The art of delegation: integration of the veterinary nursing assistant into New Zealand veterinary practice

BACKGROUND Rapid implementation of telemedicine for cancer care during COVID-19 required innovative and adaptive solutions among healthcare workers. OBJECTIVE The objective of this qualitative study was to explore healthcare workers’ experiences with telemedicine implementation during COVID-19. METHODS We conducted semi-structured interviews with 40 oncology healthcare workers who implemented telemedicine during COVID-19. The interviews were recorded, transcribed verbatim, and analyzed for themes using Dedoose software (Version 4.12). RESULTS Approximately half of participants were physicians (55%) and one quarter of participants were APPs (25%). Other participants included social workers (n=3), psychologists (n=2), dieticians (n=2), and a pharmacist. Five key themes were identified: 1) establishing and maintaining patient-provider relationships, 2) coordinating care with other providers and informal caregivers, 3) adapting in-person assessments for telemedicine, 4) developing workflows and allocating resources, and 5) future recommendations. Participants described innovative strategies for implementing telemedicine, such as coordinating inter-disciplinary visits with multiple providers. Healthcare workers discussed key challenges, such as workflow integration, lack of physical exam and biometric data, and overcoming the digital divide. Participants recommended policy advocacy to support telemedicine (e.g., medical licensure policies) and monitoring how telemedicine affects patient outcomes and healthcare delivery. CONCLUSIONS To support the growth of telemedicine, implementation strategies are needed to ensure providers and patients have the tools necessary to effectively engage in telemedicine. At the same time, cancer care organizations will need to engage in advocacy to ensure policies are supportive of oncology telemedicine and develop systems to monitor the impact of telemedicine on patient outcomes, healthcare quality, costs, and equity. CLINICALTRIAL N/A

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How do traditional Māori values affect the sustainability of Māori tourism businesses?

10.26686/wgtn.17139899.v1 ◽

2021 ◽

Author(s):

◽

Adam Ransfield

Keyword(s):

New Zealand ◽

Research Question ◽

Social Science Research ◽

Science Research ◽

Tourism Industry ◽

Structured Interviews ◽

Business Sustainability ◽

Tourism Product ◽

Kaupapa Māori ◽

The Impact

The Māori economic asset base has seen significant growth over the past 100 years. Research estimates the Māori economy to be valued at 50 billion (NZ Foreign Affairs & Trade, 2018). While this figure represents the Māori economy, Māori tourism makes a significant economic contribution to this asset base. When considering the different aspects of the New Zealand tourism product, a key aspect that sets New Zealand tourism apart from other destinations is the unique Māori culture. This cultural aspect is a key motivating factor for international tourists intending on visiting New Zealand. Māori tourism businesses offer a range of tourism products and services that are embedded in, and informed by Māori values. When incorporated in business, many of these traditional Māori values align closely to the three pillars of business sustainability. Literature on Māori tourism, Māori values and business sustainability provide some insight into this phenomenon. However, little is known about how these three components interrelate. Ultimately very little is known about how traditional Māori values impact the business sustainability of Māori tourism businesses. The aim of this thesis is to investigate whether Māori tourism businesses incorporate traditional Māori values into their business and if so, how does the application of these values affect the sustainability of Māori tourism businesses. Developed from an interpretive social science research paradigm aligned with Kaupapa Māori research, this thesis assesses the impacts of the incorporation of Māori values on the business sustainability of Māori tourism businesses. Semi-structured interviews were selected as an appropriate method of data collection. 12 respondents from eight Māori tourism businesses were interviewed and their responses along with an analysis of the wider literature enabled the researcher to answer the overarching research question – how are traditional Māori values affecting the business sustainability of Māori tourism businesses? Key research findings include the following: the importance of hiring Māori, developing cultural capacity of staff and stakeholders, preventing cultural misappropriation, providing opportunities for local communities, the relationship of Māori with the land, the importance of sustainable relationships, the impact of climate change on Kaitiakitanga, and the importance of making a profit – but not at the detriment of culture and the environment. The findings identified that to have the ability to implement sustainable practices requires financial sustainability. This thesis makes a contribution to the literature on Māori values, Māori tourism and business sustainability by providing a greater understanding of which Māori values are applied by Māori tourism businesses and how these values impact business sustainability. In particular, this thesis has done something that previous literature has not, that is, it has attributed the specific effects of individual Māori values against the pillars of business sustainability. This gives the indication of which values have the greatest impact on business sustainability. Finally, in accordance with Kaupapa Māori research, this thesis has provided a practical contribution to the Māori tourism industry. This contribution is in the form of recommendations made to enhance the business sustainability of Māori tourism businesses.

