title: Adaptation of the safewards model to the New Zealand context: A mixed-methods evaluative study

authors: Knauf, Sarah

subjects: inpatient

abstract: Background: Mental health inpatient units can provide a sanctuary for people to recover from mental illness. However, research has shown these units to be sites of conflict, in an environment that service users do not experience as therapeutic. To support a therapeutic environment, the safety and wellbeing of service users and staff need protection through reduced conflict and containment rates. Conflict can be physical or verbal aggression, self-harm, suicide attempt, absconding, substance misuse and medication refusal. Containment involves methods used to control conflict, including administration of sedative medication, coerced intramuscular medication, increased level of observation, restraint and seclusion. The Safewards model, originating in the United Kingdom in 2015, proposes 10 interventions to address conflict and containment. These interventions are centred on: therapeutic relationships; person-centeredness; teamwork; and least restrictive care. This research pursued active transformation through codesign of an adapted Safewards model to fit the socio-cultural context of New Zealand.

Objective: This thesis with publication describes the adaptation of the Safewards model to the New Zealand context. Cultural adaptation was critical due to significant health outcome disparities between Māori and non-Māori populations and the disproportionate representation of Māori within mental health services. The research sought to discover what a New Zealand model required, what the perspectives of inpatient tangata whai ora and staff were of the developed model and what changes it made to rates of conflict, containment and the ward atmosphere. Participants: Tangata whai ora and staff from the study setting were recruited to participate in focus groups before and after the implementation of the New Zealand Safewards model. Phase one focus groups included 15 staff and three tangata whai ora. Phase three focus groups included 13 staff and four tangata whai ora.

Methods: This is a mixed-methods evaluative study structured into three distinct phases, using methods of participatory action research. The adapted Safewards model was implemented for 12 months, with a staggered introduction of 11 interventions. Qualitative data were derived from the thematic analysis of focus groups. Quantitative data were from the Patient-Staff Conflict Checklist, Essen Climate Evaluation Schema, Fidelity Checklist and Te Whatu Ora Waikato service data.

Findings: A New Zealand Safewards model must: reflect a Te Ao Māori worldview; align with current practices; adapt Safewards interventions; and gain acceptance. Change management is one process that can reduce barriers to change. The adapted Safewards model reduced conflict, increased patient cohesion and improved the sense of safety perceived from staff and tangata whai ora in the study setting. The outcomes of this study hold the potential to contribute to the formulation and implementation of a New Zealand Safewards model, while also bearing relevance for the international adaptation of Safewards to culturally diverse countries and healthcare systems.

text: Adaptation of the safewards model to the New Zealand context: A mixed-methods evaluative study Background: Mental health inpatient units can provide a sanctuary for people to recover from mental illness. However, research has shown these units to be sites of conflict, in an environment that service users do not experience as therapeutic. To support a therapeutic environment, the safety and wellbeing of service users and staff need protection through reduced conflict and containment rates. Conflict can be physical or verbal aggression, self-harm, suicide attempt, absconding, substance misuse and medication refusal. Containment involves methods used to control conflict, including administration of sedative medication, coerced intramuscular medication, increased level of observation, restraint and seclusion. The Safewards model, originating in the United Kingdom in 2015, proposes 10 interventions to address conflict and containment. These interventions are centred on: therapeutic relationships; person-centeredness; teamwork; and least restrictive care. This research pursued active transformation through codesign of an adapted Safewards model to fit the socio-cultural context of New Zealand.

Objective: This thesis with publication describes the adaptation of the Safewards model to the New Zealand context. Cultural adaptation was critical due to significant health outcome disparities between Māori and non-Māori populations and the disproportionate representation of Māori within mental health services. The research sought to discover what a New Zealand model required, what the perspectives of inpatient tangata whai ora and staff were of the developed model and what changes it made to rates of conflict, containment and the ward atmosphere. Participants: Tangata whai ora and staff from the study setting were recruited to participate in focus groups before and after the implementation of the New Zealand Safewards model. Phase one focus groups included 15 staff and three tangata whai ora. Phase three focus groups included 13 staff and four tangata whai ora.

Methods: This is a mixed-methods evaluative study structured into three distinct phases, using methods of participatory action research. The adapted Safewards model was implemented for 12 months, with a staggered introduction of 11 interventions. Qualitative data were derived from the thematic analysis of focus groups. Quantitative data were from the Patient-Staff Conflict Checklist, Essen Climate Evaluation Schema, Fidelity Checklist and Te Whatu Ora Waikato service data.

Findings: A New Zealand Safewards model must: reflect a Te Ao Māori worldview; align with current practices; adapt Safewards interventions; and gain acceptance. Change management is one process that can reduce barriers to change. The adapted Safewards model reduced conflict, increased patient cohesion and improved the sense of safety perceived from staff and tangata whai ora in the study setting. The outcomes of this study hold the potential to contribute to the formulation and implementation of a New Zealand Safewards model, while also bearing relevance for the international adaptation of Safewards to culturally diverse countries and healthcare systems.

