Masters Practice Projects

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https://hdl.handle.net/10292/10895

The Masters Practice Projects collection contains digital copies of AUT masters practice projects deposited with the Library since 2017 and made available open access.

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Beginning the Journey of Becoming a Tiriti-Partner: A Critical Reflection
(Auckland University of Technology, 2023) Melville, Anton Jack
Te Tiriti o Waitangi is a contractual agreement between Māori and the Crown promising kāwanatanga, rangatiratanga, ōritetanga and wairuatanga. Despite these promises, extensive breaches of Te Tiriti o Waitangi have occurred since its inception creating significant health inequities for Māori which continue to this day. Within the health system, the dominant biomedical model of practice prioritises Western views of health which continues to reinforce colonial systems and reduce equity for Māori. There is a critical need for healthcare practitioners to work alongside Māori, working as Tiriti-partners. This practice project aims to explore Māori experiences of health services within the literature through the lens of Te Tiriti o Waitangi and use these understandings to critically reflect on my practice and to use this knowledge to help me work as a Tiriti-partner in my physiotherapy practice. A literature search was completed exploring Māori experiences of hospital and rehabilitation services. The articles of te Tiriti o Waitangi were used as a framework for analysis. Utilising the key learnings which came from the framework analysis, a case was chosen from my practice to undergo analysis through critical reflexivity. This practice project has demonstrated how clinicians and hospital services influence the experience of Māori. These are influenced by how clinicians interact with Māori during the healthcare encounter and clinicians’ previous experiences through their training and own values or beliefs. Systemic structures also contribute to health and well-being through increasing financial and social constraints, institutional racism and bias. Through critical reflexivity, I propose ways of thinking and working that can support clinicians to reduce health disparities by creating space, prioritising, and being an equal participant in whanaungatanga, acknowledging Māori kāwanatanga and rangatiratanga, and supporting wairuatanga using te reo Māori and knowledge of tikanga. By acting in these ways, clinicians can begin to reduce inequities experienced by Māori in healthcare. However, acting in this way is just the first step in becoming a Tiriti-partner and only one of the pieces required to reduce inequities. To fully achieve pae ora, healthy futures, for Māori, we must make critical reflexivity and challenging our personal assumptions a life-long journey.
Best Practice for Historic Claims Staff: The Role of Professional Supervision
(Auckland University of Technology, 2022) Tunupopo, Teagan Martha Marieta
The Historic Claims process of the Ministry of Social Development in Aotearoa New Zealand aims to settle claims from adult survivors who experienced serious abuse whilst in State Care. The Historic Claims staff hear, support and assess the claims of claimants. Their roles involve listening to details of traumatic experiences of physical, mental, emotional, and sexual abuse. The purpose of this research was to explore the role of professional supervision in potentially preventing or mitigating vicarious trauma for Historic Claims staff. This research set out to answer the question of whether Historic Claims staff experience vicarious trauma as part of their professional duties. Additionally, this research explored the role of professional supervision as a support procedure to mitigate against vicarious trauma for Historic Claims staff. A rapid narrative literature review was conducted to determine the potential impacts of consistent staff exposure to sensitive and disturbing historic claims of abuse. This research also investigated whether this impact could be defined as vicarious trauma, the benefits of professional supervision for Historic Claims staff as well as alternative and similar measures to mitigate the harms of vicarious trauma. A total of 86 articles were reviewed for this research with a condensed format that typically summarises the content of each article. Articles were inductively grouped together to present key findings. Key findings included interchangeable definitions and use of vicarious trauma, secondary traumatic stress, and burnout. Findings from this research hypothesised that Historic Claims staff are more likely to experience vicarious trauma due to increased exposure to graphic details of traumatic experiences as reported by claimants. Empathic listening and witnessing claimant distress as they retell their experiences of emotional, mental, physical and/or sexual abuse can also have disturbing and upsetting impacts for Historic Claims staff. Several factors have been identified in this study that mitigate vicarious trauma along with the benefits of professional supervision to include cultural supervision. Implications: The research has important implications for Māori and Pacifica people who are over-represented as claimants. Cultural supervision is an important factor in Aotearoa as well as areas to improve the effectiveness of professional supervision. Māori and Pacific models of trauma and health were also explored in the context of Aotearoa New Zealand. Traditional western focused approaches do not consider well enough Māori and Pacific ideologies of health and the historical context. Cultural competence and context are critical for trauma work, specifically for Historic Claims staff where the majority of claimants identify as Māori and/or Pacific Island descent. More research is needed to explore and protect trauma workers from undergoing psychological trauma that potentially affects client care. Approaches to manage vicarious trauma included debriefing, accepting support from each other, engaging in more energy-fulfilling activities, eating well, staying hydrated and prioritizing sleep hygiene. Measures to guard against vicarious trauma included awareness and education, increasing self-awareness to prevent burnout, organisational support and professional supervision.
Best Practice Recommendations for Engagement with Māori Whānau in the Neonatal Intensive Care Unit
(Auckland University of Technology, 2022) Nelson, Analina Sarah Louise
Māori (Indigenous people of Aotearoa New Zealand) are overrepresented within the populations of Neonatal Intensive Care Units (NICUs). Admission to the NICU is a stressful event for Māori whānau (family). Cultural, social, and health inequities that disproportionality affect Māori contribute further to this stress and it has become evident that the current system in place at Capital & Coast District Health Board (CCDHB) NICU (Wellington NICU) is failing to support whānau. Neonatal health practitioners (NHPs) need more support and guidance in order to improve the experiences of Māori whānau in NICUs across Aotearoa. Hence, the aim of this practice project is to develop recommendations for the development and implementation of a Recommended Best Practice (RBP) to guide NHPs for successful engagement with Māori whānau in the NICU environment. The practice change project is directed by Rosswurum and Larrabee’s (1999) model for evidence-based practice. The model contains six key stages that help guide health practitioners through a systematic process for change to evidence-based practice. These steps are assessing the need for change in practice, linking identified problems with interventions and outcomes, synthesizing the best available evidence, designing a practice change, implementing and evaluating the change to practice, and integrating and maintaining the change to practice. Due to academic time constraints, only stages 1-4 of the model were completed as part of the practice project. Adaptions were made to the model to suit the development of the project which is presented across five chapters. The practice project includes consultations with CCDHB key stakeholders, an audit of CCDHB NICU referrals to Māori support services, a survey of the CCDHB NICU environment, and a literature review. The final recommendations for practice change are presented in chapter five.