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Barriers and Facilitators of Following Perioperative Internal Medicine Recommendations by Surgical Teams: A Sequential, Explanatory Mixed-methods Study

10.21203/rs.3.rs-86551/v1 ◽

2020 ◽

Author(s):

Kristin Flemons ◽

Michael Bosch ◽

Sarah Coakeley ◽

Bushra Muzammal ◽

Rahim Kachra ◽

...

Keyword(s):

Mixed Methods ◽

Patient Outcomes ◽

Theoretical Domains Framework ◽

Medical Consultation ◽

Mixed Methods Study ◽

Role Clarity ◽

Structured Interviews ◽

Chart Audit ◽

Anticoagulation Management ◽

The Impact

Abstract Background: Preoperative medical consultations add expense and burden for patients and the impact of these consults on patient outcomes is conflicting. Previous work suggests that 10-40% of preoperative medical consult recommendations are not followed. This limits measurement of the effect of perioperative medical consultation on patient outcomes and represents a quality gap, given the patient time and healthcare cost associated with consultation. We aimed to measure, characterize, and understand reasons for missed recommendations from preoperative medical consultation.Methods: This explanatory, sequential mixed methods study used chart audits followed by semi-structured interviews. Chart audit of consecutive patients seen in preoperative medical clinic were reviewed to measure the proportion and characterize the type of recommendations that were not completed (‘missed’). This phase informed the interview participants and questions. The interview guide was developed using the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Template analysis was used to understand drivers and barriers of missed recommendationsResults: Chart audit included 295 patients (n=188, 63.7% female) seen in preadmission clinic between April 1 and April 30th, 2019. 51.8% of patients all recommendations followed (n=142). Postoperative anticoagulation management and postoperative cardiac biomarker surveillance recommendations were least commonly followed (45.2%; n=28, and 64.1%; n=84, respectively). Eighteen surgical team members were interviewed. Missed recommendations were both unintentional and intentional, and the key drivers differed by these categories. Unintentionally missed recommendations occurred due to individual-level factors (drivers: knowledge of the consultation note, lack of routine for reviewing the consultation note, and competing demands on time) and systems-level factors (drivers: lack of role clarity). Intentionally missed recommendations occurred due to user error due (drivers: lack of knowledge of guidelines or evidence) and appropriate modifications (drivers: need to adapt a preoperative plan for a complicated postoperative course).Conclusions: Only 51.8% of consult notes had all recommendations followed, suggesting a quality gap in perioperative medical care. Qualitative data suggests multiple drivers of missed recommendations that should be targeted to improve the efficiency of care for these patients.

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The impact of national context on future care planning for Korean parents in Korea and in New Zealand caring for their children living with disabilities: A cross-national study

International Social Work ◽

10.1177/0020872820949627 ◽

2020 ◽

pp. 002087282094962

Author(s):

Clara Choi ◽

Mike O’Brien

Keyword(s):

New Zealand ◽

Planning Process ◽

National Study ◽

Care Planning ◽

Care Provision ◽

Structured Interviews ◽

Korean Parents ◽

Future Care ◽

Cross National Study ◽

The Impact

An increasing concern of families caring for children living with disabilities is related to planning for their future care. This qualitative study explores how the country contexts shape the plans for future care provision of Korean parents in New Zealand and Korea. Data were collected using semi-structured interviews with parents ( n = 18) and professionals ( n = 18). The study revealed that there are differences and similarities regarding the social reality of future care planning among Koreans in different national contexts. Recommendations are made In support of future care planning process taking its place as a conventional phase of care provision for people living with disabilities.

