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October 2008 Edition Volume 3, Issue 3

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Recent IPP-SHR research demonstrates that there is a considerable cultural difference between the beliefs of traditional Aboriginal peoples and the Western biomedical notion of informed consent. The differing perspectives and cultural practices translate into a number of major concerns that impact on the practice of obtaining consent from Aboriginal peoples for medical procedures. The insights are from qualitative interviews conducted with a total of 72 participants including, Indigenous patients, their carers, Aboriginal health workers, health professionals and interpreters from rural and remote areas of the Northern Territory.

The findings indicate that differing conceptual views of health along with the Indigenous emphasis on community, rather than the individual, and authority for consenting to medical interventions, can create confusion and anger with regards to procedures for informed consent to Western medicine. For traditional Indigenous peoples there is a cultural imperative that consent is obtained from the “right” person within the network of kinship and community relationships, not necessarily solely the patient, as in Western medicine. Disrespect for such traditional

processes can lead to payback for the ill Indigenous person or their relatives, as well as considerable anger from family members.

There is also a cultural difference in relation to time, resulting in the biomedical emphasis on immediacy being in conflict with the time required for community consent. In addition, because of the differing cultural understandings of health and illness held by Indigenous peoples, it may be difficult to relate to the associated consequences and distress associated with many treatments. The consent process is further compromised by language, barriers when Indigenous peoples are not fully informed, in their own language about the potential benefits and harms of the intervention offered.

The findings of this research indicate the importance of providing a culturally appropriate means of obtaining informed consent for Indigenous patients in rural and remote areas.

McGrath, P., & Phillips, E. (2008) Western Notions of Informed Consent and Indigenous Cultures: Australian Findings at the Interface,

Bioethical Inquiry 5:21-31

Psycho-SocialUpdatea quarterly review of IPP-SHR,

CQUniversity Australia

R-IPPInternational Program of Psycho-Social Health Research

SIIC Q U N I V E R S I T Y A U S T R A L I A

New Paradigms: IT & Qualitative Research 3The balancing act: psychiatrists’ experience of moral distress .................... 4Determining the effectiveness of mental health services ................... 5Haematology and Palliative Care: New Zealand ............. 7Wheelchairs in the sand .... 7An Innovative Approach to Pediatric Dental Care: The ToothBus® ................. 8

Editorial ............................. 2Global Update .................... 4International Perspectives .. 6 From the Coalface .............. 8Journal and Book Profile ...... 10Work-in-progress ................ 12r-e-search .......................... 12

Detailed Insights into Psycho-Social Health Research

Notions of informed consent: Cultural Differences

in this issue

regulars

see page 11

OAOAOPEN ACCESS

the OffPress@ IPP-SHR

Team work is one of the key ingredients driving IPP-SHRs success in our broad range of program activities including, the review, pod-casting, research, and publication. It is a genuine privilege to be working with such an enthusiastic, clever, warm and inspiring group of people! In this issue of the review I have the pleasure of welcoming our newest member of staff to the team – Welcome, Adjunct Associate Professor David Henderson.

As the readership for the PSU is so diverse, both geographically and professionally, it is always exciting to hear from you. In this edition we have a broad range of contributions from our readers including insights on the development of wheelchairs for use in sandy conditions, play therapy in hospitals and the interface of palliative care and haematology in New Zealand. I would like to extend a sincere thank you, to all who provided us with such informative stories, for your time and important contribution to the review.

One of the ongoing themes in the feed-back we are receiving on the work of IPP-SHR is the practical value of our haematology and palliative care booklet. It is deeply satisfying to see the many creative ways in which our readers are using this booklet to create a wealth of positive changes in service delivery. The booklet is free and can be ordered directly through our website – we welcome requests, including repeat requests for them, knowing they are being used so wisely and well.

This issues’ Work-in-Progress outlines IPP-SHRs new research direction through collaboration with the Leukaemia and Blood Foundation of New Zealand (LBFNZ). We are delighted to be involved with the impressive work of the LBFNZ team and look forward to working closely on a range of productive and important projects.

As it is obvious from this editorial, due to the expanding readership base and increasing content of this publication, we are pleased announce that the PSU has now evolved into a quarterly review.

As always, this quarterly review brings to you a taste of the range ofinteresting research in psycho-social health that is being producedaround the world. From Canada, we hear of the experience of moraldistress for psychiatrists; from Denmark, mothers’ experienceswith pre-term infants; from Ireland, aspects of sexuality for womenreceiving chemotherapy; and from Australia, enhancing recovery frommental health. Happy reading!

With today’s rapid globalisation of the work force, many doors and opportunities have opened for international collaborative research projects. However, successfully managing and coordinating multi-site international research poses a multitude of challenges.

The International Program of Psycho-Social Health Research (IPP-SHR) is at the coal face of addressing these complexities involved with the coordination of this type of innovative research.