'Birthplace - Your Choice' A Smartphone Application Designed to Aid Informed Decision Making on Birthplaces for Primigravida Women in New Zealand
(Auckland University of Technology, 2019) Ballard, Sarah
Birthplace choices influence maternal and neonatal outcomes. Despite popular belief, International, New Zealand and local research confirms that birthing in an obstetric hospital does not improve maternal or neonatal outcomes for healthy, low-risk women and their babies. Research evidence agrees that it instead, increases the likelihood of unnecessary medical interventions leading to maternal and neonatal morbidities. Health outcomes for birth planned at home or in midwife-led birthing units is safer for mothers and as safe as an obstetric hospital for babies, yet in New Zealand the majority of women choose to birth in an obstetric hospital. Knowledge on birthplace options and outcomes is hindered by a lack of easily accessible, user-friendly, evidence-based information. Worldwide ehealth technologies are increasing in use with Smartphone healthcare applications (Apps) being increasingly integrated into mainstream healthcare as monitoring and information tools. The main aim of this research was to develop an ehealth Smartphone App called 'Birthplace - Your Choice' This App would provide evidence based, accessible information that focused on: birthplace choices; outcomes for mothers and babies giving birth in hospital, midwife-led birthing units and at home; obstetric interventions; and the benefits of physiological birth. This prototype App was developed as a Patient Decision Aid Tool in collaboration with Centre for Learning and Teaching, Auckland University of Technology. International Patient Decision Aid Standards criteria, decisional-conflict measurements, information processing, ehealth frameworks and communication theories informed App development. An extensive literature search was conducted to provide evidence-based content. ‘Birthplace – Your Choice’ includes New Zealand specific statistical data which makes this project unique to the birthing population information needs. The statistical likelihood of vaginal birth, caesarean, water-birth, bleeding after birth, perineal trauma, Apgar score and admission to neonatal intensive care unit is presented. Information on transfer from home or midwife-led birthing units to hospital is also provided. Written text, drop-down information options, interactive quizzes and interactive infographics are provided to engage the user with the content. Prototype testing involved a small sample of four primigravida women who each answered a questionnaire before using the ‘Birthplace – Your Choice’ App and another a week after use. Observational notes were also recorded on navigation and usability while the App was being used. Results: Use of a New Zealand specific Smartphone App has potential in aiding low-risk primigravida women in making informed decisions on their birthplace and understanding childbirth choices. The four women desired information on Birthplace options and deemed this important to make informed decisions yet none was available that was easily accessible. The women expressed their frustration at having to rely on their midwife, family and friends for information which they recognised as potentially biased. The provision of credible information via a Smartphone was appreciated and validated as a suitable platform to deliver such information. The fact that this information could be shared and discussed with others and freely accessed, improved its acceptability. Three of the women stated that the content of the App increased their confidence that they had made the right choice to birth at a midwife-led birthing unit. One of these women who tested the App at 38 weeks’ gestation stated that had she had this information earlier she would have likely chosen a homebirth. The last woman had chosen to birth at a hospital but changed to a midwife-led birthing unit after using the App. This demonstrates that women prefer and may benefit from being able to access evidence-based information on birthplace options in New Zealand. New Zealand women make their birthplace decision early in, if not before, pregnancy. This demonstrates the need for high quality information on birthplace options and outcomes to be easily accessible if any improvements in informed decision making is to occur. By explaining the benefits of physiological birthing for mother and babies, along with information on birthplace options and outcomes, the ‘Birthplace – Your Choice’ App fills a gap not being met by any current Public Health initiatives in this country. Further App development and a larger sample size is needed for meaningful statistical analysis that can measure any effect of the App on choice of birthplace. ‘Birthplace – Your Choice’ offers potential as an ehealth tool to improve education on Birthplace options, obstetric interventions, maternal and neonatal outcomes and the benefits of physiological birth. Potential benefits for maternity Stakeholders include a reduction in costs and staffing demands if exposure to accurate birthplace information results in a shift away from birth in hospitals.
