23 research outputs found

    A bridge between: Te Ao Māori and Te Ara Paerangi

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    Purpose Aotearoa New Zealand’s Research, Science and Innovation (RSI) system is undergoing a ‘once in a generation’ reform known as Te Ara Paerangi Future Pathways (TAP). One of TAP’s four high-level goals is to embed Te Tiriti o Waitangi across the RSI system. Using the analogy of bridge-making, we draw on insights from Māori submissions to TAP to identify collective Māori expectations for what a Tiriti-embedded system entails. Method Submissions were accessed through the document library on the Ministry of Business, Innovation and Employment website. 34 submissions from individuals and collectives were identified as Māori. Qualitative Document Analysis was used to identify major themes. Results Results are described with reference to basic bridge-building principles of design, foundations, materials and maintenance. Key thematic findings include: Māori, as Tiriti partners, must be meaningfully involved in the reform design; the RSI system’s foundations are deeply colonial - decolonisation is needed to value, respect and protect Māori knowledges and knowledge-holders; workforce development, infrastructure and policies are required to empower partnered and autonomous RSI approaches; and, ongoing system maintenance in the form of monitoring is required to ensure transparency, accountability and equitable benefits. Reflection Having committed to embedding Te Tiriti across the RSI system, MBIE now has a duty of care to deliver on its commitment vis-Ă -vis the National Research Priorities. This paper is a timely opportunity to set a baseline of collective expectations against which to assess the future efficacy of TAP. Ka mahi mātou, me te takune hei puananÄ« We will work with the intent to travel freely in any directio

    Curricular initiatives that enhance student knowledge and perceptions of sexual and gender minority groups: a critical interpretive synthesis

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    Background: There is no accepted best practice for optimizing tertiary student knowledge, perceptions, and skills to care for sexual and gender diverse groups. The objective of this research was to synthesize the relevant literature regarding effective curricular initiatives designed to enhance tertiary level student knowledge, perceptions, and skills to care for sexual and gender diverse populations.Methods: A modified Critical Interpretive Synthesis using a systematic search strategy was conducted in 2015. This method was chosen to synthesize the relevant qualitative and quantitative literature as it allows for the depth and breadth of information to be captured and new constructs to be illuminated. Databases searched include AMED, CINAHL EBM Reviews, ERIC, Ovid MEDLINE, Ovid Nursing Database, PsychInfo, and Google Scholar. Results: Thirty-one articles were included in this review. Curricular initiatives ranging from discrete to multimodal approaches have been implemented. Successful initiatives included discrete sessions with time for processing, and multi-modal strategies. Multi-modal approaches that encouraged awareness of one’s lens and privilege in conjunction with facilitated communication seemed the most effective.Conclusions: The literature is limited to the evaluation of explicit curricula. The wider cultural competence literature offers further insight by highlighting the importance of broad and embedded forces including social influences, the institutional climate, and the implicit, or hidden, curriculum. A combined interpretation of the complementary cultural competence and sexual and gender diversity literature provides a novel understanding of the optimal content and context for the delivery of a successful curricular initiative

    Te Aka Roa o Te Oranga, the far reaching vines of wellness: The development of a framework to evaluate alcohol and drug treatment for Māori

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    The impact of alcohol and other drug problems for Māori is well documented. Substance use has been implicated in a range of physical and mental health problems, and a variety of negative social statistics such as high rates of imprisonment. To date there has been little systematic documentation of treatment practices, and limited operationalisation of Māori health frameworks. The evaluation of the outcomes of alcohol and other drug treatments is an area in which there is a paucity of documentation, in terms of methods and frameworks for evaluation, and actual data. Te Aka Roa O Te Oranga (TAROTO) was developed from a range of projects undertaken by the National Addiction Centre. The TARATO evaluation framework embraces a holistic perspective: developed to examine the interaction between the client, whānau, practitioner, and service/organisation. The aim of the framework is to clarify the complex relationships and interactions between stakeholders within the context of treatment. It will also help to elucidate the strengths and weaknesses of individual services. Within this framework, a range of indicators and outcomes of “successful treatment” will be explored. The current project is the first phase of a broader project that will make a significant contribution to improvements in Māori health via further developing effective treatments of alcohol and other drug related problems

