Health Sciences Dissertations and Theses

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    In a perfect world Emergency Department Screening and Brief Interventions for heavy and hazardous use of substances : a feasibility study
    (2016) Travers, Kylie A.; Unitec Institute of Technology
    Screening and Brief Intervention (SBI) is an evidence based technique for reducing heavy and harmful consumption of alcohol and other drugs. There is significant evidence for both the efficacy and the effectiveness of SBI. SBI has been shown to be effective in emergency departments (EDs) in a variety of different countries. The feasibility of SBI in the ED, however, remains contentious and no studies have been done on this area in a New Zealand ED. For this feasibility study, eight experienced ED nurses attempted to provide SBI to as many of their patients as possible over a one month period, using the ASSIST-Lite screening tool (Ali, Meena, Eastwood, Richards, & Marsden, 2013). The patient’s charts were audited to see how many actually received the SBI. Of 390 eligible patients only 46 (41 screened plus five who declined) were given the opportunity to participate, equating to 11.79% of the patients who were in the care of the participating nurses. Thirteen of these patients screened positive and received a formal Brief Intervention, and another patient received information about Community Alcohol and Drug Services. There was an inverse correlation between the number of patients presenting to the ED and the average number of screenings undertaken by each nurse participant per day. Following the data collection period the nurse participants were interviewed about their experience. Semi-structured interviews with the nurse participants revealed three main themes: 1) the nurses attitudes towards SBI, 2) Working conditions, and 3) the ED environment. It was concluded that high patient numbers compared to the number of nursing staff in the ED currently precludes nurses from providing consistent SBI to all eligible patients in the ED, however, the benefits of SBI are recognised by them. With higher staffing levels, ED SBI may be feasible and of benefit to individuals, to the ED and to society.
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    The cardiac sonographer workforce impacts upon the inequity of provision of echocardiography within New Zealand
    (2015) Lewis (née Buckley), Belinda; Unitec Institute of Technology
    AIM: To identify population based regional provision of echocardiography provision within New Zealand (NZ) public hospitals. The relationship between the cardiac sonographer workforce size, demographics and capacity will be explored to better understand the regional provisions. METHODS: In March 2013 surveys were distributed to 18 public hospitals with a sonographer led echocardiography service, return rate was 100%. Questions related to sonographer workforce size and demographics, workflow processes and echo volumes. Information on District Health Board (DHB) population was obtained from government public access websites. Multivariable linear regression was performed using DHB population characteristics and workforce demographics to determine their potential contribution to echocardiogram volume. Workforce capacity was calculated from scan duration, annual scan volumes, workforce size and availability and compared to predictions using international models. RESULTS: There are 84 cardiac sonographers in NZ, 14 of them trainees. The total full-time equivalent (FTE) of cardiac sonographers is 70.4; echo FTE was 61.9 with 75% of the workforce performing echo as the only component of their role. Thirty-one (44.3%) qualified sonographers and 10 trainees (71.4%) are titled cardiac sonographer or echocardiographer. Sixty-eight (81%) cardiac sonographers have a cardiac physiology background. Thirty-five (50%) qualified cardiac sonographers hold Australasian echo qualifications. Significant regional differences in echocardiogram volumes per 100,000 population were seen amongst DHBs but not between surgical and regional centres (surgical median 1802, regional median 1658, p=0.18). There were also wide regional differences in the workforce size (FTE) per 100,000 of population served unrelated to centre type (median 1.4, range 0.9-2.7). In multivariable modelling, the population based scan volumes were predicted by DHB demographics (socioeconomic status, Māori/Pacific ethnicity and age) and workforce demographics (workforce size, centre type, trainee proportion). There were regional differences in both population-based clinical capacity and scan duration, with no clear relationship to centre type. The NZ workforce capacity is similar to predictions using a UK model, and consistently less than the USA model for all scan types. CONCLUSION: This study demonstrates regional differences in the provision of echocardiography services in NZ by population-based echo volumes. The echo volumes are impacted by both DHB demographics and the cardiac sonographer workforce size, demographics and clinical capacity. This study also provides an update on the cardiac sonographer workforce which will be essential for planning the future growth.