A Clinical Audit of the ReAktiv™ Posterior Dynamic Element (PDE) Orthosis on Ankle Trauma
(Auckland University of Technology, 2022) Gardner, Sarah Louise
Background: Injuries sustained during High Energy Trauma (HET) often require complex surgery and extensive rehabilitation and can result in long-term issues such as pain, loss of function and limitations in physical activity. The ReAktiv Posterior Dynamic Element™ orthosis is a custom-made Passive-Dynamic Ankle-Foot-Orthosis (PDAFO) that aims to alter impact and loading through the foot and ankle, reducing pain and allowing users to return to high levels of physical activity. The aim of this study was to conduct a case series on the clinical effectiveness of the ReAktiv PDE orthosis on pain and function for people that had sustained a HET injury to the lower limb. Methods: This case series retrospectively reviewed the results of three patients that had received the ReAktiv PDE Orthosis as a treatment intervention to alleviate pain and improve physical function following a HET injury to the ankle. To determine any changes in pain all participants completed the LEFS and completed a 2MWT prior to receiving the orthosis as part of the initial assessment. The PDQ and PSEQ were completed at the final fitting of the orthosis (2 weeks) and provided a baseline measure of how much the pain from their injury affected them on a day-to-day basis. A 6-week physiotherapy-led rehabilitation programme was established to help patients with gait retraining, functional movement patterns and returning to physical activity. Physical function was assessed using the 2MWT, FSST, TSA and SLB. The questionnaires (LEFS, PDQ, PSEQ) were re-recorded at the conclusion of the rehabilitation programme to determine any self-reported changes in pain since receiving the orthosis. All physical tests were re-recorded at the conclusion of the rehabilitation programme (6-weeks). Results: The ReAktiv PDE orthosis shows promise in improving self-reported pain levels in those who have sustained HET injuries to the ankle. Tracking of pain prior to receiving the orthosis, and again at the conclusion of the rehabilitation programme was recorded on 1 participant. The PDQ and PSEQ showed an improvement when using the orthosis and how much pain interfered with their life. The LEFS was recorded on two participants and showed improvement with both participants reporting a higher score at the conclusion of rehabilitation with the orthosis compared to baseline with no orthosis. Physical walking performance improved as indicated by the improvement seen in the 2MWT. Improvement in mobility and balance, measured through recording of the FSST, TSA and the SLB test at the commencement and conclusion of the rehabilitation programme was also seen. Conclusion: The ReAktiv PDE orthosis shows potential as a treatment option to improve pain levels and walking performance in those who have sustained a unilateral, HET injury to the lower limb. In addition to the application of the orthosis, the use of a 6-week physiotherapy-led rehabilitation programme, recorded further improvements in walking performance, physical mobility and balance. Further research conducted on a larger and more diverse cohort of ReAktiv PDE orthosis wearers, would help to determine the significance of the orthosis design on pain and physical performance, and the impact that the rehabilitation programme has on pain and physical function. Long-term follow up of users would also indicate whether the improvements that have been obtained during this short time frame are sustained in the long-term or whether participants experience regression due to further deterioration to their injured limb.
COVID-19 Testing and Diagnosis in Children Under Six Years of Age: A Systematic Review
(Auckland University of Technology, 2024) Ure, Kirsty
Introduction: Severe acute respiratory syndrome was first detected in 2003 and escalated in 2019 with COVID-19 causing a worldwide pandemic. This new virus presented challenges in diagnosis, especially in those under 6 years of age. While often classified as a mild disease in children, COVID-19 still presents significant health risks in the young, especially for children under 1 year of age and those with pre-existing comorbidities. Because of this, clinical guidelines and protocols addressing COVID-19 testing in preschool- aged children became necessary to direct evidence-based practice. Aim: The aim of this systematic review was to explore COVID-19 testing and diagnosis in children under 6 years of age from international peer-reviewed published manuscripts to facilitate a wider and more thorough understanding of this practice from a diverse sample of parents, children, and health care providers to inform and direct practice within Aotearoa/New Zealand. Methods: A systematic review was undertaken based on guidelines by Siddaway et al. (2019). Extant empirical research published in peer-reviewed journals from 2020–2024 on COVID-19 testing in children under 6 years of age was identified from Scopus, CINAHL, MEDLINE via PubMed, and PsycInfo via Ovid databases. Data were analysed using deductive thematic analysis. Findings: Fourteen studies involving over 5,000 participants were included. Deductive content analysis identified seven key areas: 1. Symptomology, 2. Diagnostic tests, 4. Efficacy and acceptability of testing, 4. Viral loads, 5. Vulnerability/Risk factors, 6. Health outcomes, and 7. Recommendations. Conclusion: While common symptoms such as fever and cough are prevalent in children under 6 years of age infected with COVID-19, symptomology alone is not a foolproof diagnostic tool. Additional diagnostic testing, such as nasopharyngeal swabs and polymerase chain reaction testing, is complementary to diagnosis. However, an understanding of the risk factors for contracting COVID-19, as well as the vulnerability and health outcomes of children with COVID-19, is important to consider. Implications for practice: Common symptomology for children under 6 years of age includes fever and cough; however, these symptoms are also common for other viruses. A history of exposure to COVID-19 is the most frequent positive predictive factor for infection. An assessment of the child before any decisions on diagnostic testing is useful.
A Critical Review Of The Task Related Training (TRT) Mobile App Prototype And Its Suitability For The Delivery Of TRT Locomotor Circuit Class Training For People With Stroke In An Inpatient Hospital Setting In Singapore: A Physiotherapy Perspective
(Auckland University of Technology, 2022) Mohamed Noor, Nurzahidah
Background: Stroke is the leading cause of adult disability worldwide (Tetzlaff et al., 2020), and can result in locomotor disability, impacting functional independence and participation (Knox et al., 2018). As a result, identifying interventions that reduce locomotor disability while increasing functional independence is critical. The rise of digital health has resulted in a plethora of mobile technology-based innovations that open up new avenues for stroke rehabilitation (Henson et al., 2019). By facilitating physical, cognitive, and social activity, the use of tablet technology and mobile apps provides a platform for increasing the variety (Rinne et al., 2016), dose (Stütz et al., 2017) and intensity (Norouzi-Gheidari et al., 2012) of stroke rehabilitation in the hospital and community setting (White et al., 2015). Mobile apps have the potential to support the delivery of evidenced based interventions like task-related circuit class training (CCT) which has been shown to be more effective than conventional physiotherapy in improving walking speed, walking endurance and some aspects of balance in people with stroke (English et al., 2017). The physiotherapy department at Jurong Community Hospital (JCH), National University Health System in Singapore, wanted to see if their current stroke CCT programme could be delivered digitally to keep up with technological advancements. The purpose of this critical review was to determine the suitability of Task Related Training (TRT), an app in its early prototype stage, to support locomotor CCT for stroke patients at JCH. Method: This critical review used 1) a think-aloud usability method to assess the usability and suitability of the TRT app prototype from a physiotherapy perspective, and (2) comparator methods that critiqued the app's content using motor learning and task-related training principles, and tasks reported in the CCT literature for people with stroke. Results: Initial user testing revealed that the TRT app was well-received in terms of usability and suitability. Examining the app's content revealed that it is closely aligned with motor learning and TRT principles, as well as the tasks in the CCT evidence base. From the perspective of a physiotherapy user, the TRT App has the potential to support the delivery of the JCH CCT programme. Conclusion: Future directions should see designers of rehabilitation technology consider the recommendations outlined in this review and conduct future iterative user testing with physiotherapists, therapy associates and people with stroke in Singapore. Near-live encounters with the device over extended periods of time in the CCT context would also be important. Future research should also look at validating the device's efficacy for delivering locomotor CCT programmes in people with stroke.