    Stakeholders’ Perspectives on the Quality of End-of-Life Health Care Services for Chronic Obstructive Airways Disease: A Focus Group Study

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    Introduction: Delivery of end-of-life care for severe chronic obstructive pulmonary disease (COPD) has been hampered by an unpredictable disease trajectory and poor integration of health care and social services. Objective: To critically explore the perspectives, values, and experiences of stakeholders in COPD end-of-life healthcare services in a large district in Aotearoa New Zealand. Design: Focus groups analysed utilising critical theory and Actor-Network Theory. Methods: Stakeholders in end-of-life COPD healthcare services were purposively sampled from a large healthcare network in Canterbury, Aotearoa New Zealand to participate in seven focus groups (bereaved carers, community-based health professionals, non-Māori, non-Pacific patients, and support people (two groups), Māori patients, supporters and health professionals, Pacific patients, support people and health professionals, and hospital-based health professionals). Participants discussed end-of-life care services for people with COPD. Transcripts were coded utilising descriptive and structural coding to develop themes related to provision of quality care. Participants were positioned as experts. We considered how the themes arising supported and disrupted the healthcare network for end-of-life COPD. Results: Five themes related to quality of care for end-of-life COPD were identified: compassion, competence, community, commitment, and collaboration. The absence of any of these five themes required for quality care led to power imbalances within healthcare systems. Power inequities created disconnection among stakeholders which then disrupted commitment, community, and collaboration. A dysfunctional healthcare network impeded compassion between stakeholders and did not support their competence, leading to lower quality care. All five themes were identified as essential to delivery of high-quality end-of-life care in COPD. Conclusion: Stakeholders’ perspectives of end-of-life care for COPD identified of core features of a health system network that enabled or impeded the actions of stakeholders and allocation of resources to provide quality care

    Rauaroha: He tohu Aroha rau i te akoranga

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    Nö te tau 2001 i whakatĂŒria ai e Ako Aotearoa (National Centre for Tertiary Teaching Excellence) tĂ«tahi tohu hei whakanui i ngĂ€ mahi a te tangata e whakaako ana i te taumata takiura. Me whakaatu te kaiwhiwhi tohu i tana ĂŒ roa ki ngĂ€ taumata tiketike rawa i tana mahi whakaako. Tekau mĂ€ rua ngĂ€ kaiwhiwhi toa i ia tau, kĂ€tahi ka whiriwhirihia ai e tĂ«tahi kömiti kaiwhakawĂ€ kia kotahi te tangata e whiwhi nei i te Tohu Tiketike o te Pirimia. Mö ngĂ€ tau e whĂ€ kua hipa ake nei i riro i ngĂ€ kaiako MĂ€ori te tohu tiketike nei. Ko te aronga o tĂ«nei tuhinga he whakaatu i ngĂ€ Ă€huatanga o Ă«nei kaiako kia mĂ€rama pai atu ai te whakaaro tiketike o te MĂ€ori ki tĂ«nei mea te ako

    Educating for Indigenous health equity: An international consensus statement

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    The determinants of health inequities between Indigenous and non-Indigenous populations include factors amenable to medical education’s influence, for example, the competence of the medical workforce to provide effective and equitable care to Indigenous populations. Medical education institutions have an important role to play in eliminating these inequities. However, there is evidence that medical education is not adequately fulfilling this role, and in fact may be complicit in perpetuating inequities. This article seeks to examine the factors underpinning medical education’s role in Indigenous health inequity, in order to inform interventions to address these factors. The authors developed a consensus statement that synthesizes evidence from research, evaluation, and the collective experience of an international research collaboration including experts in Indigenous medical education. The statement describes foundational processes that limit Indigenous health development in medical education and articulates key principles that can be applied at multiple levels to advance Indigenous health equity. The authors recognize colonization, racism, and privilege as fundamental determinants of Indigenous health that are also deeply embedded in Western medical education. In order to contribute effectively to Indigenous health development, medical education institutions must engage in decolonization processes and address racism and privilege at curricular and institutional levels. Indigenous health curricula must be formalized and comprehensive, and must be consistently reinforced in all educational environments. Institutions’ responsibilities extend to advocacy for health system and broader societal reform to reduce and eliminate health inequities. These activities must be adequately resourced and underpinned by investment in infrastructure and Indigenous leadership