IPP-SHR conducts its research by utilising dynamic theories such as, qualitative or naturalistic research methodology, which seeks to document the individuals’ journey through a particular experience. As such, research team members and research participants are often located in different geographical areas, with data collection and analysis subsequently occurring in different locales and time zones. Such issues coupled with normal legal and ethical criteria, in conducting and managing research, present many data management issues which have

not been adequately addressed within an information technology framework.With the advent of increased internet connectivity and utilisation, management of such issues can be performed within a centralised setting. Using such a centralised paradigm, team members can interact with each other and research data through an environment conducive to appropriate and efficient research management processes and criteria. Within such a paradigm, access to data can be regimentally controlled and use audited, providing further assurance to legal and ethics criteria.

The article presents the first step forward in initiating online collaborative software for qualitative research based around an internet portal. Through utilising server-side technologies the proposed portal would allow researchers to access and collaborate regardless of their physical location. The collaborative space would allow team members to add files, implement automatic workflow processes such as, transcription and

coding, schedule appointments, and to designate tasks to team members. An important feature is the reduction in redundant work processes and an ability to maximise research efficiency. The proposed portal will also provide opportunities for team building and mentoring through additional features such as, project reporting, discussion forums and team feedback. The creation of this innovative research tool will result in an increase in research practitioners’ abilities to successfully and efficiently engage more in this exciting and fruitful area of psycho-social research.

Holewa H., (2008) “New Paradigms: A collaborative web space for research.” In Handbook of research on digital information technologies: Innovations, methods, and ethical issues. Hershey, PA: Information Science Reference.

New Paradigms: IT & Qualitative Research

IPP-SHR Director, Dr Pam McGrath, NHMRC Senior Research Fellow OAOA

OPEN ACCESS

What is Open Access?IPP-SHR is committed to providing ease of access to all publications. If you see this symbol in the PSU it signifies that you can view the full text version online.

editorial IPP-SHR Welcomes a new team member IPP-SHR is pleased to announce that Dr. David Henderson, former Medical Director of Redland Hospital, Queensland, Australia, has joined the team as Adjunct Associate Professor. Dr. Henderson instigated IPP-SHRs research into professional ethics in medicine at Redland Hospital, and is principal investigator in current research exploring successful integration of overseas trained doctors into the Australian health workforce. Dr. Henderson was Director of Medicine at Redland Hospital from 1999 until 2007. He is a trained coordinator with the Australian Council of Health Care Standards, a member of the Complaints Advisory Committee of the Medical Board of Queensland, and has been a member of the Human Research Ethics Committee of Bayside Health District Service. Dr. Henderson has over forty years clinical experience, is a specialist in internal medicine and rheumatology, both in Australia and the United Kingdom, and has been actively involved in clinical training and examination of medical students. He has held positions with the Royal Australasian College of Physicians, the Australian Medical Association and the Arthritis Foundation of Australia.

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We would like tohear from you!‘Psycho-Social Update’ (PSU) is a review for the psycho-social enterprise, from the International Program of Psycho-Social Health Research (IPP-SHR), CQUniversity, Australia, circulated quarterly to an international audience of over 4000 service providers, policy makers and academics with an interest in the human experience of serious physical and mental illness.

If you have news to share or wish to contribute an article please contact us - we will help pass the message on!

www.ipp-shr.cqu.edu.au/contact

Routine treatment for breast cancer patients often involves surgery, chemotherapy, radiotherapy and hormone therapy, all of which impacts upon an individual’s sexuality. A lack of research exists in Ireland on nurses’ perceptions and experiences in addressing sexuality issues for breast cancer patients. In response, researchers in Ireland conducted qualitative interviews with ten oncology nurses from three different hospitals. Following a qualitative analysis of participants’ responses, five main themes emerged highlighting the challenges of incorporating sexuality into nursing care.

Firstly, sexuality was viewed as a multidimensional concept which was difficult to define as it changes from one individual to the next. Secondly, participants revealed that they were aware of the impact that chemotherapy had upon patients’ sexuality and body

image, but were hesitant to address them. Thirdly, the nurses acknowledged sexuality as important but rarely incorporated it within their nursing care. The fourth theme found that sexuality was not included in many nursing school curriculums. Although sexuality was included in some post-registration training programs, its effectiveness was inhibited by not offering practical tools on how to directly incorporate it within daily nursing care. Finally, the data noted that participants’ attitudes towards sexuality were heavily influenced by the Catholic Church teachings. This may change in the near future as Ireland is currently experiencing a liberal shift in its perception on sexuality.

These findings suggest there is a need to include sexuality in Irish nursing school curriculums, with an emphasis on holistic practical ways to include it within the direct nursing care of breast cancer patients.