Developing a Clinical Referral Pathway for the Management of Difficult Venous Access for Ward Nurses at North Shore Hospital
(Auckland University of Technology, 2022) Eappen, Seena
Peripheral Intravenous (IV) access is a commonly performed clinical procedure in hospitals, used to obtain blood samples or administer medications and fluids by the IV route. Various circumstances such as patients with difficult veins, staffing issues, staff experience, and workload demands contribute to a difficult venous access situation (DVA). Delays in obtaining IV access can be detrimental to patient care and treatment, threatening the patient’s health and increasing morbidity and mortality risks. Specifically, early adequate IV access in unwell patients is vital for life-saving therapies. Despite nurses being trained in IV cannulation techniques at North Shore Hospital , many factors intervene to affect the success of cannulation. Examples of factors are patients with poor venous access, very unwell or dehydrated patients with peripheral venous shutdown or those with physical impediments that prevent easy access to veins. Add to this the experience and confidence levels of nurses undertaking the IV cannulation and the process can be very challenging, particularly when IV access is required for critical treatments. Doctors and other expert clinicians are available during business hours if nurses cannot establish IV access. However, there is reduced support for nurses outside business hours (after hours). A clinical support team is available after hours and they can be contacted through the SmartPage© (Alcidion, 2021; Gill et al., 2013a) system. Furthermore, if the clinical support team fail to gain IV access, the anaesthetic team can be contacted to perform ultrasound-guided insertion. There is no clinical policy or pathway regarding this, many nurses are unaware of whom to contact in such a situation and what pathway to follow. Navigating these multiple levels of support can cause delays in administering medications and multiple failed attempts to obtain IV access, resulting in undesirable patient outcomes. A more efficient process is needed for nurses to access rapid support for IV cannulation when patients urgently need it. This practice project aims to streamline a clinical referral pathway for DVA. A review of the current literature is conducted to provide the background information to support this practice project and research topic. The project is then developed using John Hopkins Nursing Evidence-Based Practice (JHNEBP) model. A six-month sample of SmartPage© referral data is collected to identify the trends and situation of the referral process. The data is then analysed using descriptive statistics and thematic analysis. The four key themes identified during the data analysis were ‘patient clinical condition’, ‘difficult access’, ‘staff education and training’, and ‘urgency for treatment.’ These themes, plus the descriptive statistic results, inform improvements to the SmartPage© referral system by streamlining a referral flow chart. The significance of this practice project is that a streamlined clinical referral pathway (flow chart) will lead to a more efficient approach to managing difficult IV access after hours, thereby minimising delays in patient care and treatment and avoiding further complications.
Developing Patient Information for Women and Their Whanau Choosing to Electively End Their Second-Trimester Pregnancy Because of Foetal Abnormality
(Auckland University of Technology, 2021) Graham-Jones, Janine
Medical terminations in the first trimester of pregnancy are one of the most commonly performed medical procedures undertaken in New Zealand. It is, however, far less common to electively end a pregnancy in the second trimester on the grounds of foetal abnormality. New Zealand data obtained in 2018 suggests that 238 women chose to electively end their pregnancy because of foetal abnormality. The diagnosis of a foetal abnormality presents the parents with a difficult and often traumatic decision ... to proceed with the pregnancy and give birth to a child with known disabilities, or to electively end the life of the foetus by terminating the pregnancy. When faced with a diagnosis of severe foetal abnormality, most women choose to electively end the pregnancy. A review of the current literature suggests that the incidence of medical terminations of pregnancy for foetal abnormality is increasing. This is thought to relate to advancing maternal age, the increased availability of antenatal screening, and the advances in diagnostic testing. Medical termination of pregnancy for foetal abnormality was considered a major life event for most women. The psychological consequences of making this decision came with a range of emotional consequences including (but not limited to) grief, sadness, doubt, anger, and regret. Research showed that written information given to women making this decision was considered inappropriate, did not support their emotional requirements, and failed to prepare them for the ordeal ahead. Providing sensitive and relevant patient literature can improve their psychological well-being, reduce the impact of their decision and improve their journey. Scrutiny of local literature revealed it to be inadequate, unsuitable, and insensitive. This quality improvement project aimed to develop a sensitive, informative, and supportive pamphlet to support women and their families/whanau through the labour and delivery of their pregnancy. The psychological consequences of choosing to end a wanted pregnancy because of foetal abnormality require specific regard to the development of a patient-centered resource to support women and their families/whanau as they navigate this difficult and isolating event in their lives.
