School of Public Health and Interdisciplinary Studies
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The School of Public Health and Interdisciplinary Studies research institutes and centres play an important role in specialist teaching and research conducted by academic staff and postgraduate students. This places AUT students at the forefront of much of the ground-breaking research undertaken in New Zealand in the field of Biostatistics and Epidemiology, Psychology, Psychotherapy and Counselling, and Public Health.
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Browsing School of Public Health and Interdisciplinary Studies by Subject "1110 Nursing"
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- ItemA Tohu (Sign) to Open Our Eyes to the Realities of Indigenous Māori Registered Nurses: A Qualitative Study(Wiley, ) Komene, Ebony; Gerrard, Debra; Pene, Bobbie; Parr, Jenny; Aspinall, Cath; Wilson, DeniseAims Identify the experiences of Māori nurses and priorities for a Māori model of relational care working with Māori patients and their whānau (extended family network) in acute hospital services. Background Māori, the Indigenous peoples of Aotearoa (New Zealand), have a relational and holistic worldview fundamental to establishing relationships with Māori patients and their whānau. Increasing the Indigenous Māori nursing workforce can improve Māori patient experiences but is challenged by ongoing recruitment and retention issues. Design A qualitative Māori-centred research methodology with 12 Māori nurses. Methods Data were collected using wānanga (learning through discussion, deliberation and consideration) using he aha ō hikoi (journey mapping) and kōrero mai (storytelling). Inductive thematic analysis was undertaken using a mahi a roopū (group process) approach. This study was conducted between May 2022 and June 2022. Results Three key themes: (1) Māori first, nurse second, (2) Cultural loading and (3) Compromised realities were identified. Māori nurses' praxis used their complex cultural and clinical intelligence to engage in a mana-enhancing way (strengths-based) to improve the care delivery for whānau Māori during their hospitalization journey. Cultural loading meant Māori nurses were often burdened with unrecognized workloads as they provided care for Māori patients and whānau, which often compromised their cultural integrity. Conclusion Nurses' commitment to care for whānau and their assigned patient load created extra burdens and threatened their cultural integrity. Their experiences highlighted modes of practice rather than models of care required to improve healthcare delivery for Māori entering the hospital. These findings signal issues and areas nursing leaders need to heed, necessary for addressing the retention of Māori in nursing and improving workload equity.
- ItemExploring Mobile Mixed Reality for Critical Thinking in Nursing and Healthcare Education: A Systematic Review(Elsevier, 2023-12-16) Stretton, Todd; Cochrane, Thomas; Sevigny, Charles; Rathner, JosephBackground: The shortage of nursing and healthcare clinical placements has prompted the investigation of ways to supplement authentic learning. Mobile mixed reality has become increasingly available as the ubiquity of the technology improves, however, the affordances and design principles for the facilitation of critical thinking is yet to be explored. Objective: To examine the state of the art of how mobile mixed reality facilitates critical thinking in nursing and healthcare higher education. Design: Systematic review. Review Methods: A search in seven databases (MEDLINE, PsychINFO, AMED, ERIC, Scopus, Cochrane, and Web of Science) was conducted with 3488 titles and abstracts screened according to pre-determined inclusion and exclusion criteria. The quality of included studies was evaluated using the Mixed Methods Assessment Tool (MMAT). Results: A total of 12 studies with 1,108 participants were included. The breadth of healthcare disciplines was limited to dentistry, medicine, nursing, midwifery, and paramedicine who mainly utilised bespoke scenarios on head mounted displays. Most scenarios were emergency or critical response by nature, with limited time provided for pre-brief, debrief, or overall user time. Only two studies directly measured critical thinking, with others indirectly referring to development of ‘decision making’ by conducting diagnoses, interpretation, analysis, or evaluation of healthcare scenarios in a mixed reality environment. Affordances and design principles for future development of mobile mixed reality for critical thinking in nursing and healthcare higher education are identified. Conclusions: While some pedagogical affordances of mobile mixed reality can be identified in a narrow number of healthcare disciplines; there remains to be limited valid measure of critical thinking used to quantify effectiveness. Future studies would benefit to consider scenarios beyond emergency and critical responses, include longitudinal studies that reflect development of critical thinking over time, and exploration of co-designed scenarios with and by nursing and allied healthcare students.