Publication Details: Lavin, M., & Hyde, A. (2006) Sexuality as an aspect of nursing care for women receiving chemotherapy for breast cancer in an Irish context, European Journal of Oncology Nursing, 10;1:10-18

Listen Online: 31st October 2008, 9:05 am EST

Nurses in neonatal care units (NICU) are not only faced with the challenge of caring for the babies but also addressing the needs of the mothers. As a result, effective nursing strategies, to address these mothers’ needs, have been identified as important. Responding to this, researchers have conducted a meta-synthesis of 14 qualitative research studies on the mother’s journey within the context of a NICU. Five metaphors emerged which have implications for nursing care.

The first is facilitating the growth of the mother-baby relationship. To form a bond with their preterm infant and to gain self-assurance, mothers need the opportunity to see, feel, touch and hold their baby. Secondly, nurses need to actively assist the development of the mother’s role. In this environment they don’t feel like a “real normal” mother as their contact is inhibited by machines and the constraints of being continually supervised. Overtime, the mother gains confidence within the NICU which strengthens her role as the main caregiver of her child. Thirdly, the turbulent neonatal environment is overwhelming and

frightening to the new parent and it interferes with the mother’s ability to focus on her baby. With time this diminishes and she is then able to block it out and concentrate on her preterm infant. Fourthly, the mothers need to create care giving and role reclaiming strategies. This is a developmental process which emerges gradually as the mother gains confidence within the NICU. Lastly, the formation of a facilitative relationship with nursing staff is vital to a positive experience. Nurses need to be aware of the rushed nature of the NICU and the ever changing faces of the staff which inhibits this important relationship. Publication Details: Aagaard, H., Hall, E. (2008) Mothers’ Experience of Having a Preterm Infant in the Neonatal Care Unit: A Meta-Synthesis, Journal of Pediatric Nursing 23; 3: e26-e36

Listen Online: 12th December 2008, 9:05 am EST

Mental health professionals experience moral distress when societal demands compete with addressing the best interests of the patients. Researchers conducted one-on-one interviews with psychiatrists, nurses, psychologists and social workers to determine what situations caused moral distress, to document how practitioners resolved ethical issues and to identify supports and barriers.

The views of the psychiatrists are reported in this paper; the participants discussed several factors contributing to moral distress such as, the difficulty of balancing the assessing of the person’s state of mind with protecting the public against a potential risk. Furthermore, the psychiatrists described moral distress arising from situations in which their professional role was influenced toward acting in a way that was morally different from what it would be if the situation was removed.

In order to cope with these phenomena participants described trying to open up a dialogue with other professionals to resolve the issue. A more helpful solution involved discussions with team members about the realities of the psychiatrist’s orders. These discussions made the situation feel more fair and honest.

The research recommends that the opposing demands placed upon psychiatrists need to be reviewed and addressed so that the rate of moral distress for these health professionals can be positively influenced. Publication Details: Austin, W., Kagan, L., Rankel, M., Bergum, V. (2008) The balancing act: psychiatrists’ experience of moral distress, Medical Health Care and Philosophy 11:89-97

Listen Online: 23rd January 2009, 9:05 am EST

www.ipp-shr.cqu.edu.au

Location: Dublin, IrelandSexuality as an aspect of nursing care for women receiving chemotherapy for breast cancer in an Irish context

Location: Rockhampton, AustraliaDetermining the Effectiveness of mental health services from a consumer perspective: Part 1: Enhancing recovery

Location: Aarhus, DenmarkMothers’ experiences of having a preterm infant in the neonatal care unit: A meta-synthesis

Location: Alberta, CanadaThe balancing act: psychiatrists’ experience of moral distress

Routine outcome measurement (ROM) for all mental health services is now standard practice across Australia. The design phase of these outcome measurement tools did not take into account the views of the consumer and therefore overlooked several important factors relevant to their successful recovery. To address this gap in information researchers conducted qualitative interviews in two settings: one rural and one metropolitan health service in Victoria, Australia.

Two main themes were identified from the data: (1) treatment and, (2) support and social connectedness. Areas within treatment, which were viewed as promoting recovery, were individualised medication plans, spiritual and counselling therapies, crisis management plans, and cigarettes.

Support and social connectedness was seen by the participants as a major factor in recovery. Specifically, the issues discussed

were: supportive staff follow-up from services, respect, peer support, promoting social connectedness and individual responsibility for recovery.

The research highlights that the current ROM being utilised, to evaluate outcomes of mental health services, does not cover aspects considered important by consumers for a successful recovery. Furthermore, the study reveals a need to include consumers’ perspectives within the development of future outcome measurement tools. Publication Details: Happell, B. (2008) Determining the effectiveness of mental health services from a consumer perspective: Part 1: Enhancing recovery, International Journal of Mental Health Nursing 17: 116-122

Listen Online: 5th December 2008, 9:05 am EST

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Within Palmerstone North Hospital, New Zealand, palliative care interfaces with many services in the hospital and community including those treating non-malignant disease such as, respiratory, cardiac and renal services.

In 2005, we formalised our working relationship with oncology and developed a shared care arrangement whereby we worked closely together while allowing the patient to have a gradual transition from one service to the other over time. The lead carer was identified and information was documented and shared.

