Oral Presentations
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Item Emerald Muriwai - Maori culture and wellbeingMuriwai EEmerald Muriwai, Masters student from the New Zealand Attitudes and Values Study talks about her research assessing the buffering or protective function of cultural efficacy for Maori. This research was published in the New Zealand Journal of Psychology.Item Climate change, health, and psychology (Invited presentation: University of Auckland Health Psychology seminar series)Williams MClimate change is a problem that is caused by human behaviour, and that presents major risks to human health – including mental health. Psychology may have a crucial role to play in terms of investigating the health consequences of climate change, and also in terms of finding strategies to mitigate its extent. In this presentation, Matt will discuss some of his research on the effects of climate change on health and human behaviours such as assault, suicide, and self-harm. He will also discuss recent research on climate change communication and battling misinformation. Matt will argue that psychology could make a significant contribution to climate change research, but that producing effective and useful research on climate change may require psychologists to make significant changes to their standard research practices.Item Personal and contextual determinants of health for older rural AustraliansAllen J; Inder KJ; Lewin TJ; Attia J; Kelly BJItem Item Indwelling Catheter Care: Areas for Improvement(Sigma Theta Tau International Honour Society of Nursing, 13/07/2016) Gesmundo MHObjectives: To describe perioperative nurses? current attitude and indwelling catheter management practices, To analyse and identify areas of indwelling catheter care practice that require improvement in the light of existing evidence-based guidelines. Research Question: What areas of indwelling catheter care experience of perioperative nurses in a tertiary public hospital require improvement in the light of existing evidence-based guidelines? Design:'A qualitative research design using focus group discussions was utilised to answer the research question. The focus group discussions explored the perioperative staff nurses? attitude and indwelling catheter care experience and facilitated the identification of areas of practice that can be further improved in the light of existing evidence. Setting:' Two perioperative wards of a public tertiary hospital located in Auckland, New Zealand Participants: A convenience sample of staff nurses (n=13) from two perioperative wards were invited to participate in the focus group discussions. Study participation was voluntary, with utmost respect for human dignity and autonomy. Methods:'A qualitative approach utilising focused group discussions was done to gain insight into the nurses? attitude and indwelling catheter care experience. Thirteen (n = 13) nurses participated in the focus groups. Two focus groups were formed to facilitate the management of interviews. Seven nurses participated in the first focus group, whereas six participated in the second. The focus group discussions were organised on different dates to accommodate as many participants as possible without compromising patient care or safety. An interview prompt sheet was utilised as a guide in the focus group discussions which took approximately 45 minutes to complete. The proceedings were audio-recorded, transcribed and made accessible only to the researcher with due respect to confidentiality of information. Results:'The results of the two focus groups discussions were combined and four key themes were established, namely: preparation for catheter management, Nursing skills and knowledge, current clinical practice and catheter management resources. The focus groups revealed that the nurses did not always feel confident towards indwelling catheter management due to their lack of preparation or catheter care training. There was evidence of diversity in training and feelings of not being prepared properly during their undergraduate training due to the teaching method utilised, the time allotted for the training, the focus of the training itself and the lack of opportunity to practice catheter management skills to prevent CAUTI. These relate to feelings of insufficiency with regard to catheter care knowledge and lack of confidence with regard to catheter management skills. Diversity and deficiency in undergraduate education can be one of the reasons why nurses? practices vary thereby affecting the quality of patient care. Despite these challenges, nurses cope with the task by being resourceful and by asking colleagues for support. There are also recommendations to standardise in-service training programmes and organisational policies and procedures; and, to revisit undergraduate nursing programmes to emphasise infection prevention and control. The findings also suggest that nurses perceive catheter management as task-oriented, with the decision to insert, re-insert and remove a catheter being heavily reliant on doctors. There is, however, a growing recognition among nurses that they also make important patient care decisions. The existence of organisational protocols such as those related to catheter removal empowers nurses to make important nursing decisions. Revisiting organisational protocols also help nurses feel more confident in performing procedures. Nurses want to advocate for their patients? safety, thus increased confidence and empowerment facilitates nurses? assertion of