    Protocol for Improving Care by FAster risk-STratification through use of high sensitivity point-of-care troponin in patients presenting with possible acute coronary syndrome in the EmeRgency department (ICare-FASTER):a stepped-wedge cluster randomised quality improvement initiative

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    Introduction Clinical assessment in emergency departments (EDs) for possible acute myocardial infarction (AMI) requires at least one cardiac troponin (cTn) blood test. The turn-around time from blood draw to posting results in the clinical portal for central laboratory analysers is ~1–2 hours. New generation, high-sensitivity, point-of-care cardiac troponin I (POC-cTnI) assays use whole blood on a bedside (or near bedside) analyser that provides a rapid (8 min) result. This may expedite clinical decision-making and reduce length of stay. Our purpose is to determine if utilisation of a POC-cTnI testing reduces ED length of stay. We also aim to establish an optimised implementation process for the amended clinical pathway.Methods and analysis This quality improvement initiative has a pragmatic multihospital stepped-wedge cross-sectional cluster randomised design. Consecutive patients presenting to the ED with symptoms suggestive of possible AMI and having a cTn test will be included. Clusters (comprising one or two hospitals each) will change from their usual-care pathway to an amended pathway using POC-cTnI—the ‘intervention’. The dates of change will be randomised. Changes occur at 1 month intervals, with a minimum 2 month ‘run-in’ period. The intervention pathway will use a POC-cTnI measurement as an alternate to the laboratory-based cTn measurement. Clinical decision-making steps and logic will otherwise remain unchanged. The POC-cTnI is the Siemens (Erlangen Germany) Atellica VTLi high-sensitivity cTnI assay. The primary outcome is ED length of stay. The safety outcome is cardiac death or AMI within 30 days for patients discharged directly from the ED.Ethics and dissemination Ethics approval has been granted by the New Zealand Southern Health and Disability Ethics Committee, reference 21/STH/9. Results will be published in a peer-reviewed journal. Lay and academic presentations will be made. Māori-specific results will be disseminated to Māori stakeholders.Trial registration number ACTRN12619001189112

    "As natural as learning pathology" The design, implementation and impact of indigenous health curriucula within medical schools.

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    Initially drawing on the field of cultural safety and cultural competency, indigenous health has developed as a subject in its own right, defined from the perspective of indigenous populations. Current Australian and Aotearoa/New Zealand medical school accreditation processes require culturally responsive curricula and initiatives for indigenous peoples. To date, there has been little evidence to demonstrate whether medical schools are implementing and/or evaluating indigenous health curriculum. A Kaupapa Māori research theoretical framework was used to ensure an indigenous agenda was presented within the field of medical education. Two phases were employed: Phase one surveyed multiple medical sites in a case study (multiple sites bound by the concept of indigenous health curriculum), while phase two involved multiple stakeholders within one medical school site (multiple perspectives of indigenous health curriculum bound by one site). Semi-structured interviews were used to explore the same six subject areas of the medical school’s indigenous health curriculum across all stakeholder groups. Inductive analysis was used to encode and order the qualitative data. Data collected from quantitative surveys from each medical school site were collated and a comparative analysis presented. The findings revealed that the design of an indigenous health curriculum is highly influenced by the level of systems support, the recognition of the role of the indigenous community and the role of an indigenous health framework. The implementation of an indigenous health curriculum is characterised by a sequential method of delivery and the role given to stakeholders. The findings suggest that meaningful engagement with an indigenous community promotes transformative education and that such an approach has positive impacts on health care. As a result of the research three specific evaluation frameworks are proposed. Framework one provides the components necessary to map an indigenous health curriculum. Framework two documents a method to determine what constructive alignment looks like in an indigenous health curriculum, and framework three highlights the process by which engagement with indigenous stakeholders promotes a model of social accountability between the medical school and the indigenous community. This research argues for the use of evaluation frameworks that are able to draw on the complex interactions between variables that influence the design, implementation and evaluation of indigenous health curricula. The importance of an indigenous health framework as a core component of an indigenous health curriculum, which promotes transformative practice and community investment within a medical school and broader health environment is noted. This research also offers a counter narrative to those documented within the literature of negative health experiences by indigenous communities. This research found that an indigenous health medical curriculum can be a vehicle to promote positive health experiences as indigenous community members are re-positioned as key health stakeholders and experts in indigenous health, as opposed to solely ‘recipients’ of health care