Early Discharge for Preterm Infants Partially Tube Feeding
(Auckland University of Technology, 2023) King, Andrea
Neonatal Intensive Care Units (NICU) and Special Care Baby Units (SCBU) around the world have adopted the practice of discharging late preterm infants home partially tube feeding, enabling infants to complete the transition to full oral feeds at home. The detrimental effects separation has on mental health and the parent-infant attachment when infants remain in neonatal units is well researched, thus getting infants home to their natural environment as soon as possible is crucial to reduce long term implications of prolonged NICU stays. The aim of this project was to develop a pathway for earlier discharge for pre-term infants partially tube feeding. Early discharge support packages implemented within New Zealand and internationally were reviewed and used as a guide to tailor a package for a Special Care Baby Unit in Hawkes Bay hospital. The potential financial gains of discharging infants’ home two weeks earlier was illustrated by comparing home visits to hospital stays. The support networks within Hawke Bay Special Care Baby unit were discussed, outlining what each service can provide with the aim of creating a collaborative and supportive pathway for infants and their families in the community. To guide this project, Rosswurm and Larrabee’s (1999) model for change to evidence-based practice was utilised. Moving through the steps of this model, an early discharge pilot proposal was developed along with key stakeholders to explore what input and timeframes each service can provide necessary to assess the feasibility of implementing this proposed practice change in our unit.
The Effect of Internal Cueing Strategies on Gait in Parkinson’s Disease and Underlying Mechanisms: A Structured Review
(Auckland University of Technology, 2021) Wadhera, Meetu
People with Parkinson’s (PWP) typically present with postural instability and gait impairment leading to a high number of falls. Gait rehabilitation that incorporates movement guidance training with sensory cueing and augmented feedback has been successfully investigated in the past to facilitate gait improvement in PWP. Despite showing clinical efficacy, there are limitations to the use of external cues such as device cost and the implementation of cue strategies in daily functional activities. An alternative approach is to use internal cueing which, although less commonly used, may yield similar benefits. This structured review examines the underlying mechanisms and efficacy for use of internal cues to reduce gait impairment among people living with Parkinson’s disease. Based on 14 studies, findings suggest that internal cueing improves gait speed and step length. Findings also suggest a selective response of cueing strategies on gait outcomes. While further research is required, internal cueing may offer a low-cost self-management tool to improve gait outcomes.
The Efficacy of Hypnosis in the Treatment of Chronic Musculoskeletal Pain: A Systematic Literature Review
(Auckland University of Technology, 2021) Taylor, Damian
Hypnosis has a long history of use in the treatment of a variety of physical and psychological conditions. However, its effectiveness as a treatment for chronic musculoskeletal pain and the best method for delivery of the hypnotic intervention is still unclear. Therefore, the objective of this study is to review the research surrounding the efficacy of hypnosis for chronic musculoskeletal pain and to identify the most effective intervention delivery strategies. A systematic literature review was performed using the Scopus electronic database to locate all studies that had used hypnosis with a chronic, musculoskeletal pain condition. Thirteen studies met the inclusion criteria, of which 12 were randomised controlled trials. The total number of participants across the studies was 627, with a mean age of 48.3 years. The number of intervention sessions in the hypnosis group ranged from a single session to 14 weekly sessions, with a mean of seven sessions across the studies. The hypnotic intervention session durations ranged in length from 20 minutes up to 2.5 hours and were predominately given on a weekly basis. Collectively, the included studies provided high quality evidence that hypnosis has a positive effect in reducing pain intensity in chronic musculoskeletal conditions compared to standard care and waitlist controls. When compared to relaxation, differences between groups were less consistent but still tended to favour the hypnotherapy groups. Similarly, when compared to physical interventions such as physiotherapy or trigger point therapy, hypnosis was also shown to be more effective. The addition of hypnosis to other psychologically based interventions, such as cognitive behavioural therapy and pain education, created greater improvements in many outcome measures related to a person’s pain experience, such as average and worst pain intensity, and catastrophising. The studies that used a larger variety of hypnotic suggestions that targeted pain intensity, and the cognitive and emotional components of pain, achieved better outcomes. Hypnosis can, therefore, be recommended as a viable treatment option, either as a stand-alone-treatment or as an adjunct to other psychological interventions for the treatment of chronic musculoskeletal pain. Studies investigating the efficacy of specific components of the hypnotherapy interventions around dosage and delivery methods, with larger populations of a more homogenous sample are required to establish more robust conclusions regarding these parameters in a chronic musculoskeletal pain population.
The Efficacy of Repeat Botulinum Toxin Injections in the Management of Spasticity in Children and Young Adults with Cerebral Palsy: A Systematic Review
(Auckland University of Technology, 2022) Marlowe, Brittney Lee
Background: Botulinum toxin (BT) is a common treatment intervention for the management of spasticity in children with Cerebral Palsy (CP). There are no national or internationally recognised clinical guidelines that provide clear information about the recommended frequency of repeat doses of BT and there are inconsistencies in clinical practice. The primary aim of this review was to determine the efficacy of repeat BT injections in the management of clinical outcomes in children with CP. The secondary aim was to compare the efficacy findings with the current National Institute for Health and Care Excellence (NICE) clinical guidelines to determine if the guidelines incorporate evidence-based recommendations concerning the timing and frequency of botulinum toxin injections. Method: A systematic literature search was conducted across five databases to identify relevant articles. Eligibility criteria included participants aged between birth to 21 years old at time of enrolment, clinical diagnosis of CP, presence of spasticity, treatment intervention of two or more BT treatments, and a comparison intervention of either a different frequency of BT, other interventions, or no BT treatment. Three independent reviewers identified eligible studies. Nineteen randomised controlled trials (RCTs) and 17 observational studies met the inclusion criteria, and the 19 RCTs were analysed in this project. Study characteristics and findings were extracted, and methodological quality was assessed using Version 2 of the Cochrane risk-of-bias tool for randomised controlled trials (RoB 2). A descriptive analysis was performed to assess outcomes and determine the efficacy of i) different frequencies of repeat BT injections, ii) repeated BT versus no BT, and iii) repeated BT versus other interventions. Results: A higher frequency of BT (4-monthly versus 12-monthly) resulted in significant short-term improvements in gait and adverse events were found to be twice as frequent. Reduced frequency of BT was found to improve outcomes in occupational performance when compared to OT only. Repeated BT compared with placebo injection resulted in improvements in gait and active ROM. Repeated BT compared with other interventions such as BT only, OT only or surgical intervention resulted in significant improvements in ROM and spasticity. Implications: The findings of this review provide evidence to support repeated BT improves spasticity, ROM and gait in the short-term only when compared to physiotherapy (PT) only, OT only or placebo injection. The recommended treatment frequency of BT is 12-monthly when the goal is to improve ROM and spasticity and 4-monthly when goal is to improve gait in the short-term only. Seven future recommendations suggest additional guidelines and changes to current NICE guidelines for translation to clinical practice. Future studies to investigate the long-term effectiveness of repeated BT in children with CP is required ensuring findings capture health related quality of life (HRQL) as a measure of participation.
