Hospital information systems : a nursing viewpoint : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing Studies at Massey University

This thesis is concerned with hospital information systems. The literature relating to management information systems is examined in conjunction with the literature which specifically focuses upon hospital and nursing information systems. A field study, using a case study approach, is designed and implemented, its purpose being to analyse five sub-systems of a current hospital information system in use in one Hospital Board. This field study utilises a basic systems analysis methodology focusing upon the problem identification and performance identifications of the analysis cycle. In the problem identification phase forty-two subjects are interviewed, (83.3% of the sample being nurses in management positions). Check lists designed to test the sub-systems abilities to generate, store, retrieve and utilise data, and test the subjects knowledge of the sub-systems are devised and applied. The data obtained from the application of check lists is analysed and data flow charts and in-depth interview schedules developed for use in phase two or the performance identification phase of the field study. In phase two (performance identification) eleven subjects in administrative positions within the Hospital Board are interviewed using the data flow charts and the in-depth interview schedules as tools for eliciting data. Contrary to the author's expectations the field study results reveal a considerable diversity. In phase one the respondents possessed a sound knowledge of the admission/discharge, patient care and nursing management sub-systems. 85,7% of the nurse respondents have knowledge of the patient care sub-system and a further 79.2% have some knowledge of its ability to generate, store, retrieve and utilise information. In common with the administrators the high level of knowledge of retrieval and utlisation (89.2%) would indicate frequent use of the system. By contrast only 5.4% of the respondents in phase one had knowledge of retrieval and utilisation of the staffing information sub-system as compared with 100% in the administrators group. This same pattern emerges for the financial sub-system with 13.5% of the respondents having knowledge of retrieval and 18.9% of utilisation of the sub-system compared with 81.8% of administrators. These results indicate to the author that information systems development tends to be associated with each health discipline rather than with the macro development of a relevant, comprehensive hospital information system. To this end a series of questions are raised and possible answers provided. Finally a model which could become a prescription for future development is presented

Kaupapa hauora Māori : ngā whakaaro whakahirahira o ngā kaumātua : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Māori Studies at Te Pumanawa Hauora Research Centre for Māori Health and Development, Massey University, Wellington, Aotearoa/New Zealand

There is a requirement for all services within the New Zealand health system to be accredited with an established quality organisation and to demonstrate an ability to provide a measurable quality service to consumers. For Māori these requirements must make sense in Māori terms. This thesis is based on the view that, for Māori, the concept of health is more effectively expressed as hauora - optimal health and wellbeing for Māori. This thesis makes five contributions to Māori health and Māori health research. First, it identifies a responsive approach to engaging kaumātua effectively in the process of qualitative research. Second, it identifies a fundamental underlying conceptual framework – kaupapa hauora Māori as a means of understanding hauora – expressed in terms derived from kaumātua in Taranaki and Kahungunu. Third, it adapts this conceptual framework into an analytical research framework and then applies it to allow kaupapa hauora Māori (described in terms of worldview, values and ethics) to be identified from a range of data. Fourth, it critically analyses popular models of Māori health – Te Whare Tapa Whā, Te Wheke and Ngā Pou Mana. Finally, it proposes and details post-doctoral research that will translate kaupapa hauora Māori into a quality services framework/tool. “Kaupapa Hauora Māori” is a conceptual framework articulated by kaumātua, and has its origins in te ao Māori, from which the aronga or worldview is developed. The aronga is composed of the kaupapa or values and tikanga or ethics that provide kaumātua with the values base of hauora. These components have been identified by kaumātua and not only inform the concept of KHM but also inform the analytical research framework that is applied to the data. The values have been identified as a core set of values comprising whakapapa, wairua, whenua, whānau, tikanga te reo Māori, tinana, and hinengaro, and the associated tikanga is expressed as behaviour or ethics. These, together, influence the perception and understanding individuals have of their world and of hauora