year: 2024

title: Hei oranga mo ngā wāhine hapū (o Hauraki) i roto i te whare ora

authors: Palmer, Stephanie

subjects: Psychological wellbeing

abstract: This thesis had four-main objectives. In the first instance, it aimed to improve understanding of psychosocial variables which may mediate the quality of Māori childbirth experience, namely: social support, coping strategies, cognitive appraisal, ethnic identity and psychological wellbeing. Secondly, it aimed to examine the relationship between these variables and the quality of childbirth experience. Thirdly, this thesis aimed to develop and pilot-test an instrument for the measurement of waiora among Māori. And fourthly, this thesis aimed to test whether waiora was a predictor of participants' childbirth experience. 
Thirty-one self-identified Māori women took part in the research. All participants gave birth at Thames Hospital in Hauraki during 1994. Attention is drawn to various ethical and methodological issues which have importance in the development of kaupapa Māori and Māori centred health research paradigms, such as, the role of koha, the validity of kanohi-ki-te-kanohi recruitment strategies and the need for collaborative decision-making processes. 
Prenatal waiora, ethnic identity, cognitive appraisal, coping strategies and social support predicted both quantitative and qualitative indicators of perinatal outcome. Obstetric technology was a very strong predictor of maternal postpartum perceptions and feelings of satisfaction or wellbeing. A preliminary model of the relationship between prenatal and perinatal predictors of Māori childbirth experience is presented. 
This research identifies the need to develop knowledge on psychosocial mediators of Māori childbirth experience. It is likely, however, that the quality of Māori childbirth experience will benefit from strategies which foster feelings of waiora and ethnic identity. The likelihood of a relationship between waiora and te ao Māori childbirth resources may hold particular interest for Māori. A range of strategies to improve the reliability and validity of Hōmai te Waiora ki Ahau as a tool for the measurement of waiora have been identified. As an outcome measure, this tool may have value in a range of contexts.

text: Hei oranga mo ngā wāhine hapū (o Hauraki) i roto i te whare ora This thesis had four-main objectives. In the first instance, it aimed to improve understanding of psychosocial variables which may mediate the quality of Māori childbirth experience, namely: social support, coping strategies, cognitive appraisal, ethnic identity and psychological wellbeing. Secondly, it aimed to examine the relationship between these variables and the quality of childbirth experience. Thirdly, this thesis aimed to develop and pilot-test an instrument for the measurement of waiora among Māori. And fourthly, this thesis aimed to test whether waiora was a predictor of participants' childbirth experience. 
Thirty-one self-identified Māori women took part in the research. All participants gave birth at Thames Hospital in Hauraki during 1994. Attention is drawn to various ethical and methodological issues which have importance in the development of kaupapa Māori and Māori centred health research paradigms, such as, the role of koha, the validity of kanohi-ki-te-kanohi recruitment strategies and the need for collaborative decision-making processes. 
Prenatal waiora, ethnic identity, cognitive appraisal, coping strategies and social support predicted both quantitative and qualitative indicators of perinatal outcome. Obstetric technology was a very strong predictor of maternal postpartum perceptions and feelings of satisfaction or wellbeing. A preliminary model of the relationship between prenatal and perinatal predictors of Māori childbirth experience is presented. 
This research identifies the need to develop knowledge on psychosocial mediators of Māori childbirth experience. It is likely, however, that the quality of Māori childbirth experience will benefit from strategies which foster feelings of waiora and ethnic identity. The likelihood of a relationship between waiora and te ao Māori childbirth resources may hold particular interest for Māori. A range of strategies to improve the reliability and validity of Hōmai te Waiora ki Ahau as a tool for the measurement of waiora have been identified. As an outcome measure, this tool may have value in a range of contexts.

year: 2002

title: The influence of maritime freight cost tail risk on publicly traded transport companies

authors: Akyildirim, Erdinc

abstract: This study examines the influence of maritime freight cost tail risk events on transportation-related stock market prices. Our findings reveal a significant asymmetry: extreme negative movements in these indices have a disproportionately large adverse impact on stock returns compared to extreme positive movements. As these indices serve as barometers of global economic health, sharp declines signal contractions in global demand, fuelling investor apprehension. These concerns outweigh the potential benefits of lower input costs for most firms. We also uncover substantial heterogeneity amongst stock responses. Notably, owing to their perceived higher risk, smaller firms and those with ESG controversies are more severely impacted by these negative tail-risk events. Further, we also find that strong ESG commitments are sometimes beneficial during negative tail risk events, but not always. We attribute the observed detrimental effects of strong ESG commitments to heightened investor concern about the additional operational costs and regulatory compliance required to meet these commitments during challenging market conditions. Our results suggest companies take proactive steps to address investor concerns about the cost of ESG commitments. By doing so, companies can ensure that their pursuit of sustainability and responsibility does not conflict with their financial objectives and market resilience.

text: The influence of maritime freight cost tail risk on publicly traded transport companies This study examines the influence of maritime freight cost tail risk events on transportation-related stock market prices. Our findings reveal a significant asymmetry: extreme negative movements in these indices have a disproportionately large adverse impact on stock returns compared to extreme positive movements. As these indices serve as barometers of global economic health, sharp declines signal contractions in global demand, fuelling investor apprehension. These concerns outweigh the potential benefits of lower input costs for most firms. We also uncover substantial heterogeneity amongst stock responses. Notably, owing to their perceived higher risk, smaller firms and those with ESG controversies are more severely impacted by these negative tail-risk events. Further, we also find that strong ESG commitments are sometimes beneficial during negative tail risk events, but not always. We attribute the observed detrimental effects of strong ESG commitments to heightened investor concern about the additional operational costs and regulatory compliance required to meet these commitments during challenging market conditions. Our results suggest companies take proactive steps to address investor concerns about the cost of ESG commitments. By doing so, companies can ensure that their pursuit of sustainability and responsibility does not conflict with their financial objectives and market resilience.

year: 2025