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    ‘Flying under the Radar’ : the experiences and perceptions of Lesbian, Gay, Bisexual, Transgender, Intersex and Questioning students and how they differed from heterosexual experiences and perceptions of the campus climate at Unitec Campus in New Zealand in 2012
    (2013) Woods, Toni; Unitec Institute of Technology
    The purpose of this study was to determine the perception of students in regard to the campus climate as it affected Lesbian, Gay, Bisexual, Transgender, Intersex and Questioning (LGBTIQ) students at Unitec Institute of Technology (Unitec), in New Zealand in 2012 and whether this perception differed between heterosexual and LGBTIQ students. An online questionnaire incorporating both quantitative and qualitative type questions was developed utilising Sue Rankin’s (2003) national campus climate assessment questionnaire. The questionnaire was modified to reflect the New Zealand context and the Unitec campus. The population was drawn from the entire student body and consisted of those students who were enrolled to study at Unitec in August 2012 and had a current student email account (11,446 students). A link to the questionnaire was emailed to these 11,446 students. Three hundred and fifty-five students completed the questionnaire; 195 identified as heterosexual and 145 identified as LGBTIQ. While the findings of the study indicate that, overall, most students, both heterosexual and LGBTIQ, spoke positively regarding their experiences of studying at Unitec. The research did uncover some differences between the campus climate perceptions of LGBTIQ students and those of heterosexual students. Analysis revealed that LGBTIQ students experienced a level of invisibility and had a strong desire for a sense of community with other LGBTIQ students. They also revealed a reluctance to be “fully out”, both professionally and personally, on the Unitec campus. The theme of non-disclosure appeared to be related to perceptions of fear regarding sexual orientation. The data from this research suggests that, while the students who identified as heterosexual felt LGBTIQ identity was a non-issue, and were largely uncertain if LGBTIQ students were harassed on the Unitec campus, both heterosexual and LGBTIQ students identified uncertainty regarding institutional responses, policies, resources and curriculum for LGBTIQ students on campus The results of this survey may be utilised to impact on the focus and delivery of student services for LGBTIQ Unitec students, staff training and diversity initiatives at Unitec. Future opportunities exist to utilise this study as a baseline Unitec campus climate assessment for LGBTIQ students
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    A meta-analysis of the prevalence of lower limb asymptomatic bone stress injuries in athletes and military personnel
    (2014) Mills, Rebecca; Unitec Institute of Technology
    Bone stress injuries (BSI) appear to be widely accepted throughout the medical and sports world, although the importance of asymptomatic injuries remain unclear and their clinical relevance questionable. OBJECTIVES: To determine the prevalence of asymptomatic BSI in the lower limb using a systematic review of the published literature, secondly to identify any differences between athletic and military populations in the prevalence of lower limb asymptomatic BSI and finally to highlight the locations in the lower limb with the highest prevalence. SUBJECTS AND METHODS: An electronic database search was conducted using two databases: PubMed and Medline. Two observers independently systematically reviewed these data, assessing the studies against pre-determined criteria. The number of subjects BSI, location and imaging modalities were subsequently extracted from the selected studies. A mixed model analysis with random effect was used to calculate prevalence rates, confidence intervals and p values. RESULTS: The overall prevalence rate of asymptomatic BSI was 27/100 from all studies (military, athletes and civilian). Athletes had a significantly higher prevalence of asymptomatic BSI 75/100 than military personnel 28/100 (p= 0.0065), although the overall rates of BSI were not significantly different between these populations. The tibia was the most prevalent site for both symptomatic and asymptomatic BSI with 9.3 and 7.7 per 100 patients respectively and there was a significant difference between symptomatic (0.3/100) and asymptomatic (28/100) BSI in the tarsal bones (p=0.049) and in the fibula, 2.4/100 symptomatic and 6.8/100 asymptomatic (p=0.024). CONCLUSION: Although a number of studies identified the existence of asymptomatic BSI, most failed to provide adequate follow-up in order for their clinical significance to be properly assessed and thus it is difficult to postulate the clinical significance of the 27/100 prevalence rate given a lack of empirical evidence. The higher prevalence of asymptomatic BSI in athletes is probably multifactorial with training history, motivation, fitness levels and sampling bias all possibly explaining some or all of this higher rate.
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    Leadership in radiography : exploring radiographers’ experiences in leadership
    (2013) Sithole, Sophie-Jane; Unitec Institute of Technology
    The roles of health professionals including radiographers, are evolving due to technological advancements, globalization, economic recession and an increased aging population. Leadership has been highlighted in literature that discusses the changing role of radiographers as being an essential component that professionals should have and practise, whether in clinical practice, research or education. It is within the changing context of increasing emphasis on leadership that this study sets out to explore leadership in radiography through the lived experiences of radiographers in the Wellington region of New Zealand. The study is guided by the values of descriptive phenomenology; in particular the philosopher Edmund Husserl. Amedeo Giorgi’s modified scientific phenomenological method was employed for data analysis. Individual interviews and focus groups were used for data collection. The individual interview participants (n=5) were radiographers from the public and private sector. Three held formal leadership roles and the other two participants had no formal leadership roles. A leader from one of the sites, although having no radiography background was also included as a participant. The participants from the two focus groups were radiographers (n=6) and student radiographers (n=5) from the public sector, all with no formal leadership roles. The findings of the study indicate that the themes, besides being interlinked, also build on each other. The following themes emerged from the study: definition, identity, relationship, characteristics, types and styles of leadership and followership styles, perceptions, expectations and ideal leadership, context and appointment, promotion and leadership development. These findings contribute knowledge and understanding of the lived experiences of leadership in radiography. It is anticipated that the findings may inform a wider study on leadership in radiography and inform future leadership development strategies for radiographers in New Zealand.