Our more structured relationship with haematology began in mid-2007. We decided to adopt a similar arrangement with oncology that emphasised working together. This enabled the patient to be made

more aware of the palliative nature of their disease without feeling abandoned. It offered opportunities to discuss prognosis and choices for future management while allowing continuation of familiar procedures such as transfusions.

Continued on page 8

international perpectivesHow psycho-social research is used around the world

My current work involves a combination of palliative care and general practice. However, I originally trained in Scotland as a GP anaesthetist and worked in the Falkland Islands, South Atlantic. Together with a small team, consisting of one other GP/Surgeon and several enrolled and registered nurses, we looked after the medical needs of approximately 2000 locals situated in the town of Stanley and on 33 islands. With no other medical care available within 24 hours (not even telephone back-up), my skills grew rapidly in numerous areas such as, working as an interpreter, a forensic pathologist and in general practice. I also regularly conducted radio telephone medical clinics (RT clinic), which were broadcast to all the inhabitants who lived on 33 of the 330 surrounding islands. The RT clinic was based in the town of Stanley and was held every morning at 10am Monday through Friday. Issues of confidentiality were challenging as everyone living on the islands could listen in. Over time, subtle communication skills and previously arranged words were used to take full advantage of maintaining confidentiality. Great care was taken with each sentence as we learnt how much could be said whilst maintaining an understanding of the information being conveyed.

Innovative approaches such as, using lay medical people to convey information was used as part of our health promotion initiative. Training lay persons to disseminate health information in a common sense manner was imperative as the patients were located in distant and remote locations. Having lay persons strategically placed amongst these remote communities helped enormously in the area of public health and health promotion.

In retrospect, these seven formative years on the islands have given me a solid foundation

from which I can now draw upon to use within my current work in palliative care. The work in the Falkland Islands took place in a community in which everyone knew one another and therefore the care was on a very personal level. Due to the isolated nature of the Islands we all needed to think and work “outside the box”. All of these skills I now regularly use within my palliative care work.

I have learnt the importance of working together as part of a team whose focus is on the needs of the individual patients and their families. By acknowledging the need for patients to stay in control of their lives whilst experiencing palliative care I believe we offer a more caring and holistic approach.

I have observed that the “top down” approach of putting patients in medical categories and having teams care for them often only addresses some of the needs and leaves many other needs unmet. This type of care often results in the patient experiencing emotions of guilt and distress.

In my opinion the best approach involves a bottom-up methodology in which the needs of both the individual and family are addressed. Palliative care in haematology, especially within younger age groups, demonstrates the need for this more holistic approach.

I enjoy my work immensely and feel both privileged and honoured to have been a part of the lives of those I have cared for.

chat backwww.ipp-shr.cqu.edu.au

Chiyanzu Chinyama HeagreavesClinical Medical StudentChainama College of Health ScienceLusaka, Zambia

Chainama College of Health Science is located in Lusaka which is the capital city of the Republic of Zambia. It is the only college in the country to train Clinical Officers, Registered Mental Nurses and Clinical Officers in Psychiatry.

During my work as an Occupational Therapist in the Cape and Gulf communities, Queensland, Australia, I conducted many studies into the feasibility of providing wheelchairs, to communities that are suitable for sandy areas. Although there was an obvious need for a wheelchair which can traverse both, sand and dirt surfaces, my research found there to be insufficient sales to support importing large numbers of this type of wheelchair to Australia.

The ability to supply these specialised rural wheelchairs to outlying regions is further prohibited by several factors. Firstly, every wheelchair which is purchased must comply with the requirements set by the Australian Standards, Medical Aids Subsidy Scheme (MASS) and the Qld Funding body at a prohibitive cost of $7000- $20 000.

Secondly, every few years, contracts are altered and therefore, funding bodies in different states change their supply arrangements. Fortunately, the supplier contracts do allow for a 15% saving on purchase costs which ensures that the same service remains in remote areas as is found in more metropolitan locations.

Thirdly, my pilot study revealed that for people with spinal injury and cerebral palsy these rural wheelchairs aren’t an option, as their primary source of mobility, as they do not provide good postural support and run the risk of developing pressure ulcers and forming a postural deformity.

For these reasons many therapists prescribing wheelchairs, by using the government funding, wouldn’t support an application for a rural wheelchair as a primary chair. As funding is only available for one wheelchair, individuals would have to come up with the funds on their own to have both types of chairs.

One solution is to utilise smaller operators that can produce more customised wheelchairs for a small number of sales. If one supplier specialised and marketed to communities living in areas with high sand and dirt, a wheelchair of this kind may be a successful commercial viability. Funding for this type of wheelchair would need to come from a non-governmental agency as government agencies supply funding for only one wheelchair. Alternatively, the demand for rural wheelchairs could be raised if they were marketed to non-Indigenous and recreational

wheelchair users, thus making it a more viable commercial option.