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The impact of the Greek economic recession on workplace learning

Journal of Workplace Learning ◽

10.1108/jwl-07-2018-0094 ◽

2019 ◽

Vol 31 (5) ◽

pp. 345-358

Author(s):

Stavros Papakonstantinidis

Keyword(s):

Competitive Advantage ◽

Informal Learning ◽

Learning Strategies ◽

Workplace Learning ◽

Economic Recession ◽

Economic Recovery ◽

Business Success ◽

Structured Interviews ◽

Content Type ◽

The Impact

Purpose The paper aims to examine the impact of the Greek economic recession on workplace learning. Specifically, it surveys the views of Greek business professionals regarding whether workplace learning could be used as a competitive advantage in achieving business success. Design/methodology/approach The paper follows a qualitative research method and discusses the findings of semi-structured interviews with professionals in various industries in Greece. Findings This study provides evidence of an overall reluctance to adopt formal learning strategies. Although hiring and retaining the best talent at work is seen as a competitive advantage, Greek professionals do not attribute success to formal workplace learning. Instead, digitalization of informal learning becomes essential for acquiring new knowledge. Social implications In the first few years of Greece’s economic recovery, companies aim to keep their budgets low in anything that seems luxurious and ultimately unnecessary. The paper discusses some implications of the implementation of digitalized informal learning in business. Originality/value This study is the first to explore how Greek professionals from various business sectors and managerial levels view workplace learning during the initial years of the country’s economic recovery.

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Clients Coming Out – Men speak out about purchasing sex in New Zealand’s decriminalised environment

10.26686/wgtn.17148812.v1 ◽

2021 ◽

Author(s):

◽

Shannon Mower

Keyword(s):

New Zealand ◽

Coming Out ◽

Sex Workers ◽

Well Being ◽

Human Interaction ◽

Sex Industry ◽

Contextual Knowledge ◽

Structured Interviews ◽

Worker Rights ◽

The Impact

This thesis explores the client experience of purchasing sex in New Zealand in the context of decriminalisation. This research was conducted at a time when speculation over the impact of decriminalisation on the conduct of clients was at an all-time high. Despite vast speculation by critics, little to no research exists on client populations in New Zealand. This thesis addresses this knowledge gap and offers an initial insight into the experiences of clients in this context. The research that forms the basis of this thesis involved qualitative semi-structured interviews with 12 men and women who purchase sex in New Zealand, along with three key informants with broader contextual knowledge of clients. The clients interviewed constituted a diverse group, and in many ways, they challenged common stereotypes. For example, while all participants were motivated by sexual desire, half the sample placed more significance on their desire for human interaction. Hegemonic masculinity was also discussed as motivating their engagements with the sex industry. The interviews also revealed the impacts of purchasing sex on participants, which related more to their interactions with sex workers than the physical act of having sex. Lastly, the research explored participants’ interactions with sex workers under decriminalisation, finding that they emphasised clear communication, respect of sex worker’s boundaries, and a desire to purchase sex ethically. There are three key conclusions of this thesis. Firstly, that client stereotypes are inapplicable to the entire client population as the participants challenged many and provided support for the ‘every man perspective’. Second, that support exists for non-sexual client motivations, and following the impacts participants discussed, sex workers and their services can be considered therapeutic and supporting the well-being of participants. Lastly, that legal context does make a difference on the conduct within sex industries and under decriminalisation. The participants’ conduct was driven by an awareness for sex worker rights and working conditions, thus producing an informed, harm-reductionist approach to purchasing sex.

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Lead maternity care midwives' perspectives on the effect of severe perineal trauma on their relationship with women

10.26686/wgtn.17148983.v1 ◽

2021 ◽

Author(s):

◽

Audrene Samuel

Keyword(s):

