83 research outputs found
Exploring Electrosurgical Smoke Control Practices among New Zealand Operating Theatre Personnel: A Qualitative Study
No full textBackground: 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
Nursing Narratives of Assisted Dying Implementation in New Zealand
No full textBackground: New Zealand is a country with a health system built upon both Western and Māori world views and care is delivered to, and by people from culturally diverse backgrounds. In November 2020, the End-of-Life Choice Act was passed in New Zealand following a referendum, with assisted dying subsequently legalised in November 2021. Some form of assisted dying has been legalised in several countries and jurisdictions globally, wherein nurses play a significant role at different stages of the assisted dying process, thus impacting nursing practice and policy. However, nurses were not mentioned in the End-of-Life Choice Act in New Zealand. There is limited assisted dying literature from New Zealand, categorically nursing focused to comprehend the implications of this change for nurses, and nursing practice and policy.
Aim: The aim of this research was to develop an understanding of how assisted dying legislation and subsequent implementation impacts upon practice and policy for nurses in New Zealand.
Methods: This qualitative research was conducted through narrative inquiry and grounded within a social constructivist paradigm in the field of nursing research. Participants were ten nurses working in a range of end-of-life care settings across New Zealand. Interviews were conducted after the End-of-Life Choice Act was passed, but two to three months prior to the date where it was enacted. Thematic analysis was applied to make sense of the data and generate meaningful themes.
Results: The overall finding from this research was that, the assisted dying implementation in New Zealand challenged the professional identity of nurses. The nurses’ narratives deepened the understanding that nursing is a human profession, and nurses’ roles include compassion, care, intuition, advanced clinical skill and intricate knowledge of their communities. Nurses were not recognised as stakeholders by local boards and policymakers, showing a lack of cognisance of the significance of this legislative and social change for nursing. Participants described being excluded during implementation processes, education and resource provision thus, lessening the meaningfulness, confidence, and understanding of what it meant to be a nurse who would support patients, families, and other health professionals through this new type of death. The nurses felt that this had the potential to compromise patient care, and safety. Consequently, resulting in assisted dying challenging the professional identity of nurses, as they were unprepared to understand and fulfil their roles in assisted dying practice and policy.
Conclusion: The results suggested there is a need for change to assisted dying policy specific to nursing practice, and increased support, education, and resource allocation to better prepare nurses for assisted dying in practice. It is proposed that including the role of the nurse in the End-of-Life Choice Act, could place responsibility on policymakers and organisations, to better resource and support nurses with this legislative and social change. As nurses’ roles and responsibilities continue to grow to meet population requirements there is a growing need to clearly define nurses’ roles through the way the government shapes policy, recognising nurses as key stakeholders in any healthcare practice and policy change
Impact of Power Dynamics on Collaborative Practice: A Foucauldian-Informed Discourse Analysis
No full textDespite international initiatives to promote and encourage interprofessional collaboration in healthcare, research has identified barriers that hinder such practice in reality. Primary amongst these, are power relationships in multidisciplinary teams (MDT), which are described as hindering communication between professionals, and giving rise to stereotypical views, facilitating hierarchical relationships, limiting capacity for change, and impeding clinical decision-making.
To help understand why such practice exists, this research utilised Foucault’s approach to discourse analysis, to study the effects of power dynamics on clinical decision-making and collaborative practices, within an MDT team of a Neonatal Intensive Care Unit (NICU). Data were collected from semi-structured interviews and direct observations of three multidisciplinary team meetings and two ward rounds. The interviews were conducted to uncover the rich descriptions associated with power relationships. Topics discussed, included MDT staff's understanding of collaborative practice, real workplace examples of collaborative practice, bicultural practice and solitary or unilateral practice, examples of interactions which portrayed or supported the exertion of power, and examples of gatekeeping of power. Observations included, but were not limited to, commentary on roles, body language, interruptions, and contributions, which were recorded in the form of field notes.
Transcripts were analysed using Foucault’s understanding of power, knowledge, discourse, governmentality, and punishment. Four key discourses were identified to influence collaborative practice and power dynamics within the NICU MDT. These included the biomedical discourse, the culture of blame, the sanctity of life and collaborative practice. While all discourses were always in play, each rose to dominance in different situations. As each discourse came to the forefront of practice, it had a significant yet unique effect on staff behaviour, communication, power dynamics and collaboration. Although the biomedical discourse was a relatively dominant discourse, shaping the flow of power and the forms of communication that were favoured, collaborative practice was revealed to be a dynamic phenomenon, that was responsive to the changing situation in the NICU and to the various actors. Empowered with this understanding, MDT staff can better identify, engage in, and encourage collaborative decision-making to improve health care delivery
'A performance of appearance' : men, masculinities and appearance medicine : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Sociology, Massey University, Albany, New Zealand
Full text linkMasculinity, masculine work places and masculine grooming are all changing. Men of the twenty-first century are experiencing a deconstruction of traditional hegemonic masculinity (Connell, 1995), as the deindustrialisation of traditional male work places erode the need for men to present a work ethic based upon physical strength.1 With this erosion of traditional work places, there are changes afoot relocating men, their masculinity and their exterior appearance away from the embedded practices of traditional hegemonic masculinity towards a new ‘performance of appearance’ within contemporary interactive service employment roles.