- ItemHealth Care Providers’ Early Experiences of Assisted Dying in Aotearoa New Zealand: An Evolving Clinical Service(Springer Science and Business Media LLC, 2023-07-22) Snelling, Jeanne; Young, Jessica; Beaumont, Sophie; Diesfeld, Kate; White, Ben; Willmott, Lindy; Robinson, Jacqualine; Moeke-Maxwell, TessBackground In November 2021, assisted dying (AD) became lawful in Aotearoa New Zealand. A terminally ill person may now request, and receive, pharmacological assistance (self-administered or provided by a medical practitioner/nurse practitioner) to end their life, subject to specific legal criteria and processes. Exploring the experiences of health providers in the initial stage of the implementation of the End of Life Choice Act 2019 is vital to inform the ongoing development of safe and effective AD practice, policy and law. Aim To explore the early experiences of health care providers (HCPs) who do and do not provide AD services seven months after legalisation of AD to provide the first empirical account of how the AD service is operating in New Zealand’s distinctive healthcare environment and cultural context. Design Qualitative exploratory design using semi-structured individual and focus group interviewing with a range of HCPs. Results Twenty-six HCPs participated in the study. Through a process of thematic analysis four key themes were identified: (1) Difference in organisational response to AD; (2) challenges in applying the law; (3) experiences at the coal face; and (4) functionality of the AD system. Conclusion A range of barriers and enablers to successful implementation of AD were described. Adoption of open and transparent organisational policies, ongoing education of the workforce, and measures to reduce stigma associated with AD are necessary to facilitate high quality AD service provision. Future research into the factors that influence responses to, and experience of AD; the impact of institutional objection; and the extent to which HCP perspectives evolve over time would be beneficial. In addition, further research into the integration of AD within Māori health organisations is required.
- ItemIndigenous Social Exclusion to Inclusion: Case Studies on Indigenous Nursing Leadership in Four High Income Countries(Wiley, ) Brockie, Teresa; Clark, Terryann C; Best, Odette; Power, Tamara; Bourque Bearskin, Lisa; Kurtz, Donna LM; Lowe, John; Wilson, DeniseAIMS AND OBJECTIVES: This discursive paper provides a call to action from an international collective of Indigenous nurse academics from Australia, Canada, Aotearoa New Zealand and the USA, for nurses to be allies in supporting policies and resources necessary to equitably promote Indigenous health outcomes. BACKGROUND: Indigenous Peoples with experiences of colonisation have poorer health compared to other groups, as health systems have failed to address their needs and preferences. Achieving health equity will require leadership from Indigenous nurses to develop and implement new systems of care delivery. However, little is known about how Indigenous nurses influence health systems as levers for change. DESIGN: A Kaupapa Māori case study design. METHODS: Using a Kaupapa Māori case study methodology, coupled with expert Indigenous nursing knowledge, we developed a consensus on key themes. Themes were derived from three questions posed across the four countries. Themes were collated to illustrate how Indigenous nurses have provided nursing leadership to redress colonial injustices, contribute to models of care and enhance the Indigenous workforce. RESULTS: These case studies highlight Indigenous nurses provide strong leadership to influence outcomes for Indigenous Peoples. Five strategies were noted across the four countries: (1) Indigenous nationhood and reconciliation as levers for change, (2) Indigenous nursing leadership, (3) Indigenous workforce strategies, (4) Development of culturally safe practice and Indigenous models of care and (5) Indigenous nurse activism. CONCLUSIONS: In light of 2020 declared International Year of the Nurse and Midwife, we assert Indigenous nurses' work must be visible to support development of strategic approaches for improving health outcomes, including resources for workforce expansion and for implementing new care models. RELEVANCE TO CLINICAL PRACTICE: Curating strategies to promote Indigenous nurse leaders around the world is essential for improving models of healthcare delivery and health outcomes for Indigenous Peoples.
