of Surgery, 261(6), 1079–1084.

They conclude from their analysis that "communication failure occurred because important information was sometimes buried in documents, insufficient, inaccurate, out-of-date or not verbally reinforced. Furthermore, busy nurses were not always able to access information they required in a timely manner. Patient safety was affected, which led to delays in treatment and at times inadequate care".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/jocn.12809 or contact your DHB library, or organisational or local library for assistance.

Braaf, S., Riley, R. and Manias, E. (2015), Failures in communication through documents and documentation across the perioperative pathway. Journal of Clinical Nursing, 4 May [Epub before print]

To read the article in free full text on the Nursing Review website, go to:  http://www.nursingreview.co.nz/issue/april-2015-vol-15-2/gidday-my-name-is-not-forgetting-the-niceties/#.VUksXvmqpBc

An innovative form of enhanced capability critical care outreach called ‘iMobile’ is being provided at King’s College Hospital (KCH). Part of the remit of iMobile is to review patients who have been transferred from critical care to general wards. The iMobile team wished to improve the quality of critical care discharge summaries.

A collaborative evidence-based quality improvement project was therefore undertaken by the iMobile team at KCH in conjunction with researchers from King's Improvement Science (KIS). Plan, Do, Study, Act (PDSA) methodology was used. Three PDSA cycles were undertaken.

Methods adopted comprised: a scoping literature review to identify relevant guidelines and research evidence to inform all aspects of the quality improvement project; a process mapping exercise; informal focus groups / interviews with staff; patient story-telling work with people who had experienced critical care and subsequent discharge to a general ward; and regular audits of the quality of both medical and nursing critical care discharge summaries.

The following behaviour change interventions were adopted, taking into account evidence of effectiveness from published systematic reviews and considering the local context: regular audit and feedback of the quality of discharge summaries, feedback of patient experience, and championing and education delivered by local opinion leaders.

The audit results were mixed across the trajectory of the project, demonstrating the difficulty of sustaining positive change. This was particularly important as critical care bed occupancy and through-put fluctuates which then impacts on work-load, with new cohorts of staff regularly passing through critical care. In addition to presenting the results of this quality improvement project, the authors also reflect on the lessons learned and make suggestions for future projects.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1136/bmjquality.u203938.w3268

Goulding, L., et al. (2015). Improving critical care discharge summaries: a collaborative quality improvement project using PDSA. BMJ Quality Improvement Report, 4(1).

Eighteen articles were included and four themes were identified: "perceived disadvantages and advantages of advance directives; nurses' responsibility and roles; facilitators and barriers; and nurses' needs and recommendations ... Nurses generally believed that they were well positioned to engage in advance care planning conversations. Nurses perceived barriers relating to older people, families, environment, time, culture, cost, language and knowledge of health care teams with regard to advance care planning. In nurses' needs, education and support were highlighted".

The authors discuss the implications of these findings.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/jocn.12853 or contact your DHB library, or organisational or local library for assistance.

Ke, L.-S., Huang, X., O'Connor, M. and Lee, S. (2015). Nurses' views regarding implementing advance care planning for older people: A systematic review and synthesis of qualitative studies. Journal of Clinical Nursing, 4 May [Epub before print]

The authors conclude from their analysis of the results that "ICU clinicians experience audit and feedback as fragmented communication with feedback being especially problematic. Attention to improving communication, integration of the process into daily clinical activities and making feedback timely, specific and actionable may increase the effectiveness of audit and feedback to affect desired change".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1136/bmjqs-2015-003978 or contact your DHB library, or organisational or local library for assistance.

Sinuff, T., et al. (2015). A qualitative study of the variable effects of audit and feedback in the ICU. BMJ Quality & Safety, 24, 393-399

They conclude that challenges are "... due to the nature of the relationship between laypersons and professionals, and the embedded difference in situation and knowledge. This difference may be reduced by time and a mutually positive attitude. But participation in its ideal form cannot be achieved because of this fundamental difference. Therefore, the optimal level of patient participation can only be achieved within a framework which provides both patients and health professionals with adequate time to build relationships and shared knowledge".

To read the full abstract, and for information on how to access the full text, go to: http://www.journalofnursingstudies.com/article/S0020-7489(15)00126-1/abstract or contact your DHB library, or organisational or local library for assistance.

Angel, S. & Frederiksen, K.N. (2015). Challenges in achieving patient participation: A review of how patient participation is addressed in empirical studies. International Journal of Nursing Studies, 30 April [Epub before print]

The committee concludes that this streamlined set of measures could provide consistent benchmarks for health progress across the nation and improve system performance in the highest-priority areas.

The report can be read for free online at:  http://www.iom.edu/Reports/2015/Vital-Signs-Core-Metrics.aspx

The authors performed a single-centre, survey-based, crossed-over randomised trial involving parents of all infants who were admitted to NICU and anticipated to stay >11 days. Parents were randomly assigned using a computer-generated stratified block randomisation protocol to start with PPCBR or non-PPCBR and then crossed over to the other arm after a wash-out period. At the conclusion of each arm, parents completed the ‘NICU Parental Stressor Scale’ (a validated tool) and a satisfaction survey. After completion of the trial, the authors surveyed all healthcare providers who participated at least in one PPCBR rounding episode. They also offered all participating parents and healthcare providers the opportunity to partake in a focus group discussion regarding PPCBR.

A total of 72 parents were enrolled in this study, with 63 parents (87%) partially or fully completing the trial. Of the parents who completed the trial, 95% agreed that parents should be allowed to attend clinical bedside rounds. A total of 39 healthcare providers’ surveys were returned and 35 (90%) agreed that parents should be allowed to attend rounds. Nine healthcare providers and 8 parents participated in an interview or focus group, augmenting understanding of the ways in which PPCBR was beneficial.