Experiences of Rangatahi Māori with Mental Health Services in Aotearoa
(Auckland University of Technology, 2022) Rihari, Teina
Currently, there is a distinct lack of research on rangatahi Māori and mental healthcare in Aotearoa. Research on mental healthcare in Aotearoa has predominantly explored Pakeha and adult experiences. This present research pursued to fill this gap in the literature by investigating the experiences of rangatahi Māori with experiences with mental healthcare in Aotearoa. From these interviews, information will be extracted to add to the limited available research and uncover prospective topics for future research with rangatahi Māori. Māori-centric qualitative methodology was employed in the current study. Data was collected through semi-structured interviews with rangatahi Māori who have experiences with mental healthcare in Aotearoa. Thematic analysis was used to examine the data collected. Two overarching themes were identified: barriers and enablers. These overarching themes comprise eight emergent themes: 1a) Health literacy, 1b) Stigmatism, 1c) Time, 1d) Financial and socioeconomic factors, 2a) Whakawhānaungatanga, 2b) Transparency, 2c) Satisfaction with service, 2d) Incorporation of Māori culture/models. The findings from these themes provided recommendations for service providers and future research into rangatahi Māori mental health
Exploring Effective Pressure Injury Prevention Practices in the Paediatric Intensive Care Setting: An Integrative Review
(Auckland University of Technology, 2022) Liang, Heung Chu Judy
Pressure injuries are a common health issue affecting patients of all ages across different healthcare settings. Hospital-acquired pressure injuries are an indicator of the quality of healthcare in hospitals and can have physiological and psychological impacts for the individuals affected. Hospitalised children, especially those who are critically unwell, are of particular risk of developing pressure injuries. Pressure injuries have been associated with increased morbidity, mortality, length of stay, risk of infection and costs of treatment. This creates strain on the healthcare system, but more importantly for patients, this impacts their quality of life and delays their recovery journey. Consequently, this can have a significant negative impact psychologically on patients and their families/whānau. Prevention of pressure injuries has been a priority across healthcare settings to tackle the issues associated with pressure injuries. However, pressure injuries still remain a longstanding patient safety issue today and are costly to the healthcare system. Nurses play a vital role in the assessment, prevention and management of pressure injuries. This practice project aimed to explore effective pressure injury prevention practices in paediatric intensive care units (PICU). The integrative review method guided by Whittemore and Knafl’s five-stage framework, was used in this project. A total of fourteen studies (all quantitative) were included in this review. Each study was independently and critically appraised using the Mixed Methods Appraisal Tool. The findings of this integrative review highlighted that understanding the risk factors in a PICU patient and up-to-date knowledge about pressure injuries are foundational to prevention. Furthermore, risk assessment tools, education, care bundles and skin champions aid in the implementation of the current recommended prevention strategies. This integrative review provides an overview of the existing literature on the topic and paves the way to understanding what requires further attention and research in the future.
Exploring Electrosurgical Smoke Control Practices among New Zealand Operating Theatre Personnel: A Qualitative Study
(Auckland University of Technology, 2022) Rodrigues, Assunta
Background: Inconsistent electrosurgical smoke evacuation is a concern among operating theatre personnel at a large District Health Board in New Zealand. Despite a growing body of evidence on the hazardous nature of electrosurgical smoke and its harmful effects on operating theatre patients and personnel, there is a paucity of research on electrosurgical smoke control practices among diverse operating theatre personnel. Currently, there are no government regulations that mandate electrosurgical smoke evacuation in New Zealand. Objectives: This study explores and describes electrosurgical smoke control practices at a large District Health Board in New Zealand. It aims to gain a better understanding of diverse operating theatre personnel’s attitudes towards electrosurgical smoke, and how it influences their compliance with electrosurgical smoke evacuation. The goal is to apply the knowledge gained to develop key recommendations to mitigate operating theatre patients’ and personnel’s risk of exposure to hazardous electrosurgical smoke, promoting a healthy surgical smoke-free operating theatre environment for patients and personnel. Methods: An exploratory-descriptive qualitative methodological framework guides this study with individual semi-structured virtual interviews for data collection. A purposeful sample of six diverse operating theatre personnel, comprising of two surgeons, two nurses, an anaesthetist and an anaesthetic technician were voluntarily recruited from a large District Health Board in New Zealand. The researcher conducted the interviews which were audio-recorded. Notes were taken during the interviews. Furthermore, interviews were transcribed verbatim and analysed utilising reflexive thematic data analysis approach. Findings: Research findings suggest that compliance with electrosurgical smoke evacuation is an important yet complex issue. Three major themes emerged from the data analysis. Firstly, education on electrosurgical smoke and electrosurgical smoke evacuation across disciplines. Secondly, attitudes and perceptions about electrosurgical smoke and electrosurgical smoke evacuation. Lastly, barriers and facilitators to electrosurgical smoke evacuation. This study highlights that effective electrosurgical smoke control methods are not being consistently practiced by diverse operating theatre personnel at the District Health Board with an inherent risk of exposure to hazardous electrosurgical smoke for operating theatre patients and personnel. Findings identified that although electrosurgical smoke evacuation is routine in open surgical procedures, it is poorly upheld in laparoscopies. The data analysis indicates that certain aspects of the District Health Board policy on electrosurgical smoke evacuation are ambiguous and require updating. Conclusion: This study revealed that the education of operating theatre personnel on electrosurgical smoke and electrosurgical smoke evacuation across disciplines with strong leadership support, is the key to influence positive attitude towards electrosurgical smoke evacuation. This knowledge is vital to overcome barriers for effective and consistent compliance with electrosurgical smoke evacuation to mitigate the effects of hazardous electrosurgical smoke on operating theatre patients and personnel.