These changes are not merely occurring from free will, but are mediated by marketing trends and the promotion of the masculine body as an objectified resource, through which men can remain visible and successful in contemporary work places. This movement, however, requires a means to facilitate the changes, with the masculine habitus posed as being the vehicle for actualisation.
This thesis draws upon my lived and worked experiences as a Registered Nurse within the appearance medicine sector. I explore contemporary masculine beautification, and the potential paradoxical situation of the emergence of a new masculinity associated with a ‘performance of appearance’ within contemporary work places, but achieved through an adherence to practices associated with traditional hegemonic masculinity. Using a web content analysis approach, I explore masculine appearance medicine websites, the services they offer to men and the marketing trends implemented to engage men with this practice.
My research produces findings that are both multi-faceted and interrelated. The key outcomes suggest that changes are occurring within the construct of masculinity and that men need to both become aware of, and engage with, their habitus as a facilitator for change. The findings also present the contradictory practice of masculine appearance medicine treatments being marketed through the constraints and comforts of traditional hegemonic practices. My findings suggest that although the construct of masculinity is porous, and a shift in practices is occurring, with a ‘performance of appearance’ emerging as a feature of a new work place masculinity, men still require the comforts provided by traditional hegemonic practices in order to facilitate this change
Better Preparedness for Better Responses: Integrating Maternal and Reproductive Health into Disaster Risk Management: A Qualitative Case Study from Indonesia
No full textThis thesis explores the process of integrating maternal and reproductive health (MRH) into disaster risk management (DRM) in Indonesia. This thesis contributes to Indonesia achieving the Sustainable Development Goals, including ensuring universal access to sexual and reproductive healthcare services and the integration of reproductive health into national strategies and programmes.
This single case study of one site in Indonesia provides an understanding of the current integration of MRH into DRM from the perspectives of those affected by and involved in a disaster event. The 2013 eruption of Mount Sinabung in North Sumatera province was selected as the case for this study, as it represented a frequent type of disaster in Indonesia. This case study is underpinned by a diagnostic event approach that examined tensions and dynamic relationships between the past, present and future, and explained the relationships between events, times and processes of integrating MRH into DRM. The objectives of the case study were to: 1) analyse experiences of accessing and providing MRH services during the 2013 eruption, 2) examine perspectives of current DRM practice and 3) explore views for a future DRM model.
Participants were women who were pregnant during the 2013 eruption, community leaders, health personnel in the relocation site of Siosar and policymakers working at district, provincial and central levels. Data were obtained from focus groups and individual interviews, and analysed using thematic analysis. Data were triangulated and the results presented using a socio-ecological approach. This allowed understanding of participants’ experiences and perceptions at the micro-level, the provision of MRH services at the meso-level, the environments surrounding temporary shelters and relocation site at the exo-level, and finally overall DRM policies and systems at the macro-level.
The findings showed that during the 2013 eruption response, efforts were made to provide MRH services through establishing health teams and clinics in designated temporary shelters. Unfortunately, these temporary shelters were perceived as lacking standards as there were privacy, security, hygiene and sanitation issues that affected the MRH needs of pregnant women and other affected population groups. Furthermore, the relocation changed lifestyles, traditions and the way people earned their livelihood. Pregnant women and other affected people face ongoing challenges, including access to MRH services.
Overall, this study highlights the ongoing efforts to integrate MRH services into DRM in Indonesia, and reveals some room for improvement. A significant contribution of this study is the implications of the findings for transforming approaches to the integration of MRH into DRM in Indonesia. These findings include policy and programme recommendations pertaining to the need for community education on disasters, improvement of health sector readiness and strengthening of collaboration across sectors. This study demonstrates the importance of using a case study as a methodology and a diagnostic event as an approach to explain relationships between events, times and processes in integrating MRH into DRM
Better Preparedness for Better Responses: Integrating Maternal and Reproductive Health into Disaster Risk Management: A Qualitative Case Study from Indonesia
No full textThis thesis explores the process of integrating maternal and reproductive health (MRH) into disaster risk management (DRM) in Indonesia. This thesis contributes to Indonesia achieving the Sustainable Development Goals, including ensuring universal access to sexual and reproductive healthcare services and the integration of reproductive health into national strategies and programmes.