evidence-based practices to minimise risks and improve their patient?s condition. Finally, nurses also expressed awareness of the importance of catheter care documentation. However, there is an apparent discrepancy in what the nurses expressed as recognition of the importance of documentation and actual documentation of patient care as evidenced by variability in actual documentation and failure to relate assessment findings with the patient?s health status. Standardised documentation of patient assessment and catheter status is recommended to improve the quality of documentation in relation to nursing assessment. Current clinical practice is characterised by collaborative care. While nurses were perceived to be mainly responsible for catheter insertion, maintenance and removal, doctors also need support in terms of recognising the unnecessary presence of a patient?s catheter. Nurses expressed that cognitively able patients play a role in catheter care. This makes patient care in the current research setting unique because of nurses? perception of patient involvement. Nurses perceive that they are responsible for educating and empowering patients to actively participate in their care. Catheter care also involves advocating for the patient?s interests. Nurses feel vulnerable and fear going against their patient?s preference when faced with circumstances that require ethical decision-making. Nurses are aware that in patient centred care, the patient?s moral, cultural and religious values need to be considered. Thus, nurses overcome this feeling of concern by maintaining an open communication with the patient. Nurses also identified their gender as a barrier to catheter care due to unwritten, agreed rules of behaviour that guide clinical practice. To remove this barrier without compromising patient preference, a standardised organisational policy on catheterisation has been recommended. Nurses also reported clinical practises that puts patient?s safety at risk and indicated poor knowledge and hence clinical practice. A multi-pronged approach in educating and addressing practice discrepancies has been recommended to improve nurses? knowledge and practise. Overall, clinical practice related to catheter care requires nursing skills, decision-making, critical thinking and a complete grasp of ethical principles. Finally, with regard to catheter management resources, nurses are aware that organisational policies on catheter management are available intranet, although some have concerns with locating it. Ease of access to policies and consistency with day to day workflow can potentially enhance nursing care. Support from colleagues also proves to be valuable when nurses cannot access policies. The nurses also reported that the existence of policies on catheter removal helped standardise the process itself and guided nurses in their decisions. For those who found the organisational policy not suitable for various types of patients, their expertise in the use of the nursing process and collaborative care helped them arrive at important decisions and interventions. Decision-support tools were recommended to be utilised as these facilitate decisions regarding deviations from specific organisational guidelines. While organisational policies facilitate decisions and nursing care, these do not replace nurses? knowledge and skills in providing quality patient care. Conclusion:'There are various areas in catheter care that can be improved further. These include: diversity in catheter care practise of which some may be of concern to patient safety; variability in actual documentation of care and failure to relate assessment findings with the patient?s health status; heavy reliance on doctors for the decision to insert, re-insert and remove a catheter; gender as a barrier to catheter care due to unwritten, agreed rules of behaviour that guide clinical practice; and difficulty in accessing organisational policies. Nurses have identified recommendations to address these concerns. These include: standardisation of in-service training programmes and organisational policies and procedures without compromising patient preference; standardisation of documentation of patient assessment and catheter status; empowerment of nurses through evidence-based protocols; multi-pronged approach in the delivery of in-service education; creation of policies that are consistent with day to day workflow and are easy to access; and utilisation of decision-support tools that address deviations from specific organisational guidelines.Item Impact of a Catheter-Associated Urinary Tract Infection (CAUTI) Education Package on Nurses' Knowledge, Attitude and Indwelling Catheter Management Practices(Sigma Theta Tau International Honour Society of Nursing, 17/03/2016) Gesmundo MHObjectives: 1. To identify staff nurses' current knowledge, attitudes and indwelling catheter management practices 2. To implement a catheter-associated urinary tract infection (CAUTI) education package on two surgical wards 3. To determine if a significant difference exists in the staff nurses' indwelling catheter management practices before and after the introduction of a CAUTI education package Research Question: What is the impact of a CAUTI education package on the knowledge, attitude and indwelling catheter management practices of nurses? Design:A descriptive design involving mixed methods approach was utilised to answer the research question. The methods used include focus group discussions that explore and describe nurses' attitude