The authors conclude that parents and healthcare providers strongly support PPCBR. They go on to say that NICUs should develop policies allowing PPCBR while mitigating the downsides and concerns of parents and healthcare providers such as decreased education opportunity and confidentiality concerns.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1136/archdischild-2014-306724

Abdel-Latif, M.E., et al. (2015). Parental presence on neonatal intensive care unit clinical bedside rounds: Randomised trial and focus group discussion. Archives of Disease in Childhood Fetal & Neonatal Edition, 100:F203-F209

To read a one-page extract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/ans.13017 or contact your DHB library, or organisational or local library for assistance.

Civil, I. and Shuker, C. (2015). Briefings and debriefings in one surgeon's practice. ANZ Journal of Surgery, 85: 321–323. 

To read the full story, go to: http://www.nursingreview.co.nz/news-feed/2015/acp-nursing-being-brave-being-open-and-really-listening-to-patients/#.VTCNuPmUd8E

Practitioners frequently encounter safety problems that they themselves can resolve on the spot. In this qualitative study, the authors ask: when faced with such a problem, do practitioners fix it in the moment and forget about it, or do they fix it in the moment and report it? They consider factors underlying these two approaches.

Among the findings were that the organisations had no formal way of assessing which of their patients were using PHRs; none of the organisations had a strategy to promote PHRs among patients with chronic conditions or those who frequently visited hospitals or emergency departments; and PHRs were popular with most providers and patients, because they saved time, mainly by eliminating “telephone tag.”

The authors discuss the implications of these findings.

Now available to read in free full text at: http://dx.doi.org/10.1136/amiajnl-2014-003055 

To read a Commonwealth Fund summary of the study, go to: http://www.commonwealthfund.org/publications/in-the-literature/2014/oct/organizational-strategies-promoting-personal-health-records

Wells, S., et al. (2015). Organizational strategies for promoting patient and provider uptake of personal health records. JAMIA, 22(1), 213 - 222.

The theme of the conference is The Primacy of Healthcare Communication, and the conference will be held in New Orleans, Louisiana, on October 25-28, 2015.

To find out more about this event, go to:  http://www.aachonline.org/dnn/Events/InternationalConference(ICCH).aspx

Staff from the Commission’s Partners in Care programme are visiting health and disability services to seek feedback from the sector and health consumers about the guide, which will be launched in June 2015.

To download the draft guide and for information on how to give feedback (including through face-to-face meetings), go to:  http://www.hqsc.govt.nz/our-programmes/consumer-engagement/news-and-events/news-2/news/2080/

• key concepts in spreading ideas
• evidence on what is known about what works to spread improvement
• practical suggestions for planning your communications, engaging the right people, sustaining interest in the work and celebrating and sharing achievements.

Read the quick guide: Using communications to spread improvement

The authors combined data from focus groups and individual user experience. Adults with type 2 diabetes were recruited through website advertisements and posters displayed at local GP practices and diabetes groups.

Participants used a risk calculator that provided individualised estimates of cardiovascular risk. Risk information was presented using natural frequencies, visual displays, and a range of formats. 

Thirty-six participants contributed data. Users demonstrated a range of complex cognitive and emotional responses, which might explain the lack of change in health behaviours demonstrated in the literature.

The authors conclude that cardiovascular risk calculators for people with diabetes may best be used in conjunction with health professionals who can guide the user through the calculator and help them use the resulting risk information as a source of motivation and encouragement.

This is an open access article that can be read in free full text at: http://dx.doi.org/10.3399/bjgp15X683953

Nolan, T., et al. (2015). Patient reactions to a web-based cardiovascular risk calculator in type 2 diabetes: A qualitative study in primary care. British Journal of General Practice, 1 March [Epub before print].

Forty-two articles were included. "The reported incidence of FTR varied between 8.0 and 16.9%. FTR was inversely related to hospital volume and nurse staffing levels. Delayed escalation occurred in 20.7–47.1% of patients and was associated with greater mortality rates in 4 studies (P < .05). Causes of delayed escalation included hierarchy and failures in communication. Of five interventional studies, two reported a significant decrease in intensive care admissions (P < .01) after introduction of escalation protocols; only 1 study reported an improvement in mortality".

The authors discuss the implications of these findings, including for the development of interventions.

To read the full abstract, and for information on how to access the full text, go to: http://www.sciencedirect.com/science/article/pii/S0039606014007132 or contact your DHB library, or organisational or local library for assistance.

Johnston, M.J., et al. (2015). A systematic review to identify the factors that affect failure to rescue and escalation of care in surgery. Surgery, 157(4), 752-763.

The booklet is available to read and download in full text at:  http://www.hqsc.govt.nz/publications-and-resources/publication/2046/

Ten research articles, in either adults or paediatrics were included. "Information transfer, post-handover technical errors and high risk events were positively influenced by the use of structured clinical handover tools. Handover duration did not change when using structured handover protocols".

The authors conclude that research in this area is in its early stages of development. 

To read the full abstract, and for information on how to access the full text, go to: http://www.australiancriticalcare.com/article/S1036-7314(15)00034-X/abstract or contact your DHB library, or organisational or local library for assistance.

Gardiner, T.M., et al. (2015). Clinical handover of the critically ill postoperative patient: An integrative review. Australian Critical Care, 19 March [Epub before print].

A comprehensive communications strategy guided communications work during the Campaign. The main aims of the communications strategy were to engage the hearts and minds of frontline National Health Service (NHS) staff in the Campaign and promote their awareness and understanding of specific QI interventions and the wider patient safety agenda. The authors used qualitative and quantitative measures to monitor communications outputs and assess how the communications strategy influenced awareness and knowledge of frontline NHS staff.

The communications strategy facilitated clear and consistent framing of Campaign messages and allowed dissemination of information related to the range of QI interventions. It reaffirmed the aim and value of the Campaign to frontline staff, thereby promoting sustained engagement with Campaign activities. The communications strategy also built the profile of the Campaign both internally with NHS organizations across Wales and externally with the media, and played a pivotal role in improving awareness and understanding of the patient safety agenda. Ultimately, outcomes from the communications strategy could not be separated from overall Campaign outcomes.