New Zealand ◽

Maternity Care ◽

Genital Tract ◽

Postnatal Period ◽

Perineal Trauma ◽

Structured Interviews ◽

Geographical Regions ◽

Severe Perineal Trauma ◽

Ongoing Relationship ◽

The Impact

Although childbirth is a time of happiness and joy for couples, happiness can be flawed by pain and discomfort associated with perineal trauma sustained during childbirth. It is estimated that 85% of vaginal births are accompanied by trauma to the perineum. A higher risk of trauma is sustained at the first birth compared with subsequent vaginal births. In New Zealand, midwives work in partnership with the woman. The Lead Maternity Care (LMC) midwife has an ongoing relationship with the woman in her care that starts when the pregnant woman books with the midwife and ends at six weeks postpartum. The relationship between the woman and the LMC midwife involves trust, shared control, responsibility and a shared meaning through mutual understanding. Midwives fear they will be held responsible by women who sustain severe perineal trauma during their birth for the outcome. There is a lack of research into how New Zealand midwives’ relationships are affected when women in their care sustain severe perineal trauma. This research sought to explore the experiences of LMC midwives who have cared for women who sustained severe perineal trauma during childbirth. The objective of this study was to understand the effects of severe perineal trauma on the midwife/ woman relationship. The aim was to explore LMC midwives` perception of how they were affected when women in their care sustained severe genital tract trauma during birth. Qualitative descriptive methodology was used. Face-to-face semi-structured interviews were conducted with LMC midwives from three geographical regions in lower North Island of New Zealand. The participants were eight midwives who had personal experience of caring for a woman who sustained severe genital tract trauma during childbirth. The findings revealed three themes: building a relationship with women, participants’ perceptions of the effects of severe perineal trauma on women, and the impact of severe perineal trauma on the midwife. The findings demonstrate that LMC midwives build relationships with women during the antenatal period. This relationship ensures an excellent partnership, established on the foundation of trust and respect, developed with the women. Midwives are affected on a personal and professional level when woman sustains trauma during childbirth, and the midwife adopts ways of coping. In the aftermath of severe perineal trauma, the woman may suffer health problems. This can impact her relationship with her LMC midwife during the postnatal period.

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Reducing Ethnic and Geographic Inequities to Optimise New Zealand Stroke Care (REGIONS Care): A Nationwide Observational Study Protocol (Preprint)

10.2196/preprints.25374 ◽

2020 ◽

Author(s):

Annemarei Ranta ◽

Stephanie Thompson ◽

Matire Louise Ngarongoa Harwood ◽

Dominique Ann-Michele Cadilhac ◽

Peter Alan Barber ◽

...

Keyword(s):

New Zealand ◽

Data Collection ◽

Observational Study ◽

Focus Groups ◽

Patient Outcomes ◽

Stroke Care ◽

Cost Efficacy ◽

Nationwide Observational Study ◽

The Impact

BACKGROUND Stroke systems of care differ between larger urban and smaller rural settings and it is unclear to what extent this may impact on patient outcomes. Ethnicity influences stroke risk factors and care delivery and patient outcomes in non-stroke settings. Little is known about the impact of ethnicity on post-stroke care especially in Māori and Pacific populations. OBJECTIVE To describe the study protocol for the Reducing Ethnic and Geographic Inequities to Optimise New Zealand Stroke Care (REGIONS Care) Study METHODS This large nationwide observational study assesses the impact of rurality and ethnicity on best practice stroke care access and outcomes involving all 28 New Zealand hospitals caring for stroke patients capturing every stroke patient admitted to hospital during the 2017-2018 study period. In addition, it explores current access barriers through consumer focus groups, and consumer, carer, clinician, manager, and policy maker surveys. It also assesses economic impact of care provided at different types of hospitals and to different ethnicities, as well as exploring cost-efficacy of individual interventions and care bundles. Finally it compares manual study data collection to routine health administrative data, and explores the feasibility of developing outcome models using only administrative data and the cost-efficacy of using additional manually collected registry data. Sample size estimates: Part 1a - 2,400 participants to identify a 10% difference between up to four geographic sub-groups at 90% power with alpha 0.05 and 10-20% loss to follow-up. Part 1b - 7,645 to include an estimated 850 Māori and 419 Pacific patients to provide >90% and >80% power respectively. Part 2 – fifty patient/carer surveys, forty provider surveys, and ten focus groups to achieve saturation of themes. Study outcome(s): Main outcome is modified Rankin Score at 3 months (mRS). Secondary outcomes include mRS, EQ-5D-3L, stroke recurrence, vascular events, death, and readmission at 3, 6, and 12 months as well as cost of care and themes around access barriers. RESULTS The study is underway with national and institutional ethics approval in place, 2,379 patients recruited for part 1a, 6,837 for part 1b, ten focus groups conducted, and 70 surveys completed. Data collection is essentially completed including follow-up assessment, however, primary and secondary analyses, data linkage, data validation, and health economics analysis still underway. CONCLUSIONS The methods of this study may provide the basis for future epidemiological studies to guide care improvements in other countries and populations.