toward catheter care and CAUTI prevention; pre-test and a post-test to measure and compare the nurses' level of knowledge on CAUTI prevention; and document analysis of a catheter maintenance checklist to identify staff nurses' catheter management practices. Setting: Two surgical wards of a general district hospital located in Manukau City, Auckland, New Zealand Participants: A convenience sample of staff nurses (n=27) from the two surgical wards were invited to participate in the study through e-mail. Information about the research was discussed through flyers. Study participation was voluntary, with utmost respect for human dignity and autonomy. Methods:The study had three phases. The first phase utilised focus group discussions that involved the gathering of baseline data to determine nurses' knowledge and attitudes about catheter management and CAUTI prevention. The second phase involved the implementation of education sessions and utilised a pre and post-test to measure nurses' level of knowledge. The final phase or the evaluation phase identified the impact of the education package on the nurses' knowledge, attitudes and whether this was translated into practice. This phase utilised an evidence-based checklist that nurses complete daily given patients with urinary catheters. Results:A total of 13 staff nurses attended two focus group discussions. The focus group revealed that there is diversity in the undergraduate training experience and on-the-job training of nurses that relate to their catheter management practices. Another theme that emerged from the focus group is the nurses' awareness, access and use of organisational policies and guidelines which serve as a primary go-to guide when recalling information at work. The staff also highlighted that the quality of their current catheter care practice utilizes a collaborative approach, is dependent on the nursing process and is affected by the nurse's and the patient's gender. The nurses also verbalized that there is training required in the use of catheter management resources. Lastly, catheter care challenges such as gender, dementia in patients and ethical dilemma affect nurse's catheter management practices. Fourteen nurses attended the education session. For the pre and post-test, paired t-test was carried out in order to test for a significant difference in the overall score. Descriptive statistical analyses indicate that there is a significant difference (p < 0.0001) in the overall score between the pre and post-test, with a mean difference of 6.64 and 95% CI of (4.96, 8.33). Document analysis of the catheter maintenance checklist revealed that most of the post-surgery patients came to the ward with catheters already in, thus prompting the nurses to complete only the catheter maintenance part of the checklist and the catheter removal part if necessary. Majority of the patients also had their catheters removed on the first day and this is documented on the checklist. Noticeable also is the dwindling of numbers of completed checklists when the study period reached its fourth month. Conclusion:The CAUTI education package had a significant impact on the nurse's knowledge. While various factors affect catheter management practices, enhanced training will not only improve nurses' knowledge, but their practice as well. Catheter maintenance checklists serve as procedure prompts for nurses although dwindling of numbers may be expected as time passes by. This could be remedied by regularly reminding staff to complete the checklist and documentation. Finally, quality improvement initiatives on CAUTI prevention would help improve CAUTI rates and nurses' knowledge, skills and attitude toward catheter management.Item Plastic Pollution Prevention in Pacific Islands Countries(2/12/2020) Farrelly TKey findings from research conducted with ten Pacific Island waste management leaders. After identifying key policy gaps and the unique challenges facing each country, the participants and the research team offer recommendations to strengthen plastic pollution policy frameworks across the region.Item What Works to Improve Staff Compliance With Multi-Drug-Resistant Organism (MDRO) Screening(Sigma Theta Tau International Honor Society of Nursing, 22/06/2017) Hernandez MAWhat Works to Improve Staff Compliance with Multi-drug Resistant Organism (MDRO) Screening Monina H. Gesmundo, MN (Honours), PGDip HSc (Merit), PGCert Tertiary Teaching, BSN, RN, RM, CNS School of Nursing, Massey University, Auckland, New Zealand Purpose of the presentation: To present the evaluation of the effect of multi-modal interventions on the staff MDRO admission screening compliance rate in various departments of a tertiary public hospital in New Zealand Target Audience: The target audience of this presentation are staff nurses, nurse educators, nurse managers, quality improvement advisers and infection control practitioners who are keen to identify interventions that work in improving staff compliance to MDRO admission screening Objective: To evaluate the effect of multi-modal interventions on the staff MDRO admission screening compliance rate in various departments of a tertiary public hospital Research question: What is the effect of multi-modal infection prevention and control interventions on the staff MDRO admission screening compliance rate in various departments of a tertiary public hospital? Design: A retrospective review of monthly MDRO admission screening audits was done to compare the compliance rate before and after multi-modal interventions