The authors conclude that systematic and structured communications can support and enhance QI initiatives. From their experience, they developed a ‘communications bundle’ consisting of six core components. They recommend that communications bundles be incorporated into existing QI methodology, though details should be tailored to the specific context and available resource.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1179/1753807615Y.0000000006

Cooper, A., et al. (2015). Exploring the role of communications in quality improvement: A case study of the 1000 Lives Campaign in NHS Wales. Journal of Communication in Healthcare, 8(1), 76-84.

"Common narrative themes that emerged were: difficulties accessing general practice services, language barriers, poor doctor–patient relationships, and problems with the cultural acceptability of medical care".

The authors discuss the implications of these findings.

To read the full abstract, and for information on how to access the full text, go to:http://dx.doi.org/10.3399/bjgp15X683977 or contact your DHB library, or organisational or local library for assistance.

Cheng, I-H., et al. (2015). Refugee experiences of general practice in countries of resettlement: A literature review. British Journal of General Practice, 1 March [Epub before print]

The workshop summary report is available to read free online - see: http://www.iom.edu/Reports/2015/Informed-Consent-Health-Literacy.aspx

The workshop summary report is available to read free online - see: http://www.iom.edu/Reports/2015/Communicate-to-Advance-Publics-Health.aspx

The authors found "... three themes common to the facilitators of and barriers to collaboration and teamwork between GPs in general practice: (1) roles and responsibilities; (2) respect, trust and communication; and (3) hierarchy, education and liability".

The authors discuss the implications of these findings.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/jan.12647 or contact your DHB library, or organisational or local library for assistance.

McInnes S., Peters K., Bonney A. & Halcomb E. (2015). An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice. Journal of Advanced Nursing, 3 March [Epub before print]

In this case the focus was on multi-disciplinary communication within daily board rounds on an acute medicine and care of the elderly ward. Baseline assessment and post intervention testing of perceptions of change by both full and core team were undertaken to establish the impact of VERP training. In addition pre and post focus group discussion and film analysis supplemented evaluation.

The findings support the view that after VERP training of a core team, board rounds were seen as consistently easier to participate in, providing improved focus, were more efficient in goal setting and resulting in better care for patients as well as improved pathways to discharge. This suggests benefits to the communication "culture" of a multidisciplinary team resulting in increased benefits for the wider team. It is concluded that the use of tailored VERP training for personal, professional and team development is relevant, feasible, and worthy of further testing and investigation.

This case study is available to read in free full text at:  http://dx.doi.org/10.1136/bmjquality.u206968.w2801

Hellier, C., et al. (2015). Improving multidisciplinary communication at ward board rounds using video enhanced reflective practice. BMJ Quality Improvement Reports, 4.

This study examined the current practices of senior emergency physicians’ at 2 large Australian hospitals in regards to test result notification, along with their attitudes to direct patient notification of clinically significant abnormal and normal test results. Results showed that more than half of the emergency physicians surveyed (54%) were uncomfortable with patients receiving direct notification of abnormal test results. A similar proportion (57%) was comfortable with direct notification of normal test results. The authors conclude that, although patients’ direct access to test results could serve as a safety net reducing the likelihood of abnormal results being missed, emergency physicians’ concerns need further exploration.

To access a free full text version of the article, go to: http://www.jmir.org/2015/3/e60/

Callen J., et al. (2015). Emergency physicians’ views of direct notification of laboratory and radiology results to patients using the internet: A multisite survey. Journal of Medical Internet Research, 17 (3), e60, doi: 10.2196/jmir.3721

A simple solution to a costly problem has seen a Hauraki health provider reduce the number of people missing specialist hospital appointments by about 49 per cent – saving the public hundreds of thousands of dollars.

Te Korowai Hauora o Hauraki has reduced its patient ‘did not attend’ (DNA) rates from 25.6 per cent in 2005 to 11.82 per cent last year.

Te Korowai kaiawhaina services co-ordinator Heather Makiri-Wi spends up to two hours a day phoning and texting up to 30 patients in an effort to ensure they make appointments.

She said patients do not turn up for several reasons such as lack of transport, fear or sometimes they just forget.

Makiri-Wi said a common problem is that many patients cannot afford to use their phones to cancel an appointment.

“If there was an 0800 number it would help,” she said.

The DNA phone and text monitoring programme was initiated by the hospital in 2005 with the DNA rate dropping from 25.6 per cent to 16 per cent the following year.

The programme ceased after a new computer system was installed at Thames Hospital but it was reactivated in 2011.

The efforts since then have led to the lowest recorded DNA rate.

Te Korowai general manger of operations Gwendol Welburn said the results show how important it is to follow up with patients.

“There is definitely a need for someone like Heather to do this,” she said.

Welburn said many people do not realise it costs the hospital about $375 per patient, $600,000 per year when they miss a scheduled appointment but more so it also delays treatment for someone else.

Outpatients manager Rodger Clark said the Ministry of Health expects everyone will receive a first specialist appointment within four months of being placed on the waiting list.

“It is frustrating when people do not attend appoints because that appointment could have been offered to someone else.”

He said paediatrics was one of the worst for DNAs with 45 per cent of December bookings unattended.

Thames Hospital and community service manager Jacquie Mitchell said people don’t realise the implications their actions have.

“We wait for a person to show up, someone we have invested a whole lot of time in and [then when they don’t] other people get frustrated because they miss out on an appointment or surgery.

“It could be your family or neighbour who misses out on an appointment,” she said.

However Mitchell is delighted at the success of Te Korowai’s monitoring programme and thanked all the staff for their efforts.

The average rate for DNAs in Thames is 9 per cent, about 1600 people, compared to 8 per cent across the Waikato DHB area.

Further work is being done to reduce those figures, including a weekend monitoring system.

A new patient orientated approach to bookings by the hospital’s dietetic clinic has seen a dramatic drop in appointment non-attendance, from 50 per cent of patients to zero in the last 6 months.

Dietitian Nicole Walker found that with one call both she and her patients are getting more out of appointments.

“The high level of non-attendance meant clinician’s time was being wasted and the waiting list of people who weren’t being seen was growing.