Another solution would be a change to the Therapeutic Goods Administration (TGA), which currently prohibits the development of “backyard” solutions such as, making a one-off design for an individual. I did observe a successful solution during my pilot study and this was when communities purchased a beach wheelchair which was for shared use only. By focusing on the above issues there could be great progress made in supplying more appropriate wheelchairs for individuals living in rural and remote areas.

Stephen HalesOccupational Therapist Queensland

Stephen refers to an article featured in the

Psycho-Social Update, Volume 3 Issue 1.

For further information on the study and access to literature associated with this topic please visit www.ipp-shr.cqu.edu.au.

Wheelchairs in the sand...

I am currently studying clinical medicine at the Chainama College, which is a psychiatric hospital with a teaching clinic and the only hospital in Zambia offering psychological courses focusing on psycho-social issues. During my work in peer and community education I developed an interest in psycho-social research.

Psycho-social research is incorporated into courses teaching counselling skills in my college. This is relevant as many of the clients we encounter have problems in the area of “adjustment”. The psycho-social training enables us to position our understanding and knowledge of clients undertaking treatment to help better facilitate an individualised and appropriate clinical response. This is particularly important as many clients originate from peri-urban and remote parts of the republic, and have unique and specific needs in relation to preventive and ongoing care within communities facing challenges such as, lack of services, and rural and remote issues. Psycho-social training helps us understand clients better and provide tailored care plans when services are not easily available for clients.

Furthermore, currently there is research occurring in my country which is looking at how psycho-social counselling can be applied to patients who are considered to be recovering from a mental disorder. The goal is to assist the patient to come to an understanding that the society and environment in which they live can positively influence their recovery.

As a medical practitioner we encourage the client to live a normal and productive life. Our role as a practitioner is to help facilitate a client’s integration back into the community. It is important to realise that different clients face different problems and therefore we need to understand their psychological and social status in order to ease the transition towards a successful recovery.

Integration into medical practices

Radio telephone medical clinics and issues of confidentiality

Insights from New Zealand on the interface between haematology and palliative care

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Dr Alison BleaneyDirector, Georges Bay Medical Practice Service, Tasmania, Australia

Dr Joy Percy Palliative Care Palmerstone North HospitalNew Zealand

Give us a buzz, drop a line or flick us an email. Internat ional Perspect ives aims to give an insight into al l aspects of psycho-social issues around the globe. Whether i t is recent advances in innovat ive programs addressing psycho-social issues, musings about psycho-social prac t ices, or an update on the relevance of psycho-social issues within your town, country or region, we are keen to hear from you i f you have anything you wish to share,

In Psycho-Social Update, Volume 3 Issue 1, we featured an article about the equipment, power and travel issues that make palliative care provision difficult in remote communities. On the surface it would seem that provision of equipment such as wheelchairs suitable for use in sandy areas could be supplied to communities. Stephan Hales, Occupational Therapist, shows that the situation is complex, involving economics, safety standards and suppliers.

The Department of Recreation and Play Therapy aims to empower children and families through effective therapeutic experiences, with the purpose of promoting hospitalisation as a positive experience for children and their families. We aim to provide a non-threatening role and assist in implementing familiar experiences in an otherwise unfamiliar environment. Extensively trained in child development, play therapists educate children and their families about potentially painful, uncomfortable and invasive experiences, and encourage children to adopt lifetime coping strategies.

We utilise play techniques to create a familiar environment to support children and families. Each therapeutic plan aims to encompass the psychosocial and medical needs of the child within the hospital environment and alongside other hospital disciplines. Illness and stays at a hospital can interrupt a child’s routine, affect their emotional wellbeing, and hinder their developmental progress. Hospital play therapists draw on their knowledge of development, education, the family and community to involve the child in provisions that will address their interests and needs sensitively.

By communicating with the child, family members and other hospital employees, the play therapist gathers necessary information which will assist in the preparation, of a child, for the general hospital environment, provide education prior to surgery or procedures that are age appropriate for the patient, provide therapeutic experiences for play and enable opportunities for an outlet of expression.

Sydney Children’s Hospital has been nationally and internationally recognised as experts in the areas of Procedure Education and Distraction Play Therapy. The hospital was the first facility in Australia to employ a full time play therapist

that provided recreational and, most importantly, distraction play therapy for seriously ill and traumatised children. The hospital was also the first to have a full time play therapist in the Emergency Department.

Music therapy is the planned and creative use of music to address an individual’s physical, emotional, intellectual and/or social needs. The use of music can provide links to home, family, friends and school. It can also be used to alleviate

stress and anxiety as well as assisting in pain management. The department employs 13 staff members, which includes three part-time music therapists.

Sydney Children’s Hospital

Kerry Crannis,

Manager of the Department of Recreation and Play Therapy at Sydney Children’s Hospital, Randwick, New South Wales, Australia.