This single case study of one site in Indonesia provides an understanding of the current integration of MRH into DRM from the perspectives of those affected by and involved in a disaster event. The 2013 eruption of Mount Sinabung in North Sumatera province was selected as the case for this study, as it represented a frequent type of disaster in Indonesia. This case study is underpinned by a diagnostic event approach that examined tensions and dynamic relationships between the past, present and future, and explained the relationships between events, times and processes of integrating MRH into DRM. The objectives of the case study were to: 1) analyse experiences of accessing and providing MRH services during the 2013 eruption, 2) examine perspectives of current DRM practice and 3) explore views for a future DRM model.
Participants were women who were pregnant during the 2013 eruption, community leaders, health personnel in the relocation site of Siosar and policymakers working at district, provincial and central levels. Data were obtained from focus groups and individual interviews, and analysed using thematic analysis. Data were triangulated and the results presented using a socio-ecological approach. This allowed understanding of participants’ experiences and perceptions at the micro-level, the provision of MRH services at the meso-level, the environments surrounding temporary shelters and relocation site at the exo-level, and finally overall DRM policies and systems at the macro-level.
The findings showed that during the 2013 eruption response, efforts were made to provide MRH services through establishing health teams and clinics in designated temporary shelters. Unfortunately, these temporary shelters were perceived as lacking standards as there were privacy, security, hygiene and sanitation issues that affected the MRH needs of pregnant women and other affected population groups. Furthermore, the relocation changed lifestyles, traditions and the way people earned their livelihood. Pregnant women and other affected people face ongoing challenges, including access to MRH services.
Overall, this study highlights the ongoing efforts to integrate MRH services into DRM in Indonesia, and reveals some room for improvement. A significant contribution of this study is the implications of the findings for transforming approaches to the integration of MRH into DRM in Indonesia. These findings include policy and programme recommendations pertaining to the need for community education on disasters, improvement of health sector readiness and strengthening of collaboration across sectors. This study demonstrates the importance of using a case study as a methodology and a diagnostic event as an approach to explain relationships between events, times and processes in integrating MRH into DRM
Patient choice as illusion: autonomy and choice in end-of-life care in the United Kingdom and New Zealand
No full textDeath is a reality of life as we will all die. Despite this inevitability, death in the twenty-first century remains unwelcome and has been sequestered into the enclaves of medical practice as a means of quelling the rising tide of fear it provokes. Using a narrative analysis approach to examine online social media commentary of personal experiences, this research explores the reality of patient choice at end-of-life in the United Kingdom (UK) and New Zealand. Specifically it examines the barriers encountered when individuals seek control of the dying trajectory and how this unfolds for the patient compliant with the medicalised ‘good death’ and for those seeking the right-to-die; contextualising these issues within the human rights framework. This research explores the means through which medical practice maintains power over the dying individual, actualised through the use of specialist knowledge and the medical vernacular. It compares the use of specialist palliative models of care with euthanasia and assisted suicide, and examines the selective collaboration between medicine and law as a means of subverting the individual who attempts to disrupt the contemporary accepted norms when dying. My research suggests that patient choice when dying is an illusion in practice, despite individual choice being considered an essential component in clinical decision making. I highlight that those seeking the right-to-die disrupt the normative compliance expected in the doctor/patient relationship, thus, positioning them as deviant and other. I suggest that there is a potential weakness in the construct of medical power and is evidenced in the selective reliance upon law when clinical decisions are challenged by the deviant individual. Finally, I suggest that although the equity in the doctor/patient relationship remains unbalanced at present the right to choice at end-of-life remains a potent prospect; with the re-invigoration and re-presentation of the Ars Moriendi having the potential to reflect the self-centricity of the contemporary Western individual to access the ‘good death’ of choice
The Gendered Role of Pastoral Care Within Tertiary Education Institutions: An Autoethnographic Reflection During COVID-19
No full textEmerging research highlights that the pandemic has exacerbated gendered inequities for academic women. These disparities prior to COVID-19 included a significant gender pay gap, and women channelled into administrative, teaching, and pastoral care roles that are not recognised with career advancement and remuneration compared to research routes much more readily facilitated for and by male colleagues. Using a collaborative auto-ethnographic approach we reflect on our experiences of emotional labour in supporting nursing students throughout the COVID-19 pandemic and the invisibility of this crucial work within academia. We noted that the patriarchal construction of academia remains present and highly visible to the detriment of many female career trajectories
Small Homelike Facilities in Aged Residential Care: Resident Outcomes.
No full textAn integrative review of the literature about resident outcomes in small homelike Aged Residential Care facilities
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