“By calling the patient directly, confirming their appointment time, and what they wanted to achieve, the patient felt more in control, better cared for, and also came more prepared to their appointments.

“I can tell them exactly what they need to do, whether to create a food diary or bring in any extra information.

“I went from having 30 to 40 patients on my waitlist down to zero and patients only waiting two to ten working days for an appointment.”

“By creating this relationship the patients feel more obligated to show up and feel like they already know me. Just through one phone call the appointment became far more personalised.”

Nicole says that it takes her about 30 minutes to call her patients per week, but she estimates that she’s saving two to three hours a week through the reduction of non-attendances.

“If they have any simple enquiries that can be attended to over the phone I can help them on the spot, rather than having them come all the way into the clinic.

“It also allows me to discover who physically cannot attend appointments and refer the community dietetic service.”

Nicole will present her findings at the national meeting of the New Zealand Society for the Study of Diabetes on the first week of May.

The next phase of the programme focuses on rolling out the learnings from the project to the sector.

To read the full detail of the rollout programme on the HQSC website, go to: http://www.hqsc.govt.nz/our-programmes/reducing-perioperative-harm/news-and-events/news/2022/

Nineteen in-depth interviews were conducted with men and women (aged 45–59). Participants were given two types of colorectal screening information to read: factual and narrative. Participants gave their views on both types of information. Data were analysed using Framework Analysis.

The most frequent responses to the narrative information were that they were reassuring, made colorectal screening more vivid, participants could relate to the people in the stories and they liked the range of narratives presented. Despite the narrative information being seen as more persuasive by some, this was not regarded as manipulative or negative. Both types of information were seen as equally credible. Participants felt a combination of facts and narratives would be useful when considering an offer of colorectal cancer screening.

The authors conclude that, overall, participants were positive about the addition of narrative information to the currently provided factual information about colorectal cancer screening. Supplementing existing factual information with narrative information may provide participants with a more complete understanding of participation in colorectal cancer screening when considering an offer to be screened.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1111/hex.12357

Bennett, K. F., von Wagner, C. and Robb, K. A. (2015). Supplementing factual information with patient narratives in the cancer screening context: A qualitative study of acceptability and preferences. Health Expectations, 1 March [Epub before print]

To read the full story in The Age, go to:  http://www.theage.com.au/national/health/doctor-makes-a-plainspeaking-change-for-change-day-20150302-13szkf.html

Eight studies were included and the authors identify four themes - enacting participation, challenges to participation, promoting participation and types of participation. The majority of studies used qualitative methodologies.

"On medical wards, patients and nurses desire, perceive or enact patient participation passively. Challenging factors for patient participation include patients’ willingness, nurses’ approach and confusion around expectations and roles. Information sharing was identified as an activity that promotes patient participation, suggesting nurses encourage active communication with patients in practice. Involving patients in assessment and care planning may also enhance patient participation. For education, enhancing nurses understanding of the attributes of patient participation, as well as patient-centred care approaches may be beneficial for medical ward nurses".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1016/j.ijnurstu.2015.02.010 or contact your DHB library, or organisational or local library for assistance.

Tobiano, G., et al. (2015). Patient participation in nursing care on medical wards: An integrative review. International Journal of Nursing Studies, 52(6), 1107–1120

The video, which is featured on the DHB's website (www.southerndhb.govt.nz), profiles support staff, senior managers, doctors, nurses, allied health and patients sharing their thoughts on the importance of having an open, transparent and proactive culture of direct feedback, reporting learning and improving. A culture in which staff "speak up" readily about safety issues and report perceived risks.

Talking about the video, Tina Gilbertson, Director of Quality commented, "the video is part of a larger programme of initiatives designed to further progress our safety culture; one that puts staff at the centre of patient safety and recognises the
pivotal role they have in preventing harm." 

Mrs Gilbertson says that the DHB wants staff to feel confident about sharing their experiences and this new video showcases a variety of staff showing their support
for an open approach to information sharing, recognising that patient safety is everybody's responsibility.

The launch of the new video has been timed to coincide with the imminent roll out of the new South-Island wide electronic risk management system - Safety 1st - which is due to "go live" in Southern Hospitals on the 3rd March.

You can watch the video here.

This study evaluated the readability of Australian online health information and investigated whether it matches the average reading level of Australians.

The researchers enrolled 65 consecutive patients (n=33, breast reconstruction surgery; n=32, orthopedic surgery) and asked them to use a mobile phone daily to complete a validated quality of recovery scale (QoR-9) and take photographs of the surgical site for the first 30 days post-op. Surgeons were asked to review patient-entered data on each patient in their roster daily. A semistructured questionnaire was administered to patients and surgeons to assess satisfaction and feasibility of the mobile device.

All 65 patients completed the study. The mean number of logins was 23.9 (range 7-30) for the breast patients and 19.3 (range 5-30) for the orthopedic patients. The mean number of logins was higher in the first 14 days compared to the 15-30 days post-op for both breast patients (13.4 vs 10.5; P<.001) and for the orthopedic patients (13.4 vs 6.0; P<.001). The mean score for overall satisfaction with using the mobile device was 3.9 for breast patients and 3.7 for orthopedic patients (scored from 1 (poor) to 4 (excellent)). Surgeons reported on the easy-to-navigate design, the portability to monitor patients outside of hospital, and the ability of the technology to improve time efficiency.

The authors conclude that the use of mobile apps for monitoring the quality of recovery in post-operative patients at home was feasible and acceptable to patients and surgeons in the current study. Future large scale studies in varying patient populations are required.

This is an open access article and is available to read in free full text at:  http://doi.org/10.2196/mhealth.3929

Semple JL, Sharpe S, Murnaghan ML, Theodoropoulos J, Metcalfe KA (2015). 
Using a mobile app for monitoring post-operative quality of recovery of patients at home: A feasibility study. JMIR mHealth uHealth; 3(1):e18.

To read the blog post, go to:  https://www.hqsc.govt.nz/blog/is-communication-the-key-to-quality-in-health-care/

They conclude from the results that "peer review of cancer MDTs is feasible and acceptable. We describe valuable lessons learnt and recognise that further development of the proposed peer-review model and national benchmarking of MDTs against established outcome measures is required if this process is to be widely implemented".