Play Therapy: An empowering therapeutic tool

www.ipp-shr.cqu.edu.au

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Programs and Practitioners

The most common chronic childhood disease in the United States is tooth decay with one-fourth of children between the ages of 2 and 5 being affected. The USA has no national health care system and therefore children from low income families are most at-risk for untreated tooth decay resulting in chronic pain, lack of school attendance and behavioural problems.

To improve access to dental care for this “at-risk” pediatric population, scattered across six rural counties in Western North Carolina, a community benefit program was begun by the Mission HealthCare Foundation. The result of fundraising was the creation of a very innovative program involving two fully functional custom made mobile dentistry buses, each known as the ToothBus®. Serving rural areas in Western North Carolina, the ToothBus® provides much needed dental care for at-risk children who don’t have a regular dentist, have a Medicaid or Health Choice coverage (public insurance for low income children), but are unable to find a dentist who will accept Medicaid or Health Choice, and can’t afford private dental care. Some of these children also have complex psychological conditions. In 2000, the ToothBus® program became independent of philanthropic support for its survival, and functions as part of the Pediatric Service Line within Mission Hospital located in Asheville, North Carolina.

Each ToothBus® serves children aged 6 to12 years who are attending elementary school in six different counties. Service to five other rural counties has been phased out with development of local dental capacity.

The key to the success of the ToothBus® is the sum of all the factors involved in the program: The initial involvement of office staffs’ collaborative efforts with county and school officials and staff to invite participation in the dental program. The friendly driver who collects children from class and walks with them to their first visit on the big shiny bus with its eye catching colorful hand paintings and bold graphics; the warm atmosphere inside the bus, far from a traditional dental office, with art on the walls and ceiling; televisions for favorite videos and games, and some familiar objects, before being introduced to the not so familiar dental equipment. Each dentist leads the team in a calm, relaxed, manner using a reassuring tone, humor, and a gentle approach to gain the trust of their delicate and sometimes highly nervous patients. The dental assistants talk about the newest kids movies and sing songs with the young patients helping to distract them, answer their questions and hold their hands.

The result of this care is a child who not only leaves the ToothBus® with improved oral, and therefore, overall health, but also with a positive emotional attitude towards dentistry which is vital for subsequent successful visits. Most children look forward to follow-up visits with great anticipation. Feeling good and looking good acts as positive reinforcement to further care. For some children, eating food without pain is a priceless reward in itself.

Dental Program Asheville, North Carolina, USA

An Innovative Approach to Pediatric Dental Care: The ToothBus®

from the coalface

Mission Children’s Dental Programis a part of Mission Children’s Hospital.

Readers interested in this topic may also be interested in an upcoming IPP-SHR podcast. Due for release on 21 November 2008. Dr Joan Coad explores children’s preference of thematic design and colour for hospital and clinical environments.

IPP-SHR Podcasts - Bringing you the latest in Psycho-Social Health Research from around the world.

Insights from New ZealandContinued from page 7

This relationship could occur wherever the service was delivered including, in hospital, the community or hospice. Palliative care addresses all the different areas such as physical, spiritual and psycho-social. Joint visits by members of the haematology and palliative care teams play a key role in making this work. These relationships with team members are often long lasting in nature and central to their palliative care experience.

Introduction of a “palliative approach” and “change of focus of care” allowed for greater communication between patients and families, regarding their expectations and fears, and gave them the opportunity for re-setting their goals. There has been a positive response to this initiative, and hope that this will become the accepted practice throughout New Zealand and other countries.

Dr Percy refers to an ongoing discussion within the Psycho-Social Update exploring issues relating to haematology and palliative care. Insights from Germany on these issues are available in Volume 3 Issue 2.

IPP-SHR has an extensive body of research exploring this interface and encourages interested readers to order the booklet.

chat back

Haematology and Palliative Care: Towards an Integrated Practice.

To order, simply fill out the reply-paid card or visit www.ipp-shr.cqu.edu.au.

344 people were killed in the Beslan terrorist attack, of these 186 were children. Almost every member of Beslan lost someone they loved. For IPP-SHR podcasts, Hamish Holewa spoke to Dr Ughetta Moscardino about her work with survivors and caregivers of survivors from Beslan. Discussed were the

protective factors associated with their society having a strong sense of cohesion, community and social opportunities. Factors relating to parenting, health and resilience were also discussed.

Listen Online: 17 October 2008, 9:05am EST

Within populist culture, Alzheimer’s disease has been described as a death that leaves the body behind, death in slow motion, or becoming a mere shadow of one’s self. Hamish Holewa spoke with Dr. Hazel McRae about her research into participant’s experiences of living with early stage Alzheimer’s disease. Participants reported strategies such as social comparison, humour, hope, instrument

telling and normalisation as methods of coping with the disease. Additionally, medicalisation of the disease, in which terms the disease is beyond the control of the individual, is another successful strategy used by people living with early stage Alzheimer’s.

