title: Acceptance culture theory: A constructivist grounded theory on bullying of junior doctors in the New Zealand healthcare system

authors: Bashir, Sarah

subjects: Workplace bullying

abstract: Workplace bullying has been a serious workplace concern for centuries, with individuals confronting various forms of abuse, mistreatment and bullying at work. Historical accounts indicate that the powerful Egyptian pharaohs strategically lured tribal people to work at their construction sites, which led to submission, slavery and bullying. Regardless of the era, the enduring nature of bullying issues illustrates that individuals can misuse their power by using bullying to establish control and authority over other individuals. In contemporary environments such as New Zealand (NZ) healthcare organisations, workplace bullying remains a significant threat that exposes healthcare workers, including junior doctors, to health and safety issues. 
Despite literature documenting the prevalence and harmful impacts of bullying on NZ junior doctors, there is a lack of theoretical explanations behind bullying in this context. This notable gap in understanding the explanations of bullying impedes effective prevention and management of workplace bullying among NZ junior doctors. The research aimed to explain the bullying process among NZ junior doctors with the objective of facilitating prevention and management. 
Twenty doctors (n=20) from various specialities in medicine and surgery participated in in-depth interviews. Data collection and analysis were guided by the Constructivist Grounded Theory (CGT) approach. Seven core categories resulted from the data analysis. Six provided explanations of bullying, highlighting the complex interplay of many factors, including social and individual characteristics of the bullies and victims, team dynamics, hierarchy, organisational culture, systemic factors, and acceptance culture. The seventh core category described the prevention and management of bullying. 
CGT analysis of the data led to the development of Acceptance Culture Theory (ACT), which is the contribution of this study. ACT outlines the social process of acceptance of bullying at multiple levels of individuals’ ecological systems. An acceptance of bullying at the micro level caused individuals to endure and accept bullying, with effects seen at multiple levels (micro, meso, exo and macro) that perpetuated an acceptance culture of bullying in the individuals’ work environments, keeping them trapped in a cycle of bullying. 
Effective prevention and management are possible by breaking the acceptance culture using comprehensive approaches encompassing macro, meso, exo, and micro levels. Alleviating hierarchal structures, frequent changes in leadership, organisational support, changes in policies and procedures, and a robust reporting system are critical for the effective prevention and management of bullying. By addressing the root causes of workplace bullying, a safe and healthy workplace can be offered for NZ junior doctors.

text: Acceptance culture theory: A constructivist grounded theory on bullying of junior doctors in the New Zealand healthcare system Workplace bullying has been a serious workplace concern for centuries, with individuals confronting various forms of abuse, mistreatment and bullying at work. Historical accounts indicate that the powerful Egyptian pharaohs strategically lured tribal people to work at their construction sites, which led to submission, slavery and bullying. Regardless of the era, the enduring nature of bullying issues illustrates that individuals can misuse their power by using bullying to establish control and authority over other individuals. In contemporary environments such as New Zealand (NZ) healthcare organisations, workplace bullying remains a significant threat that exposes healthcare workers, including junior doctors, to health and safety issues. 
Despite literature documenting the prevalence and harmful impacts of bullying on NZ junior doctors, there is a lack of theoretical explanations behind bullying in this context. This notable gap in understanding the explanations of bullying impedes effective prevention and management of workplace bullying among NZ junior doctors. The research aimed to explain the bullying process among NZ junior doctors with the objective of facilitating prevention and management. 
Twenty doctors (n=20) from various specialities in medicine and surgery participated in in-depth interviews. Data collection and analysis were guided by the Constructivist Grounded Theory (CGT) approach. Seven core categories resulted from the data analysis. Six provided explanations of bullying, highlighting the complex interplay of many factors, including social and individual characteristics of the bullies and victims, team dynamics, hierarchy, organisational culture, systemic factors, and acceptance culture. The seventh core category described the prevention and management of bullying. 
CGT analysis of the data led to the development of Acceptance Culture Theory (ACT), which is the contribution of this study. ACT outlines the social process of acceptance of bullying at multiple levels of individuals’ ecological systems. An acceptance of bullying at the micro level caused individuals to endure and accept bullying, with effects seen at multiple levels (micro, meso, exo and macro) that perpetuated an acceptance culture of bullying in the individuals’ work environments, keeping them trapped in a cycle of bullying. 
Effective prevention and management are possible by breaking the acceptance culture using comprehensive approaches encompassing macro, meso, exo, and micro levels. Alleviating hierarchal structures, frequent changes in leadership, organisational support, changes in policies and procedures, and a robust reporting system are critical for the effective prevention and management of bullying. By addressing the root causes of workplace bullying, a safe and healthy workplace can be offered for NZ junior doctors.

year: 2024

title: Sports-related brain injury in the general population: An epidemiological study

authors: Theadom, Alice

subjects: Brain injury

abstract: Objectives
To determine the incidence, nature and severity of all sports-related brain injuries in the general population.