This article is available to read in free full text at: http://dx.doi.org/10.5694/mja14.00768

Slavova-Azmanova, N. S., et al. (2015). Peer review of cancer multidisciplinary teams: Is it acceptable in Australia?  Medical Journal of Australia, 202 (3), 144-147.

To download or order hard copies of Ministry of Health resources, go to the HealthEd website: https://www.healthed.govt.nz

To find out more and watch the video, go to:  http://www.open.hqsc.govt.nz/medication/publications-and-resources/publication/1993/

To view the website, go to:  http://www.vizhealth.org/

To read more about this project, go to:  http://www.rwjf.org/en/research-publications/find-rwjf-research/2015/01/visualizing-health--a-new-website.html

"Eight variables were identified as having direct predictor effects as to why nursing care was being missed, and included shift type, nursing resource allocation, health professional communication, workload intensity, workload predictability, the nurses' satisfaction with their current job and their intention to remain working. Additional indirect effects of other variables explained 34% of the variance of the total scores for why nursing care was reported as being missed".

Now available to read in free full text at: http://dx.doi.org/10.1111/jocn.12688 

Blackman, I., Henderson, J., Willis, E., Hamilton, P., Toffoli, L., Verrall, C., Abery, E. and Harvey, C. (2015). Factors influencing why nursing care is missed. Journal of Clinical Nursing, 24(1-2), 47–56.

The passport is a communication aid for people living with disabilities to use with their health care providers. It is to be filled out by a consumer or carer and outlines specific information about the person’s disability or medical condition that will assist staff treating that person to provide the appropriate care.

To find out more, go to:  http://www.hqsc.govt.nz/our-programmes/consumer-engagement/news-and-events/news/1989/

To view the video, go to:   http://www.theguardian.com/healthcare-network/video/2015/feb/02/greeting-crucial-care-kate-granger-nhs-video

"Nine studies met the quality and inclusion criteria. The research reported in seven of the nine studies was conducted in the US, one was conducted in Australia and the other in the UK. The majority of studies focussed on South-east Asian refugees. Themes identified across the studies included language and the use of interpreters; navigating the Western health-care system; culture and illness beliefs; medication non-adherence; use of traditional medicine; and family, peer and community support. There is a significant paucity of published research exploring barriers to medication and pharmacy services among resettled refugees. This systematic review highlights the need for appropriate interpreting and translation services, as well as pharmacy staff demonstrating effective cross-cultural communication skills".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1071/PY14121 or contact your DHB library, or organisational or local library for assistance.

Bellamy, K., et al. (2015). Access to medication and pharmacy services for resettled refugees: A systematic review. Australian Journal of Primary Health, 12 January [Epub before print]

Ten English National Health Service hospitals were identified with the shortest length of stay after elective colonic surgery between January 2011 and December 2012. Semi-structured telephone interviews were conducted with a senior colorectal surgeon and ward nurse at each site. 

These units standardised clinical care based upon an Enhanced Recovery Program. Beyond this, they organised the clinical team to efficiently and reliably deliver this package of care, with the majority of day-to-day care delivered by consultants and nurses. Patients were closely monitored for postoperative deterioration, using a combination of early warning scores, nurses’ clinical judgement and regular senior medical review. Of note, operative volume and laparoscopy rates in these units were not statistically significantly different from the national average. The postoperative analgesic strategy varied widely between units, from routine epidural use to local anaesthetic infiltration or patient-controlled analgesia.

The authors conclude that the Enhanced Recovery Program may be seen as necessary but not sufficient to achieve the best length of stay results. In the study units, consultants and nurses led and delivered the majority of patient care on the ward. High quality teamwork helped detect and resolve clinical issues promptly, with nurses empowered to contact consultants directly if needed. Other units may learn from these teams by adopting protocol-based, consultant- or nurse-delivered care, and by improving coordination and communication between consultants and ward nurses.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1186/s13037-014-0050-5

Byrne, B.E., et al. (2015). Understanding how colorectal units achieve short length of stay: An interview survey among representative hospitals in England. Patient Safety in Surgery, 9:2.

The authors found that "eighteen (16%) of 114 videoed consultations involved instances of screen-sharing. Screen-sharing occurred in six of the subset of 16 consultations with interviews and was a significant theme in 19 of 26 interviews. The screen was shared in three ways: ‘convincing’ the patient of a diagnosis or treatment; ‘translating’ between medical and lay understandings of disease/medication; and by patients ‘verifying’ the accuracy of the EHR. However, patients and most GPs perceived the screen as the doctor's domain, not to be routinely viewed by the patient".

The authors discuss the implications of these findings.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/hex.12320 or contact your DHB library, or organisational or local library for assistance.

Milne, H., Huby, G., Buckingham, S., Hayward, J., Sheikh, A., Cresswell, K. and Pinnock, H. (2014). Does sharing the electronic health record in the consultation enhance patient involvement? A mixed-methods study using multichannel video recording and in-depth interviews in primary care. Health Expectations, 18 December [Epub before print]

They identify a number of major themes: barriers included the culture of the unit, communication, and a lack of resources. Themes associated with facilitating early mobilisation included organisational change, improved communication between medical units, and improved resources.

Based on their analysis, the authors suggest that a dedicated mobility team led by physiotherapists may help address the barriers related to mobility.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1016/j.aucc.2014.11.001 or contact your DHB library, or organisational or local library for assistance.

Barber, E. A., et al. (2014). Barriers and facilitators to early mobilisation in intensive care: A qualitative study. Australian Critical Care, 19 December [Epub before print]

The workshop summary is available as a free PDF download at:  http://iom.edu/Reports/2014/Facilitating-Patient-Understanding-of-Discharge-Instructions.aspx

In the videos, four Māori people share their experience of both working in a health service and being a patient or whānau of a patient. The participants work within a Māori health service so the videos include views both as a consumer and provider of services.