Listen Online: 24 October 2008, 9:05am EST

In some developing countries, non-adoption of evidence-based childbirth practices has resulted in a higher rate of episiotomy and deaths from haemorrhaging during childbirth. To explore this topic, Hamish Holewa spoke with Dr Marci Campbell about her study on facilitators and barriers to adoption of evidence-based perinatal care in Latin American hospitals. Two evidence based practices were identified as not always following evidence-base medicine, including: routine episiotomy rather than

selective episiotomy; and active management of the third stage of labour. Findings indicated evidence-based practice was not necessarily followed due to issues associated with: providing evidence-based medicine; cultural and social translation; lack of role models and hierarchical leadership. To facilitate adoption of best practice, increased access to information, continuing education and peer/role model teaching is needed. Listen Online: 10 October 2008, 9:05 am EST

Journal of Bioethical InquiryThe Journal of Bioethical Inquiry focuses on issues in medicine, the health sciences, and general health care. It provides a medium in which these areas can be discussed and debated. Contemporary topics such as the impact of current world events upon health care are also included. The journal aims to find innovative approaches to solve problems within the health care arena.

Website: www.springerlink.com/content/1176-7529

Spirituality and the mind: Investigation and ApplicationWhere: Rochester, Minnesota, USA

When: 6 - 7 November 2008For more information visit:www.mayo.edu/pmts/mc2300-mc2399/mc2301-79.pdf

Physical and Mental Wellness – Integrative Approaches to HealthWhere: Perth, Australia

When: 1 - 2 December 2008For more information visit:www.varioinstitute.com/conference/2008

5th World Congress World Institute of Pain – WIPWhere: New York, NY, USA

When: 13 - 16 March, 2009For more information visit:www.allconferences.com/conferences/20071230075236

Australasian Association of Hospital Play SpecialistsWhere: Sydney, Australia

When: 19 & 20 March 2009For more information contact: kerry.crannis@sesiahs.health.nsw.gov.au

Association of Oncology Social Work:The Enduring Impact of 25 Years of Advancement in Psychosocial CareWhere: Savannah, Georgia, USA

When: 6-8 May, 2009For more information contact: info@aosw.org

Health in Transition – Researching for the FutureWhere: Adelaide, South Australia

When: 16-20 August 2009For more information visit: www.healthintransition2009.org.au

IPP-SHR podcasts explore the latest in the world of psycho-social health research. With thorough commentary, convenience of access and global coverage, catch up on the latest in psycho-social health news.

Listen, read and participate. IPP-SHR provides full online access to podcasts, transcripts and related links. Users can listen to the podcast and read any additional accompanying information, including, articles, powerpoints, author or institution information. IPP-SHR has made it easy to listen to the podcast, and users without subscription systems can automatically receive podcasts delivered to your email. Podcasting is easy - just read below.

Austral–Asian Journal of Cancer -Open AccessAustral-Asian Journal of Cancer (ISSN-0972-2556) is the first international cancer journal published within Asia and Australia. This journal is a multidisciplinary oncology journal covering all aspects of cancer treatment and research including, scientific, clinical and psycho-social. Free online access to the community of researchers and full text articles.

Website: www.ajcancer.org

Living with Leukaemia, Lymphoma and Myeloma: A Guide to Patients and FamiliesLiving with Leukaemia, Lymphoma and Myeloma is a book designed to guide and provide a source of information for anyone diagnosed with a blood cancer. It provides an easy read that explores, with rich information and insights, the experience from the perspective of the patient and their family.

Website: www.ipp-shr.cqu.edu.au

A-Z of Qualitative Research in HealthcareThis is an excellent basic resource for students starting to understanding qualitative methods, and busy researchers who need to quickly clarify an issue. Terms and concepts associated with qualitative methodologies are clearly explained, well referenced and alphabetically listed for speedy and easy access. It is a useful addition to any researcher’s bookshelf.

Immy Holloway (2008) A-Z of Qualitative Research in Healthcare, Second Edition, Blackwell Publishing,Oxford, UK. Website: www.johnwiley.com.au

book review

Listen online at www.ipp-shr.cqu.edu.au/podcasts

Podcasts are digital audio files that you can listen to on your computer or portable music device (iPod, mobile phone, i-River). Podcasting gives you the flexibility to listen to your favourite programs at a time, method and place which is convenient to you. IPP-SHR provides four methods of listening to our podcast.

1. Audio-on-Demand - Listen online or download from the IPP-SHR website. Just click on the Podcast icon.www.ipp-shr.cqu.edu.au/podcasts

2. Subscribe to the podcast using programs such as i-tunes, Juice or another subscription program.

3. Email Updates - Subscribe to the email update. When a new podcast is released an email will be automatically sent to your nominated address with a link to the podcast.

4. Listen through the PSU - Click on the podcast title of the electronic version of the PSU and it will automatically play on your computer!