Exploring the Experiences of Pacific Peoples Within Twelve Step Programmes
(Auckland University of Technology, 2022) Nolan, Laura Alexandra Claire
Background: Pacific peoples present with disproportionately higher rates of substance use disorder than the general population, however, are less likely to access mental health and addictions services for support. Despite recent investments into the mental health and addictions sector, uptake of support for Pacific peoples experiencing addictions remains low. The call from Pacific peoples heard throughout the He Ara Oranga Inquiry into Mental Health and Addictions (2018) has been for the adoption of ‘Pacific ways’; promoting Pacific models of health and focusing on healthy relationships, use of Pacific languages and feelings of connectedness. This study aims to explore the experiences of Pacific peoples within Twelve Step Programmes, to ascertain the beneficial and non-beneficial aspects from a Pacific perspective. The findings from this research are intended to inform the development of meaningful interventions for Pacific peoples seeking addictions support. Method: This research project conducted face to face talanoa style interviews with six Pacific peoples who have attended a Twelve Step Programme within the past two years. Interviews were semi-structured and underpinned by the Health Research Council of New Zealand (2014) Pacific Health Research Guidelines. A qualitative research approach was applied using Charmaz’s Constructivist Grounded Theory (2006) methodology alongside Braun and Clarke’s (2006) thematic analysis. Results: Three main themes emerged from the data, which were categorized into a set of subthemes within each primary theme. The first primary theme centred around Pacific peoples lacking knowledge of Twelve Step Programmes. The second theme detailed aspects of Twelve Step Programmes that resonated with Pacific peoples, such as; hospitality and welcoming, spirituality, talanoa, fellowship and connectedness, and volition. The third primary theme explored aspects of Twelve Step Programmes that were non-beneficial for Pacific peoples, which centred around Pacific people being the ethnic minority in Twelve Step Programmes; the need for a Pacific subgroup, and the need for separate spaces for men and women. Conclusion: The recommendations from this research project have been made with the view to enhance and further develop on addictions supports available for Pacific peoples. This research may be of benefit to the alcohol and drug sector; frontline addictions services, mental health and addictions workforce development bodies, Pacific health organisations and policy makers.
Factors Influencing Adoption and Sustained Use of Rehabilitation Technologies in Clinical Practice: A Scoping Review
(Auckland University of Technology, 2022) Lim, Xiao Min Lilian
Background: In response to a growing recognition of the potential of rehabilitation technologies (RT) to improve efficiency in and outcomes from rehabilitation the purchase of RTs were prioritised in the author’s practice setting. However, after the initial few months of use these devices were often abandoned and no longer routinely used in rehabilitation practice. These incidences in the author’s clinical context mirror poor uptake of RT and abandonment of such devices. This scoping review sought to investigate the factors influencing adoption and sustained use of RT in clinical practice with a particular focus on patient and therapist perspectives. Method: This scoping review followed Arksey and O’Malley's five-stage methodology framework, advanced by Levac et al.. Eight electronic databases were searched from inception to April 2021. A total of 5486 unique papers were returned and screened by abstract and title. Data was analysed in two phases: Phase 1: Qualitative data exploring adoption found in the reviewed articles (including systematic reviews of quantitative research and qualitative research, scoping reviews and narrative reviews) was extracted and analysed through a six-step inductive thematic analysis process as described by Braun and Clarke. Subsequently, a thematic map was developed. Phase 2 involved the analysis of data pertaining to sustained use through an abductive approach where the codes generated were mapped onto existing themes developed in Stage 1. New themes emerged related to sustained use and there was an extension of themes that had been identified from the adoption literature. The results of the scoping review were then mapped to the current decision-making processes within the author’s practice context to identify potential gaps in the process, serving as a roadmap to guide the revision of the evaluation and decision-making processes within the author’s organisation. Results: Thirty-six studies were included in the scoping review, of which 28 review articles explored factors influencing adoption, six looked at factors influencing both adoption and sustained use while two primary research papers explored sustained use only. In Stage 1 four key themes were identified as influencing the adoption of RT in clinical practice; “knowledge”, “device design”, “patients’ and therapists’ circumstances and characteristics” and “person-centred approach”. In Stage 2 an additional theme, “wider systemic conditions” was identified and subthemes in existing four themes were modified, expanded or added. This included: (i) modifying subthemes of “(therapist’s) attitudes and beliefs”, “perception of self and societal values” and “ease of set-up and operation” (ii) expanding subthemes of “how to operate the device”, “how to tackle problems and access to support”, “demographic characteristics” and “supporting workload” and (iii) adding a subtheme on “individual preferences”. The themes prompted the generation of recommendations for the revision of the evaluation and decision-making processes within the author’s organisation, and to improve the adoption and sustained use of RT in the practice setting. Conclusion: There is limited research exploring the factors influencing sustained use of RT in clinical practice. The research to date provides sign posts for therapists, patients and carers, designers and developers of RT, management and decision makers of RT purchases and funders of the purchases, which may inform the development, evaluation and implementation of RT. Further research is required to facilitate continuous usage of RT within the clinical setting.