The videos explore the importance of relationships with whānau when working with Māori consumers, cultural considerations for health providers, and how to work with patients and whānau.

The videos are presented as four individual stories, and also as shorter clips edited into themes. The themes are:

• looking after Māori in hospital
• one Māori voice
• Māori cultural practices
• communicating with Māori in a health setting
• whānau support in health care
• health literacy among Māori.

The videos are available to view at:  http://www.hqsc.govt.nz/our-programmes/consumer-engagement/publications-and-resources/videos-maori-responsiveness/

The aim of this study was to explore how novice and experienced GPs manage patients with medically unexplained symptoms (MUS) and how these skills are taught and learned in GP training in Australia.

In this constructivist grounded theory study with 24 general practice registrars and supervisors in GP training practices across Australia, the authors found that registrars lacked a framework for managing patients with MUS. Some described negative feelings towards patients that were uncomfortable and confronting. Registrars also were uncertain about their clinical role: where their professional responsibilities began and ended. Supervisors utilised a range of strategies to address the practical, interpersonal and therapeutic challenges associated with the care of these patients.

The authors conclude that negative feelings and a lack of diagnostic language and frameworks may prevent registrars from managing these patients effectively. Some of these negative feelings, such as frustration, shame and helplessness, are shared between doctors and patients. Registrars need assistance to identify and manage these difficult feelings so that consultations are more effective. 

This is an open access article and can be downloaded and read in free full text at:  http://dx.doi.org/10.1186/s12875-014-0192-7

Stone, L. (2014). Managing the consultation with patients with medically unexplained symptoms: A grounded theory study of supervisors and registrars in general practice. BMC Family Practice, 15:192.

The authors include studies from other groups such as children, the elderly, and persons with mental health, cancer, and other chronic conditions.

This article is available to read in free full text at:  http://onlinelibrary.wiley.com/doi/10.1111/sdi.12194/full

Bennett, P. N., Parsons, T., Ben-Moshe, R., Weinberg, M., Neal, M., Gilbert, K., Rawson, H., Ockerby, C., Finlay, P. and Hutchinson, A. (2014). Laughter and humor therapy in dialysis. Seminars in Dialysis, 27: 488–493.

Southern DHB today announced the winner of the 2014 “Southern Innovation Challenge.”

Southern DHB Emergency Management Manager, Paul McNamara and Southern DHB Emergency Management Coordinator, Owen Black’s idea to produce a smartphone Emergency Management app to be used as an additional communications channel to Southern DHB staff was awarded first place and the team won $15,000 towards its development.

The app will enhance the level of communication in an emergency and will be used by the Emergency Management team for important notifications which in these situations may not reach staff through the usual channels of staff emails, intranet posts, and social media.

Southern DHB Chief Executive Officer, Carole Heatly said that it was very hard to choose a winner and the level of applications was extremely high.  “However the app stood out as being a very innovative way of increasing Southern DHBs ability to maintain services in an emergency event by improving communications to our staff,” she said.

The “Emergency Management app” was one of six ideas awarded funding through the Southern Innovation Challenge. The other successful entries included a new range of easy-to-use resources for people on waiting lists with the Primary Mental Health Brief Intervention Service and Mental Health, Addictions and Intellectual Disability Service; a Central Otago tele-paediatric diabetes clinic; digital photo frames to introduce staff to the service users and their families/whānau as part of the Safe Wards initiative; an ipu whenua, a biodegradable vessel to return the embryo and umbilical cord to the earth and a falls prevention initiative through visual education aids for clients such as pamphlets and placemats.

This is the third year that the Southern Innovation Challenge has taken place and 16 applications were presented to the panel.

 “The judges were looking for ideas that identified with Southern District Health Board’s strategic priorities and we certainly saw this in the applications,” said Ms Heatly.

The winners will be able to follow through with their proposal with the help of the prize money, organisational support and support from Otago Polytechnic.

The Southern Innovation Challenge was sponsored by Westpac Banking Corporation and Otago Polytechnic with this year’s sponsorship totalling $25,000.

This year’s judging panel consisting of Carole Heatly (Chief Executive Officer), Lexie O’Shea (Executive Director of Patient Services), Leanne Samuel (Executive Director Nursing and Midwifery),  Cherie McConville (Director of Performance), David Tulloch (Chief Medical Officer), Peter Harris (Innovation Facilitator, Otago Polytechnic) and John Blaikie (Private Advisor, Westpac Banking Corporation).

In the latest issue (attached below):

Southern District Health Board is launching a project named “mō tātou, ā, mō kā uri ā muri ake nei (for us and those after us)” This smokefree leadership poster series features  a number of Southern District Health Board and WellSouth Primary Health Network staff, with each poster accompanied by personal anecdotes.

The purpose of this poster series is to promote smokefree leadership within healthcare settings, by personalising a commitment to smokefree in primary and secondary care.  This has been achieved through stories shared that provide a focus and resource for ongoing smokefree activities as we progress towards New Zealand being smokefree by 2025.

Healthcare professionals from across the southern district (including professionals from primary care, paediatrics, mental health, surgical and respiratory disciplines) share why smokefree is important to them and their support for Southern DHB’s commitment to the national 2025 goal.  The exhibition aims to  create a smokefree culture that extends beyond the current national Health Target (Better Help for Smokers to Quit).

Smoking continues to be a major public health problem in New Zealand causing the deaths of approximately 5,000 New Zealanders every year.  The 2014 Surgeon General’s Report on Smoking and Health highlights that the list of illnesses caused by smoking has grown and now includes diabetes, colorectal cancer and liver cancer and for the first time, women are as likely as men to die from many of the diseases caused by smoking.  These include lung cancer, chronic obstructive pulmonary disease (COPD) and heart disease.  Cigarette smoking makes people less healthy, reduces quality of life and is a major determinant of health inequalities.

“The 2013 census data from Statistics New Zealand show that smoking prevalence is 15% (down from 23% in 2006) which is very encouraging.  The majority of people who smoke want to stop and appreciate help from their healthcare workers.