Do you have a book to review?If you have a book or journal that you would like to display in this profile, please send a copy to PSU REVIEWS, PO BOX 796 TOOWONG Q 4066 AUSTRALIA

What is Podcasting?

Detailed Insights into Psycho-Social Health Research

Adoption of Evidence-based Medicine

Health Culture and Resilience - Surviving the Terrorist Attacks in Beslan

Mere Shadows? – Living with early stage Alzheimer’s Disease

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upcomingpodcasts@ IPP-SHR

journal and book profile

IPP-SHR Podcasts - Bringing you the latest in Psycho-Social Health Research from around the world.

IPP-SHRs Director, Dr Pam McGrath, has recently completed a speaking tour of New Zealand covering haematology and palliative care issues, organised by the Leukaemia and Blood Foundation of New Zealand (LBFNZ). The speaking tour involved three cities, Auckland, Palmerston North and Christchurch, each with a lunchtime seminar and dinner lecture.

The success of the speaking tour fostered the initiation of ongoing research collaboration between LBFNZ and IPP-SHR. Formalised in a recently signed Memorandum of Understanding, LBFNZ and IPP-SHR are now committed to working together to further psycho-social research within the New Zealand health community.

The first project of this collaboration will be the exploration of issues associated with Relocation for Specialist Treatment for Haematology and Patients and their Families.

IPP-SHR links with LBFNZ: A cross-the-Tasman collaboration

If you received this letter in error or do not wish to receive any subsequent editions, please visit “Contact us” at www.ipp-shr.cqu.edu.au. The material contained in “Psycho-Social Update” is intended only to provide a summary and general overview on matters of interest. It is not intended to be comprehensive. The views and information expressed within “Psycho-Social Update” are not necessarily the views or opinions of IPP-SHR or its affiliates. IPP-SHR takes no responsibility for the accuracy or otherwise of the content of “Psycho-Social Update” and recipients are advised not to rely upon any representations, statements, content or information without independent verification. For your convenience and information, “Psycho-Social Update” contains links to other sites. IPP-SHR makes no representation or warranty as to the accuracy or any other aspect of the information on those linked sites. No link to another site should be construed as an endorsement or recommendation of any information, goods or services referred to.

in progresswork

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A downpour of emails, a torrent of documents or drowning in versions - a sinking feeling perhaps? In research, the need

to collaborate is obvious. Data collection is dispersed, stakeholders are varied and dissemination methods endless. Collaboration has its benefits, although facilitating it can be problematic. Three major issues arise when electronically collaborating: communication; version control and information management; and data control.

The most widely used and understood method of electronic data collaboration is email. With ease of use, wide acceptability and increasingly flexible accessibility, it will continue to be the number one ad-hoc collaborative channel. However, email has its limitations: email does not easily index information and managing multiple documents with numerous people working on them is nigh-on impossible. As definitive as it was at the time, trying to find the final version of a submission, sent three months ago, can be an arduous experience. Furthermore, for confidential and sensitive information, emails hold information like sieves hold water.

However, as the complexity of projects and people contributing increases, the need for specifically designed collaborative software is needed. Such software generally uses two methods of collaboration. One method maintains a “virtual” space where each member of the collaborative space has a private editable copy of project related material, whilst the other method relies on a centrally controlled copy. Over email, these tools have significant benefits: collaboration can be undertaken in a secure method; access to data can be controlled through user accounts, passwords and encryption. Document versions and changes can be tracked and synchronised between team members and with the ability to annotate decisions referring to such changes. Additionally, project related material can be centrally stored creating conceptual space, where team members can interact and form a community.

Generally, collaborative spaces where each member holds a privately editable copy of a file, which is automatically updated on team members computers once changes are made, are easy to setup and suited to more ad-hoc applications. This is particularly the case as such software usually has the ability to bypass corporate firewalls and does not require IT support to implement, making it

easy to collaborate across the institution or company. Backup and storage is based on the paradigm of sharing many copies of the one file in many places. There is no central point, so for small projects, team members have to be aware if they are concurrently upgrading machines or deleting files.

Central collaborative software requires additional resources at implementation and generally has more defined project interaction rules, data access rights and defined roles. Whilst this might be seen as a burden, it also has the potential to increase collaboration with other researchers or the wider community. Using such rules, team members may be able to post information to a wider audience than intended. Although, this may be a question for your ethics committee, it does provide a glimpse into possible future directions, e.g. Wikipedia.

Collaborative software still needs to mature before gaining wider acceptance. After initial productive decreases, substantial benefits can be uncovered for a trained collaborative team. Although the biggest hurdle to using collaborative software is convincing others to use it; once implemented, expect to be syncing rather than sinking!

“Sinking or Syncing:” Collaborative Software

Contact Details:IPP-SHR, CQUniversity, Brisbane Office, PO BOX 796 TOOWONG Q 4066 AUSTRALIA Telephone: + 61 7 3025 3377 Email: ipp-shr@cqu.edu.au