Communications among staff and patients on a stroke rehabilitation ward form the focus of this article, which reports on some aspects of a larger study using a grounded theory approach. Tape-recorded interviews were transcribed and analysed concurrently according to recommendations for the approach. A main theme entitled building a relationship was identified, and this process was found to occur in a context varying from participative at one end of a continuum to hierarchical at the other. Building a relationship was found to be influenced by role, personal qualities and organizational context. Appropriate relationships between role-holders were subject to negotiation, leading to a resulting congruence or incongruence between participants' expectations of each other and their roles. Personal qualities were brought into play in the process, with patients' views of staff and staff views of patients both being influential. Some of these views seemed to parallel what has been described in earlier literature as 'the sick role' and the labelling of patients as 'good' or 'bad'. Responses to personal qualities led to nurses ascribing meaning to patients' behaviour in terms of adjustment to their stroke, giving time to them to help them to adjust, and withdrawal and handing over to other staff if this strategy failed. Organizational context also had an influence on building a relationship, with time constraints being identified particularly by nurses, and the need to fit in the most essential aspects of care. Place was also important, in that nurses were confined to the ward as a work location, whereas other therapists and doctors worked in other places and sometimes had the facility to take patients off the ward to concentrate on therapy. The findings are discussed against the background of related literature and the conclusion is drawn that the crucial role of nurses in rehabilitation is not recognized and valued, and that shortages of resources-especially suitably qualified and trained nursing staff-are a negative influence on building the relationships which are vital to successful rehabilitation.

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The notion of choice, especially of informed choice, is a central tenet of maternity services in most western countries; it also underpins debate about rising rates of intervention that are now a feature of childbirth in many of these countries. Our study investigated the shaping of understanding and practice in relation to these rising rates of intervention in childbirth in the New Zealand context. Critical hermeneutics was used to analyse the data from interviews with nine midwives and obstetricians, and six focus groups with 33 women. This article reports on the notion of choice, which featured prominently in all the interviews. It became clear that women’s choices were strongly influenced and determined by social change, by the gendering of women, and by values such as control, predictability, convenience, the ‘quick fix’ and the normalization of surgery. We argue that the prevailing notion of ‘informed’ choice obscures the structural and social influences on ‘choice’.

This article presents the findings of research which investigated what is shaping the understanding of the public and also the practice of health professionals in relation to rising rates of intervention in childbirth. This research was carried out in response to the increasing rates of intervention in childbirth in Aotearoa, New Zealand using critical hermeneutics methodology. The particular approach used was critical interpretation as formulated by Hans Kogler. The findings revealed that the everyday world and its associated processes of socialization in the 21st century—in particular pain, choice, and technology—shapes the practice of health professionals and the understanding of the public in relation to increasing intervention. These findings are supported by the revelation that many of the social and cultural values that underpin Western society in the 21st century, such as convenience, ease, and control, correlate with intervention being increasingly sought after and used. This milieu of intervention, which increasingly surrounds childbirth, calls into question those things that have traditionally been at the heart of childbirth: the ability of the woman to birth and the clinical skills of the health professional. The research presented in this article provides insight into those things that are creating a milieu in which intervention is increasingly normalized.

This paper examines studies on older adult's recovering from hip fracture and views these in relation to practice. A metasearch engine was used to access health databases to identify studies relevant to recovery from hip fracture that occurs predominantly in the older adult. Three themes emerged: professional; quality of life, and ageing status.Results suggest recovery has a predominant functional restorative focus although recovery outcome is also influenced by physical function and psychosocial factors.Results suggest that the patient-centric approach has been lost in the drive for organisational efficiency has potentially driven care delivery, which has emphasised safer interventions and improved programmes. This has reduced complications and shortened length of stay in hospital but the psychosocial factors that have a long-term affect on recovery have been lost altogether. Investigating the patient-centric approach to care for older adults recovering from hip fracture is required to balance the organisational efficiency within healthcare systems. Mental health recovery models may provide such a framework to review the patient focused approach.2