“The smokefree leadership poster series aims to raise the awareness of smokefree in a healthcare environment and create a culture of smokefree led by these champions and the many other smokefree champions we have in the primary and secondary healthcare setting,” said Southern DHB Smokefree Co-ordinator, Debby Newton.

For more information about quitting smoking go to the Public Health South website about smokefree here

Posters will be launched on:

Monday 8th December                                                                   Tuesday 9th December

Southland Hospital (outside the cafe)                                     Dunedin Hospital (by enquiries desk)

5.30 pm                                                                                                5.30 pm

Following the launch the posters will be distributed to all Otago and Southland hospitals and General Practices.

Data from 5,024 newly-diagnosed breast cancer patients treated in 111 breast center hospitals in Germany were analysed and combined with data on hospital characteristics. Multilevel linear regression models were calculated taking into account hospital characteristics and adjusting for patient case mix.

Younger patients, those receiving mastectomy, having statutory health insurance, not living with a partner and having a foreign native language report higher unmet information needs. The data demonstrate small between-hospital variation in unmet information needs. In hospitals that provide patient-specific information material and that offer health fairs as well as those that are non-teaching or have lower patient-volume, patients are less likely to report unmet information needs.

The authors conclude that hospitals may contribute to reducing the patients? information needs by means that are not necessarily resource-intensive.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1186/s12913-014-0601-6

Kowalski, C., et al. (2014). Meeting patients’ health information needs in breast cancer center hospitals – a multilevel analysis. BMC Health Services Research, 14:601.

It will feature current news, press releases and the latest stories on the health care, research and education the region’s health providers deliver every day.

For further information, go to: http://www.waikatodhbnewsroom.co.nz/

The authors report on health and health care use; health care costs and access; timeliness of care; care coordination and safety; doctor-patient relationship; health promotion; end-of-life planning; and management of chronic conditions and caregiving.

The article is available to read in free full text at:  http://dx.doi.org/10.1377/hlthaff.2014.0947

Osborn, R., et al. (2014). International survey of older adults investigates access, coordination, and patient-centered care. Health Affiars, 33(12), 2247-2255

Studies were included if they reported on physician-related and physician-reported barriers to adequate communication and decision making. Barriers were categorized as related to physicians? knowledge, physicians? attitudes or physicians? practice. Study quality was assessed using design-specific tools. Evidence for barriers was graded according to the quantity and quality of studies in which they were reported.

Thirty-six studies were included. The authors determined 90 barriers, of which 46 related to physician attitudes, 24 to physician knowledge and 20 to physician practice. Stronger evidence was found for physicians? lack of communication training and skills, their attitudes towards death in the ICU and their focus on clinical parameters, and their lack of confidence in their own judgment of the patient's true condition.

The authors conclude that many physician-related barriers hinder adequate communication and shared decision making in ICUs. Better physician education and palliative care guidelines are needed to enhance knowledge, attitudes and practice regarding end-of-life care. Patient, family and health care system related barriers need to be examined.

This is an open access article and can be downloaded and read in free full text at:  http://dx.doi.org/10.1186/s13054-014-0604-z

Visser, M., et al. (2014). Physician-related barriers to communication and patient and family-centred decision making towards the end of life in intensive care: A systematic review. Critical Care, 18:604.

To read the full story, go to: http://www.thecommunityguide.org/news/2014/tobacco-comprehensive.html

To read the full abstract, and for information on how to access the full text, go to:  http://www.annemergmed.com/article/S0196-0644(14)01406-1/abstract? or contact your DHB library, or organisational or local library for assistance.

Kessler, D.O., et al. (2015). Debriefing in the emergency department after clinical events: A practical guide. Annals of Emergency Medicine, 65(6), 690–698

Fifty-eight studies were included (54 RCTs and four CBA studies), with 7,188 participants. Based on the results from their analysis, the authors conclude that "there is low-quality evidence that [cognitive-behavioural training]  and mental and physical relaxation reduce stress more than no intervention but not more than alternative interventions. There is also low-quality evidence that changing work schedules may lead to a reduction of stress. Other organisational interventions have no effect on stress levels. More randomised controlled trials are needed with at least 120 participants that compare the intervention to a placebo-like intervention. Organisational interventions need better focus on reduction of specific stressors".

This article is available to download and read in free full text at:  http://onlinelibrary.wiley.com/enhanced/doi/10.1002/14651858.CD002892.pub5

Ruotsalainen JH, Verbeek JH, Mariné A, Serra C. (2014). Preventing occupational stress in healthcare workers. Cochrane Database of Systematic Reviews, 11, CD002892.

Taranaki DHB won the Government category at the Maori Language Awards 2014 on Friday 7 November in Rotorua, edging out the other finalists, the Inland Revenue Department (Palmerston North) and the New Zealand Qualifications Authority. The awards were run by Te Taura Whiri i te reo Maori / Maori Language Commission. 

Ngawai Henare, Chief Advisor for Maori Health said, “We are thrilled to have won the Government category award.  It acknowledges the work that’s been done by lots of people to make te reo Maori much more visible throughout Taranaki Base Hospital and the Taranaki DHB campus.”

The Taranaki DHB submitted an application based on its commitment to incorporate bilingual signage around Project Maunga (the hospital redevelopment) and the rest of the Taranaki DHB campus as well as usage of te reo Maori in pamphlets, posters and the new Children’s Ward.

“Part of the challenge of improving Maori health is about making services more inviting for Maori so they’ll actually feel ok about coming here to receive services,” commented Ms Henare.

“One way of doing this is to reflect Maori culture in the environment. Project Maunga (the hospital redevelopment project) was a great opportunity to do this, and now bilingual signage is prominent around the hospital and campus.”

Ms Henare emphasised the importance of working with the eight iwi of Taranaki through their representative body, Te Whare Punanga Korero (TWPK), to make the bilingual signage project happen. 

“This project is a good example of the strength of the relationship the Taranaki iwi has with the Taranaki DHB, as a Crown agent. This is an influential relationship that’s based on the principles of the Treaty of Waitangi and it is important to acknowledge this project is as much about TWPK as it is the Taranaki DHB,” she said.