    "As natural as learning pathology" The design, implementation and impact of indigenous health curriucula within medical schools.

    No full text
    Initially drawing on the field of cultural safety and cultural competency, indigenous health has developed as a subject in its own right, defined from the perspective of indigenous populations. Current Australian and Aotearoa/New Zealand medical school accreditation processes require culturally responsive curricula and initiatives for indigenous peoples. To date, there has been little evidence to demonstrate whether medical schools are implementing and/or evaluating indigenous health curriculum. A Kaupapa Māori research theoretical framework was used to ensure an indigenous agenda was presented within the field of medical education. Two phases were employed: Phase one surveyed multiple medical sites in a case study (multiple sites bound by the concept of indigenous health curriculum), while phase two involved multiple stakeholders within one medical school site (multiple perspectives of indigenous health curriculum bound by one site). Semi-structured interviews were used to explore the same six subject areas of the medical school’s indigenous health curriculum across all stakeholder groups. Inductive analysis was used to encode and order the qualitative data. Data collected from quantitative surveys from each medical school site were collated and a comparative analysis presented. The findings revealed that the design of an indigenous health curriculum is highly influenced by the level of systems support, the recognition of the role of the indigenous community and the role of an indigenous health framework. The implementation of an indigenous health curriculum is characterised by a sequential method of delivery and the role given to stakeholders. The findings suggest that meaningful engagement with an indigenous community promotes transformative education and that such an approach has positive impacts on health care. As a result of the research three specific evaluation frameworks are proposed. Framework one provides the components necessary to map an indigenous health curriculum. Framework two documents a method to determine what constructive alignment looks like in an indigenous health curriculum, and framework three highlights the process by which engagement with indigenous stakeholders promotes a model of social accountability between the medical school and the indigenous community. This research argues for the use of evaluation frameworks that are able to draw on the complex interactions between variables that influence the design, implementation and evaluation of indigenous health curricula. The importance of an indigenous health framework as a core component of an indigenous health curriculum, which promotes transformative practice and community investment within a medical school and broader health environment is noted. This research also offers a counter narrative to those documented within the literature of negative health experiences by indigenous communities. This research found that an indigenous health medical curriculum can be a vehicle to promote positive health experiences as indigenous community members are re-positioned as key health stakeholders and experts in indigenous health, as opposed to solely ‘recipients’ of health care

    Severe COPD and the transition to a palliative approach

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    Patients with severe chronic obstructive pulmonary disease (COPD) have a chaotic trajectory towards death. Research has focused on identifying a “transition point” that would allow identification of those patients who may benefit from a palliative approach to their care, or referral to a specialist palliative care service. This article aims to outline difficulties in identifying this transition point, summarise current literature on this topic and suggests a model based on clinical milestones. Educational aims To outline the difficulties associated with identifying patients with severe COPD who are at risk of dying. To summarise current research on this topic. Key points A specific transition point is difficult to identify in severe COPD. Tools are available that may assist the physician in identifying those at risk of dying. It is essential that the patient voice is heard, patients can describe specific events that may be used as a “trigger” for a palliative approach. Specialist palliative care services may only be required for a subgroup of patients whose needs cannot be managed by the primary care team
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