Design
Population-based epidemiological incidence study.

Methods
Data on all traumatic brain injury events sustained during a sports-related activity were extracted from a dataset of all new traumatic brain injury cases (both fatal and non-fatal), identified over a one-year period in the Hamilton and Waikato districts of New Zealand. Prospective and retrospective case ascertainment methods from multiple sources were used. All age groups and levels of traumatic brain injury severity were included. Details of the registering injuries and recurrent injuries sustained over the subsequent year were obtained through medical/accident records and assessment interviews with participants.

Results
Of 1369 incident traumatic brain injury cases, 291 were identified as being sustained during a sports-related activity (21% of all traumatic brain injuries) equating to an incidence rate of 170 per 100,000 of the general population. Recurrent injuries occurred more frequently in adults (11%) than children (5%). Of the sports-related injuries 46% were classified as mild with a high risk of complications. Injuries were most frequently sustained during rugby, cycling and equestrian activities. It was revealed that up to 19% of traumatic brain injuries were not recorded in medical notes.

Conclusions
Given the high incidence of new and recurrent traumatic brain injury and the high risk of complications following injury, further sport specific injury prevention strategies are urgently needed to reduce the impact of traumatic brain injury and facilitate safer engagement in sports activities. The high levels of ‘missed’ traumatic brain injuries, highlights the importance in raising awareness of traumatic brain injury during sports-related activity in the general population.

text: Sports-related brain injury in the general population: An epidemiological study Objectives
To determine the incidence, nature and severity of all sports-related brain injuries in the general population.

Design
Population-based epidemiological incidence study.

Methods
Data on all traumatic brain injury events sustained during a sports-related activity were extracted from a dataset of all new traumatic brain injury cases (both fatal and non-fatal), identified over a one-year period in the Hamilton and Waikato districts of New Zealand. Prospective and retrospective case ascertainment methods from multiple sources were used. All age groups and levels of traumatic brain injury severity were included. Details of the registering injuries and recurrent injuries sustained over the subsequent year were obtained through medical/accident records and assessment interviews with participants.

Results
Of 1369 incident traumatic brain injury cases, 291 were identified as being sustained during a sports-related activity (21% of all traumatic brain injuries) equating to an incidence rate of 170 per 100,000 of the general population. Recurrent injuries occurred more frequently in adults (11%) than children (5%). Of the sports-related injuries 46% were classified as mild with a high risk of complications. Injuries were most frequently sustained during rugby, cycling and equestrian activities. It was revealed that up to 19% of traumatic brain injuries were not recorded in medical notes.

Conclusions
Given the high incidence of new and recurrent traumatic brain injury and the high risk of complications following injury, further sport specific injury prevention strategies are urgently needed to reduce the impact of traumatic brain injury and facilitate safer engagement in sports activities. The high levels of ‘missed’ traumatic brain injuries, highlights the importance in raising awareness of traumatic brain injury during sports-related activity in the general population.

year: 2014

title: Speaking the unspoken: Racism, sport and Māori

authors: Hippolite, Holly Raima

subjects: New Zealand

abstract: In this paper, we consider the silence that surrounds issues of racism in New Zealand sport. We argue that the intersection of two key ideologies – New Zealand’s purported history of good race relations, and the positive contribution that sport is believed to make to racial equality – contribute to a culture of silence in which it is difficult to talk about, let alone discuss constructively, Māori experiences of racism. Our aim is to put the issue on the agenda through engagement with ten experienced Māori sport participants, coaches and administrators whose experiences demonstrate the existence of, and pain caused by, cultural and institutional racism in New Zealand sport. In this aim, we do not seek to hide behind a veil of neutrality or objectivity. Rather, following a kaupapa Māori research approach, our interest is in bringing to light the voices, frustrations and concerns of Māori sportspeople in order to contribute to a much-needed conversation.

text: Speaking the unspoken: Racism, sport and Māori In this paper, we consider the silence that surrounds issues of racism in New Zealand sport. We argue that the intersection of two key ideologies – New Zealand’s purported history of good race relations, and the positive contribution that sport is believed to make to racial equality – contribute to a culture of silence in which it is difficult to talk about, let alone discuss constructively, Māori experiences of racism. Our aim is to put the issue on the agenda through engagement with ten experienced Māori sport participants, coaches and administrators whose experiences demonstrate the existence of, and pain caused by, cultural and institutional racism in New Zealand sport. In this aim, we do not seek to hide behind a veil of neutrality or objectivity. Rather, following a kaupapa Māori research approach, our interest is in bringing to light the voices, frustrations and concerns of Māori sportspeople in order to contribute to a much-needed conversation.

year: 2010