Fear of Falling After Hip Fracture: A Systematic Review of Prevalence, Measurement, Associations with Physical Function, and Interventions
(Auckland University of Technology, 2021) Gadhvi, Chandini
Background Hip fracture is a common and debilitating injury amongst older adults. Fear of falling (FoF) may impede rehabilitation after hip fracture. An updated systematic review to synthesize the existing literature on FoF after hip fracture is needed. Aim This study aims to review and synthesize existing literature to answer four research questions about the 1.) prevalence of FoF, 2.) psychometric properties of measurement instruments, 3.) association with physical function, and 4.) effectiveness of interventions in reducing FoF, in hip fracture patients. Methods A systematic electronic search was undertaken in the EBSCO Health, Scopus and PsychINFO databases in January 2021 for articles on FoF after hip fracture. Data in relation to each research question was extracted and analysed. The methodological quality of the studies was critically appraised using the ‘Risk of Bias Tool for Prevalence Studies’, ‘COSMIN Risk of Bias checklist for Patient-reported outcome measures’, modified version of the ‘Appraisal Tool for Cross-sectional studies’, and the ‘Cochrane Risk of Bias 2’ tools for each research question, respectively. Results 35 articles (34 studies) with 3809 participants were included. Prevalence rates for FoF after hip fracture ranged between 22.5% and 100%, and the prevalence tended to decrease as time progressed post hip fracture. The ‘Falls Efficacy Scale – International’ (FES-I) and ‘Fear of Falling Questionnaire – Revised’ (FFQ-R) were found to be reliable, internally consistent, and valid tools in hip fracture patients. FoF after hip fracture was consistently associated with measures of physical function including balance, gait speed, composite physical performance measures and self-reported function. Exercise-based interventions with or without a psychological component were not effective in reducing FoF after hip fracture. Motivational interviewing and accelerated/ supported discharge with home based rehabilitation may have some impact on FoF, however, more high quality trials are needed to confirm this finding. Overall, there was insufficient evidence to conclude about the effectiveness of interventions in reducing FoF after hip fracture. Conclusion The literature on FoF after hip fracture has grown in the last decade. FoF is prevalent after hip fracture and is associated with poorer physical function. Only two instruments have been validated for measuring FoF in the hip fracture population. However, there is a need for more robust and larger studies to guide clinical practice regarding interventions to address FoF after hip fracture.
Healthcare Professionals’ Perceptions and Knowledge of the Management and Removal of Underwater Seal Chest Drains in Children and Young People: New Zealand
(Auckland University of Technology, 2023) Morrison, Jacqueline
Paediatric patients with underwater seal chest drains are cared for in certain areas within a paediatric hospital setting. Presently within a paediatric hospital in New Zealand there is a clinical underwater seal chest drain guideline to guide chest drain insertion, management, and removal yet there is inconsistency in what the guideline states and current practice. This quality improvement project undertook a integrative review of the international literature on underwater seal chest drain management and explored healthcare workers perceptions and knowledge on the management and removal of underwater seal chest drains in children and young people at a large children’s hospital in New Zealand. Method: An integrative review was undertaken to summarise previous international empirical peer-reviewed literature published from 2011 - 2022 to provide a comprehensive understanding on the management and removal of underwater seal chest drains in children and young people. A qualitative design using face-to-face interviews with healthcare professionals from one large children’s hospital in New Zealand who had a key role in underwater seal chest drain management and removal was undertaken in 2022. Analysis: The integrative review and face to face interview data were analysed separately using the six phases of Braun and Clarks’ (2006) thematic analysis. This included familiarising oneself with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes and generating a report. The findings of both research designs were brought together in the discussion. Results: A total of nine studies were included in the review. An inductive analysis of nine manuscripts generated one theme (disparity in healthcare professionals’ knowledge and practice with underwater seal chest drain management), three sub-themes (healthcare professionals, practice considerations, adverse events) and nine categories (discipline and context, knowledge, education, indications, underwater seal chest drain tubing and characteristics, management, assessment, complications, interventions). Face to face interviews were undertaken with seven healthcare professionals. An inductive analysis of the interviews generated one theme (a gap between theory, guidelines and practice of underwater seal chest drain management), four subthemes (management, practice considerations, scope of practice, current practice), eleven categories (collaboration, care delivery, indications, insertion-removal, adverse events, guidelines, knowledge, demographics, reality, ability, context). The results highlighted that there was a disparity in healthcare professionals’ knowledge and practice with underwater seal chest drain management as well as a gap between theory, guidelines and reality of practice for underwater seal chest drain management. Conclusion: There is a lack of research for underwater seal chest drain management and removal, particularly in paediatrics. There is a discrepancy between healthcare professionals’ perceptions and knowledge of underwater seal chest drain management and removal, to what is required to manage and remove underwater seal chest drains safely and effectively. There is an urgent need to provide healthcare professionals with the relevant education and knowledge to be able to adequately care for children with underwater seal chest drains and ultimately prevent any adverse events. It is also recommended that healthcare professionals utilise contemporary evidence-based research to create and update clinical practice guidelines for underwater seal chest drain management and removal.

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