Ms Henare also emphasised the importance of the relationship the Taranaki DHB has built with Te Reo o Taranaki Trust, experts in the Taranaki dialect of the Maori language who provided the translations for all our signage.  “Te Reo o Taranaki applied a rigorous process to decide on the correct translations.  Mitchell Ritai and his team were finalists themselves in the Community award category and were present at the awards evening as well.  It was fitting for them to join with the Taranaki DHB and Te Whare Punanga Korero on the stage to collect the award.”

The 2014 Taranaki DHB Maori Language Awards application highlighted several things:

• how the use and awareness of Maori culture and te reo Maori has been raised in and around the hospital. For example, the widespread use of bilingual signage in and around the hospital which has created lots of interest and discussion.
• how the Taranaki DHB’s leadership has supported increasing the visibility of te reo around the hospital. For example, the Taranaki DHB Board now has specific time allocated at every Board meeting for raising cultural awareness. This is delivered by one of its Board members.
• how it has been ensured the reo used is of a high quality and relevant to Taranaki. Involving Te Reo O Taranaki Trust who are experts in te reo o Taranaki and have been of immense value here, and the Taranaki DHB has committed to maintaining this relationship.
• Taranaki DHB has long term plans for incorporating te reo Maori including:
• its commitment to including bilingual signage on all its facilities, as these are refreshed and updated over time.
• discussion with Te Reo O Taranaki as to how Taranaki DHB can deliver Maori language lessons to staff, hopefully in the not too distant future.

Thirty seven orderlies at Palmerston North and Wanganui Hospitals yesterday graduated with nationally recognised certificates, after a year of study.

The Spotless centralAlliance orderlies – 29 from Palmerston North Hospital, and eight from Wanganui - graduated with the National Certificate in Health, Disability and Aged Support (orderlies) - a level three qualification on the New Zealand Qualifications Authority framework. They required 62 credits (about 620 hours equivalent) drawn from three sets of unit standards to qualify.

The orderlies were supported in their assessments of theory and practical components of study by Spotless centralAlliance (MDHB and WDHB), the two DHBs, Career Force ITO, and the Service and Food Workers Union. The assessments were undertaken at work and in orderlies’ own time, with mentoring and group sessions held as part of the student support strategies. Spotless centralAlliance is the first in New Zealand to certificate orderlies to this qualification.

The 16 standards included: infection control, handling dangerous goods, code of rights, maintaining a safe and secure environment, team work, administrative systems, communication with patients, and customer service.

Some staff are continuing on with their studies which they expect to complete by the end of the year. Consideration is now being given to delivery of a 2015 centralAlliance programme.

Participants were 32 people with at least one LTC (chronic obstructive pulmonary disease, diabetes, asthma and coronary heart disease) and 10 practitioners. Consultations between patients with LTCs and health-care practitioners were audio-recorded. Semi-structured interviews were completed with patients and practitioners, using stimulated recall. Patients were re-interviewed 3 months later. 

Behaviour change talk in consultations was rare and, when it occurred, was characterised by deflection and diffidence on the part of practitioners. Patient motivation tended to be unaddressed. While practitioners positioned behaviour change work as outside their remit, patients felt uncertain about, yet responsible for, this work. Practitioners raised concerns that this work could damage other aspects of care, particularly the patient–practitioner relationship.

The autors conclude that behaviour change work is often deflected or deferred by practitioners in consultations, who nevertheless vocalise support for its importance in interviews. 

This is an open access article and can be downloaded and read in free full text at: http://dx.doi.org/10.1111/hex.12304

Hunter, C., Chew-Graham, C. A., Langer, S., Drinkwater, J., Stenhoff, A., Guthrie, E. A. and Salmon, P. (2014). ‘I wouldn't push that further because I don't want to lose her’: A multiperspective qualitative study of behaviour change for long-term conditions in primary care. Health Expectations, 7 November [Epub before print].

The law currently allows language checks on overseas non-European applicants and on doctors from the European economic area.

Proposed changes will allow the Nursing and Midwifery Council, General Dental Council, General Pharmaceutical Council and Pharmaceutical Society of Northern Ireland to put in place systems for carrying out proportionate language controls on European applicants and for taking fitness to practise action where there are concerns about the English language skills of professionals who are already in practice. The changes will apply to nurses, midwives, dentists, dental care professionals, pharmacists and pharmacy technicians.

For further information, go to: https://www.gov.uk/government/consultations/language-controls-for-healthcare-and-associated-professions

Nurses and other health professionals are welcoming the Health Quality & Safety Commission “Let’s PLAN for better care” initiative, aimed at improving health literacy.
PLAN stands for: ‘P = Prepare for your visit; L = Listen and share; A = Ask questions; N = Note down what you need to do next.’

NZNO professional nursing adviser Angela Clark says, “Our members can see the benefit of an initiative like this in all sectors of the health system, especially for Māori, Pacific and migrant communities, who are more likely to have unmet health needs than other groups. There are many reasons why people don’t get the health care they need when they need it, and low levels of health literacy are a major reason.”

“There is strong international evidence linking a person’s level of health literacy with their health status. When people are involved in their own health care and understand what’s happening they are less likely to be hospitalised, less likely to have to go to an Emergency Department and more likely to interpret health labels and health messages correctly.”

“Involving patients in the assessment and planning of their own healthcare significantly improves the quality of health care they receive and their feeling of satisfaction and empowerment. Raising health literacy levels is a win-win solution for New Zealanders, nurses and other health professionals.”

LHS covers, but is not limited to the following topics:

• New models of clinical and social care leadership
• Strategic management within healthcare organizations (incl. crisis management)
• Improving patient care and services through effective management practices
• Leadership learning, training and development (incl. personal leadership and performance accountability)
• Mentoring, coaching and succession planning
• Resourcing / resource constraints
• Public health challenges and community health programmes
• Collaboration - communication strategies and multidisciplinary teams
• Integrated care pathways
• Patient expectations / the patient as leader
• Ethics
• Technology