- ItemInforming Women About Maternal Vaccination in Aotearoa New Zealand: Is It Effective?(Elsevier, ) Young, Amber; Charania, Nadia; Gauld, Natalie; Norris, Pauline; Turner, Nikki; Willing, Esther
- ItemMidwives’ Perceptions of Enablers and Barriers to Pertussis and Influenza Vaccination in Pregnancy and Information Sharing(Nzcom, 2023-08-23) Young, Amber; Willing, Esther; Gauld, Natalie; Dawson, Pauline; Charania, Nadia; Norris, Pauline; Turner, NikkiBackground: Vaccination in pregnancy against influenza and pertussis protects the pregnant woman/person and their infant against severe disease. Aotearoa New Zealand has a lower uptake of vaccination in pregnancy than some other countries, despite this immunisation being publicly funded. Coverage is also inequitable, with Māori, Pacific people, and people from high deprivation areas less likely to be vaccinated. Many barriers exist to vaccinations in pregnancy, e.g., access barriers and lack of knowledge about vaccination. Discussions about recommended vaccines with healthcare professionals, particularly midwives, may have a positive impact on vaccine decision-making. Aim: This study aimed to investigate midwives’ perceptions of enablers and barriers with discussions about vaccinations in pregnancy, barriers to vaccination in pregnancy, and influences on vaccine decision-making in pregnancy. The study also aimed to gather midwives’ insights into what might improve vaccination uptake. Method: A structured questionnaire was developed containing a mix of closed and open-ended questions. The questionnaire was sent out to 3002 midwives registered in Aotearoa New Zealand in October 2021, using REDCap electronic data capture tools. Simple descriptive statistics were undertaken on the quantitative data. The answers to the open-ended questions were analysed using a direct, qualitative content analysis approach. Findings: Fifty-one midwives’ responses were included in the analysis (1.8% response rate). Almost all reported sufficient knowledge of vaccinations in pregnancy but had varying levels of confidence when discussing them. The most common enablers to conversations were good relationships, easy communication, and having the time and resources available. Respondents perceived that barriers to conversations were negative preconceptions, communication difficulties and lack of time. Lack of awareness, cost to access services and competing priorities for time were also thought to reduce the likelihood of vaccination in pregnancy. To improve vaccine uptake, respondents identified the need for accessible and suitable vaccination venues, appropriate information and the support of all healthcare professionals involved in maternal healthcare. Conclusion: Midwives surveyed understand the importance of vaccination in pregnancy but there may be lack of confidence, time or resources to effectively engage in discussions. A trusting relationship is important but this can be affected by disengagement or late presentation to healthcare services. Resources to counter pre-existing negative ideas and support communication would help midwives to provide useful information about vaccination. Furthermore, respect and cultural understanding of hapū Māori and their needs will positively support their ability to make informed decisions.