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Exploring partnerships between nonprofit organisations in New Zealand

10.26686/wgtn.17005984.v1 ◽

2021 ◽

Author(s):

◽

Nicola Joy Sutton

Keyword(s):

Decision Making ◽

New Zealand ◽

Voluntary Participation ◽

Resource Allocations ◽

Structured Interviews ◽

Nonprofit Organisations ◽

Nonprofit Partnership ◽

The People ◽

The Impact

Nonprofit partnership with government and with business is well documented in the literature. However partnership between nonprofit organisations has largely been ignored. This research focuses on such New Zealand partnerships. It investigates three aspects of partnership: the reasons why organisations partner, the resources they allocate to those partnerships, and the competencies used by the people managing the partnerships. How these three partnership aspects influence each other and the effect of that on the partnerships is also explored. The study focuses on the ‘partnership’ rather than the ‘co-existence’ end of Craig and Courtney’s (2004) continuum where elements such as working from agreed values, sharing resources and decision making, and developing systems to support the partnership will be evident. Two partnerships were selected as case studies. Data came from semi-structured interviews with seven participants from five partner organisations. The literature provided a framework for analysing the interview data in relation to the three aspects of partnership. This framework led to the identification of four new motivational factors, two new resource allocations and two new competencies. The literature also provided six theories that help explain partnership motivations. In addition to the three aspects (motivation, resources, and competencies) of partnership, it became clear that these things made a difference: · the term used to describe what they were doing – collaboration or partnership, · the context, · the presence of trust and goodwill, · voluntary participation in partnership, and · the level of formality. The findings demonstrated that the motivation to partner at all was the most important of the three aspects of partnership. It influenced resource allocations and the competencies used by partnership managers. Resource allocations did not influence the motivation to partner but influenced the competencies used by the partnership managers. And the competencies used by the partnership managers influenced the resources allocated by organisations but generally did not influence the motivation to partner. The findings add to our knowledge about nonprofit-nonprofit partnership and will help people to plan partnerships. I also propose five areas for further research: · factors that influence formality, · factors that prevent nonprofit partnership, · role of competencies in motivating partnership, · quantity of resources and the impact on outcomes, and · ownership of intellectual property.

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Exploring partnerships between nonprofit organisations in New Zealand

10.26686/wgtn.17005984 ◽

2021 ◽

Author(s):

◽

Nicola Joy Sutton

Keyword(s):

Decision Making ◽

New Zealand ◽

Voluntary Participation ◽

Resource Allocations ◽

Structured Interviews ◽

Nonprofit Organisations ◽

Nonprofit Partnership ◽

The People ◽

The Impact

Nonprofit partnership with government and with business is well documented in the literature. However partnership between nonprofit organisations has largely been ignored. This research focuses on such New Zealand partnerships. It investigates three aspects of partnership: the reasons why organisations partner, the resources they allocate to those partnerships, and the competencies used by the people managing the partnerships. How these three partnership aspects influence each other and the effect of that on the partnerships is also explored. The study focuses on the ‘partnership’ rather than the ‘co-existence’ end of Craig and Courtney’s (2004) continuum where elements such as working from agreed values, sharing resources and decision making, and developing systems to support the partnership will be evident. Two partnerships were selected as case studies. Data came from semi-structured interviews with seven participants from five partner organisations. The literature provided a framework for analysing the interview data in relation to the three aspects of partnership. This framework led to the identification of four new motivational factors, two new resource allocations and two new competencies. The literature also provided six theories that help explain partnership motivations. In addition to the three aspects (motivation, resources, and competencies) of partnership, it became clear that these things made a difference: · the term used to describe what they were doing – collaboration or partnership, · the context, · the presence of trust and goodwill, · voluntary participation in partnership, and · the level of formality. The findings demonstrated that the motivation to partner at all was the most important of the three aspects of partnership. It influenced resource allocations and the competencies used by partnership managers. Resource allocations did not influence the motivation to partner but influenced the competencies used by the partnership managers. And the competencies used by the partnership managers influenced the resources allocated by organisations but generally did not influence the motivation to partner. The findings add to our knowledge about nonprofit-nonprofit partnership and will help people to plan partnerships. I also propose five areas for further research: · factors that influence formality, · factors that prevent nonprofit partnership, · role of competencies in motivating partnership, · quantity of resources and the impact on outcomes, and · ownership of intellectual property.

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