were implemented. The audit was conducted in the care of older people and elective surgical department of a public tertiary hospital in Auckland, New Zealand from December 2010 to November 2014. Setting: Two departments of a public tertiary hospital in Auckland, New Zealand Methods: Monthly MDRO admission screen audits were done in a representative ward of each department for the purpose of quality improvement. Audits were conducted by generating a monthly list of patients who were eligible to be screened for MDRO on admission to the ward. Twenty patients were randomly selected from the monhtly list for a specified period of time to evaluate whether nurses screened them for MDRO within 24 hours of admission. Eligibility to be screened is based on the criteria published in the organisational policy for MDRO management. Nursing staff compliance rate with the MDRO admission screen policy was computed using frequency and percentage. Multi-modal interventions focusing on the nursing staff were implemented by the infection control practitioner. Interventions include: monthly MDRO admission screen compliance audits, regular reporting of audit result, feedback with regard to missed screens, regular education sessions with the nursing staff and staff encouragement from both the infection control practitioner and nurse manager. Compliance rates were reported to the charge nurse managers on a monthly basis through an e-mail. Compliance rates of greater than 90% were celebrated and reinforced, whereas a drop in the compliance rate or a compliance rate of < 90% was followed up with the nurse manager. Regular 10-15 minute-education sessions during staff handovers were done by the infection control practitioner to present the audit results, to provide input, to answer queries and to encourage the staff to do better. Nurse managers also encourage staff to improve screening compliance rate. Data analysis utilized Microsoft Excel Software in quantitative data collation and encoding. MDRO admission screen audits were presented using descriptive statistics such as frequency, percentage, mean, median and mode. Standard deviation was used to show data variability. T-test was utilized to test for a significant difference in the overall compliance rate before and after the multi-modal interventions were introduced. T-test is a parametric procedure of testing the difference in group means. The level of significance was set at P < 0.05 to identify a significant difference in the compliance rate. Results: Results show that the MDRO admission screen compliance rate in the two departments were variable. The average compliance rate from October, 2012 to November, 2014 in the elective surgical department is 85.75% compared to 75.91% from December, 2010 to September, 2012 (Table 1). Table 1.MDRO admission screen compliance at the elective surgical department Surgical Department Before* After** Mean 75.90909091 Mean 85.75 Number of patient records audited 1670 Number of patient records audited 2058 Number of monthly audits completed 22 Number of monthly audits completed 24 *Period coverage is from December, 2010 to September, 2012 **Period coverage is from October, 2012 to November, 2014 In the care of older people department, results show that the MDRO admission screen compliance was also variable. The average MDRO admission screen compliance rate from August, 2013 to October, 2014 is 96.80% compared to 83.84% from December, 2010 to July 2013 (Table 2). Variability in the compliance may be due to patient acuity, staff mix, thorough history-taking of the patient, review of previous admissions, completeness of handover, staff knowledge of the organisational policy, staff motivation to adhere to organisational policy and availability of staff support. Table 2.MDRO admission screen compliance at the health of older people department Health of Older People Before*** After**** Mean 83.83870968 Mean 96.8 Number of patient records audited 2599 Number of patient records audited 1452 Number of monthly audits completed 31 Number of monthly audits completed 15 *** Period coverage is from December, 2010 to July 2013 ****Period coverage is from August, 2013 to October, 2014 Statistical analysis of the overall MDRO admission screening compliance rate before and after the interventions showed a significant difference (P < 0.05) in the compliance rate in both departments. A two-sample T-test with unequal variance was utilized in the statistical analysis given the variability in the screening rate and count. Table 3 provides a summary of the statistical testing done. The last column shows that there is a significant difference in the compliance rate in the surgical department (P < 0.009) and the care of older people department (P < 0.00003) Table 3.Descriptive summary of statistical testing of the MDRO admission screen compliance rate before and after the interventions Departments Before After T-Test (P < 0.05) Number of Audits Mean Compliance Rate Number of Audits Mean Compliance Rate Surgical Department 22 75.91 24 85.75 0.009324379 Care of Older People 31 83.84 15 96.80 0.000036141 Conclusion: The multi-modal interventions addressed to nurses had a significant impact on the MDRO admission screening compliance rate in various departments of a tertiary public hospital. While various factors may affect the staff MDRO admission screening compliance rate, the rate could be kept at a high level through regular audits, regular reporting of audit result, regular education sessions and consistent staff encouragement.