- ItemSupporting Patients and Their Carers to Participate in Infection Prevention and Control Activities: The Views of Patients, Family Members and Hospital Staff From Bangladesh, Indonesia, and South Korea(Elsevier, 2023-06-30) Park, JY; Pardosi, JF; Islam, MS; Respati, T; Nurhayati, E; Chowdhury, K; Charania, NA; Seale, HBACKGROUND: Hand hygiene reminders for healthcare workers (HCWs) are commonly used to empower patients. However, this approach overlooks the role of family carers in delivering direct contact care in Asian countries. Limited knowledge exists regarding empowerment strategies for patients and their family carers in infection prevention and control (IPC) recommendations. This study aimed to provide a comprehensive exploration of IPC empowerment within the context of family involvement in care provision across Bangladesh, Indonesia, and South Korea METHOD: In-depth interviews were conducted in five tertiary-level hospitals in Bangladesh, Indonesia, and South Korea. A total of 64 participants through 57 group interviews were interviewed, comprising two groups: 1) patients and family/private carers; and 2) HCWs. RESULT: The study identified barriers to engaging patients and family carers in IPC measures. These included concerns about the patient-HCW hierarchical relationship, lack of knowledge about healthcare-associated infection, IPC, and patient zone, perceptions of IPC as a barrier to family connections, and disempowerment of patients in IPC due to family bonds. CONCLUSION: This study provides diverse perspectives on IPC empowerment, revealing challenges faced by patients, family carers, and HCWs. The interlaced relationship established by social norms of family carer provision hinders the empowerment of family carers. Acknowledging the cultural influence on healthcare arrangements and its implication for IPC empowerment is crucial in mitigating these barriers.
- ItemUsing Co-design Methods with Chinese Late-life Immigrants to Translate Mixed-method Findings to Social Resources(SAGE Publications, ) Yan Zhao, Ivy; Holroyd, Eleanor; Garrett, Nick; Neville, Stephen; Wright-St Clair, Valerie AMainland Chinese born in the 1940s–1950s have experienced unique socio-cultural circumstances that have shaped their late-life immigration experiences. Little is known about what this population perceives would reduce their loneliness. This study aimed to investigate the role of co-design in the development of community-based resources/services for ameliorating the loneliness of Chinese late-life immigrants. Eight co-researchers completed three co-design workshops, and two key service providers were consulted. Co-researchers co-designed guidebooks on accessing primary healthcare facilities, social services, aged care facilities, and public transport, which were considered helpful for ameliorating loneliness. Co-housing was co-designed as a concept and regarded as a feasible way of living to strengthen social interactions and reduce loneliness. Providing more public social housing, adding ‘next-bus stop’ announcements, and conducting loneliness screening were recommended at the national level. Our findings affirmed the need to truly listen to the voices of both service end-users and service providers.
- ItemWhakawhanaungatanga - Building Trust and Connections: A Qualitative Study Indigenous Māori Patients and Whānau (Extended Family Network) Hospital Experiences(Wiley, 2023-10-27) Komene, Ebony; Pene, Bobbie; Gerard, Debra; Parr, Jenny; Aspinall, Cath; Wilson, DeniseAIMS: Investigated the experiences of Māori (the Indigenous peoples of Aotearoa, New Zealand) patients and whānau (extended family network) engaging with acute hospital inpatient services and their priorities for a Māori-centred model of relational care. DESIGN: A qualitative Māori-centred research design using a Thought Space Wānanga (learning through in-depth group discussion, deliberation and consideration) approach. METHODS: Two wānanga were conducted between May 2022 and June 2022, with 13 Māori patients who had been acutely hospitalized within the past 12 months and their whānau members. The first wānanga utilized storytelling and journey mapping to collect data. The second wānanga refined the initial themes. Wānanga were audio-recorded and then inductively coded and developed into themes. RESULTS: Thirteen patients and whānau attended the first wānanga, while 10 patients and whānau participated in the second wānanga). Four themes were developed: (1) Whakawhanaungatanga (establishing connections and relationships), (2) Whakamana (uplifting the status and esteem of Māori), (3) Whakawhitiwhiti kōrero (the importance of communicating, discussing and deliberating) and (4) Kotahitanga (working together with purpose) all provide insights into the importance of effectively engaging and connecting with Māori patients and whānau when acutely hospitalized. CONCLUSIONS: The experiences and priorities of Māori patients and whānau affirm the international literature, suggesting that Indigenous relational concepts are critical to building relationships, connections and trust. Despite existing healthcare models for working with Indigenous peoples, their poor application contributes to sub-optimal healthcare experiences at all points of their healthcare journey. A relational mode of practice focused on engagement and forming connections better meets the needs of Indigenous peoples engaging with inpatient health services. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Despite the existence of Indigenous models of care, Indigenous peoples consistently report a lack of engagement and connection when accessing inpatient health services. Without establishing relationships, applying models of care is challenging. IMPACT (ADDRESSING): What problem did the study address? Internationally, healthcare systems are consistently ill-equipped to deliver culturally safe care for Indigenous and marginalized peoples, evident in ongoing health inequities. Like other reports of Indigenous experiences of health services, Māori express dissatisfaction with care delivery in an acute inpatient setting. This study investigated Māori patients and whānau experiences engaging with acute hospital inpatient services and their priorities for a Māori-centred model of relational care. What were the main findings? Māori patients and whānau recounted negative experiences with healthcare professionals lacking effective relationships and trust. Satisfaction occurred when engagement with health care professionals resembled Indigenous cultural rituals of encounter that considered their holistic, collective and dynamic worldviews. Previous models of relational care, while helpful, are not Indigenous and so do not address their needs, such as engagement as a mode of practice (how) to achieve this. Where and on whom will the research have an impact? This research impacts Indigenous peoples' health outcomes, particularly Māori, and nurses and clinicians working and interacting within acute inpatient and other hospital settings. Indigenous research methods support co-constructing knowledge for translation into practical outcomes through transformational practices, policies and theory development. REPORTING METHOD: We used the Consolidated Criteria for Strengthening the Reporting of Health Research Involving Indigenous Peoples (CONSIDER) statement (see File S2-CONSIDER Checklist) and the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (see File S3-COREQ Checklist). PATIENT OR PUBLIC CONTRIBUTION: Māori patients and their whānau interviewed about their experiences were involved in data interpretation.
- ItemWhat Do Health Care Professionals Want To Know About Assisted Dying? Setting the Research Agenda in New Zealand(Springer Science and Business Media LLC, 2023-04-10) Young, Jessica; Snelling, Jeanne; Beaumont, Sophie; Diesfeld, Kate; White, Ben; Willmott, Lindy; Robinson, Jacqualine; Ahuriri-Driscoll, Annabel; Cheung, Gary; Dehkhoda, Aida; Egan, Richard; Jap, James; Karaka-Clarke, Te Hurinui; Manson, Leanne; McLaren, Cam; Winters, JanineBackground New Zealand recently introduced law permitting terminally ill people to request and receive assisted dying (AD) in specified circumstances. Given the nature and complexity of this new health service, research is vital to determine how AD is operating in practice. Objective To identify research priorities regarding the implementation and delivery of AD in New Zealand. Methods Using an adapted research prioritisation methodology, the researchers identified 15 potential AD research topics. A mixed-methods survey of health professionals was undertaken where respondents were asked to rate the 15 topics according to the relative importance for research to be conducted on each issue. Respondents could also suggest additional research areas, and were invited to participate in a follow-up interview. Results One hundred and nineteen respondents completed the survey. 31% had some experience with AD. The highest rated research topic was the ‘effectiveness of safeguards in the Act to protect people’; the lowest rated topic was research into the ‘experiences of non-provider (e.g., administrative, cleaning) staff where assisted dying is being provided’. Respondents suggested 49 other research topics. Twenty-six interviews were conducted. Thematic analysis of interview data and open-ended survey questions was undertaken. Six research themes were identified: general factors related to the wider health system; the experiences of health care providers at the bedside; medico-legal issues; the impact of AD; experiences on the day of dying; and the overall effectiveness of the AD system. Key issues for stakeholders included safety of the AD service; ensuring access to AD; achieving equity for ‘structurally disadvantaged’ groups; and ensuring the well-being of patients, families/whānau, providers and non-providers. Conclusions Based on early experiences of the implementation of the AD service, health professionals provide important insights into what research should be prioritised post-legalisation of AD. These findings can be used to shape the research agenda so that research may inform law, policy and best practice.