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    Experiences of patients attending and participating in clinical nurse specialist-managed heart failure clinics : a thesis submitted to Massey University of Wellington in partial fulfillment of the requirements for the degree of Master of Philosophy (Nursing)
    (Massey University, 2007) Dewar, Suzanne Judith
    It is very clear from discussions with patients attending outpatient clinics, that nurse-led clinics fulfilled an important function in the holistic care of patients with heart failure. Previously the biomedical model of health care dominated the health system and was considered all that was required. Knowledge about health care has improved greatly and this is in keeping with patients' expectations in today's world of easy access to Internet information. Ongoing health care therefore, needs to meet the needs of these patients in the interests of improved quality of life in a population with a significant chronic illness. This research sits in the mixed method paradigm, however the focus is predominantly qualitative using exploratory narrative inquiry informed by Polkinghorne (1988) to gain a perception of the meaningfulness of patients' experience of nursing clinics. The aim of this research is to explore what is important to the patients; to explore what the patient's perceive as their needs when they attend or participate in Heart Failure Clinical Nurse Specialist (HFCNS) clinics; to describe the experiences of patients attending the HFCNS services with the aim of gathering information to develop and improve the health care of these patients. All patients attending the nurse-managed heart failure secondary care clinic over an eight-week period were invited to fill in a questionnaire. Fifty-five patients completed the form. The aim of the questionnaire was to describe the clinic population demographics. Three short answer questions were also included to give direction for the interviews that were to follow. The six participants for interview were chosen purposely to give a range of age, gender and ethnicity that would be representative of the clinic population. Key themes for the patients were identified and included: gaining knowledge; making changes; partnership/mentorship; ethnicity/cultural perceptions; and collegial collaboration/ professional care. The research gave a clear picture of the patients' perceptions of the reality of the experience of nurse-managed secondary care clinics. Issues to do with cultural safety as well as general care presented a multi- faceted and complex canvas. Furthermore knowledge of ethnicity and cultural mores shows a need for ongoing efforts to be innovative in reducing disparities that persist in Maori and Pacific peoples' health and wellness. Overall the evidence indicates that nurse-managed heart failure clinics show positive outcomes for patients' perceived needs and, fill what was a gap in care.
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    Evaluation of back education programme at the Medical Rehabilitation Unit, Palmerston North Hospital : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 1994) Williams, Mei Wah
    Chronic low back pain is a significant health care problem and is frequently one of the most difficult conditions to treat. For the individual, chronic low back pain evolves into a constellation of problems involving psychological and behavioural symptoms as a result of the recurrent pain. Numerous pain clinics have been established providing a multidisciplinary approach to the treatment of chronic pain. A considerable amount of evidence has attested to the efficacy of a comprehensive treatment approach for the management of chronic pain. Despite the support for pain clinics, many outcome studies have been plagued by methodological difficulties. The present study was designed to improve on previous methodological shortcomings and evaluate the efficacy of a multidisciplinary treatment for chronic back pain. The programme, carried out over four mornings per week for three weeks, was conducted in an outpatient clinic of a public hospital. Twenty-four patients consecutively referred to the pain clinic were randomly assigned to treatment and waitlist control conditions. The treatment group was assessed four times and the waitlist control group assessed six times throughout the study. The two groups were compared for differences on a variety of outcome measures on three separate occasions; at pretreatment, immediately after treatment and at follow-up. Outcome measures included self-reported pain intensity, mood, coping skills and physical disability; and objective measures of physical impairments. Multivariate analyses of variance (MANOVA) for outcome measures were carried out. Results suggested significant improvements were achieved after treatment in depression levels and muscle strength. No significant gains were reported in physical functioning such as everyday activities, flexibility, spinal functioning, or pain intensity. When assessed at follow-up six months later, the original gains in mood were maintained but a significant decline in muscle strength was reported. The goals of the programme to improve physical functioning and return to work were not achieved, thus predictions for the efficacy of the chronic back pain programme were not supported. Implications of these findings are discussed together with recommendations for improving outcomes, especially the importance of physical reactivation.
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    Outcome measures in brain injury rehabilitation : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 2004) Robinson, Christina Mary
    Brain injury rehabilitation services require competent measures of outcome to monitor the progress made by individuals in their care. The FIM + FAM is the measure most widely used for this purpose. However, research suggests that this measure contains a number of limitations and does not adequately assess the activity limitations and participation restrictions experienced by individuals who have suffered brain injuries. The current study examined five outcome measures (BICRO-39, MPAI-4, R-CHART, CIQ, and DRS) for their suitability as possible replacement measures at Cavit ABI in Wellington and Auckland. Ten participants with brain injuries (eight males, two females; seven with TBI, three with injuries due to stroke) were administered six different outcome measures by therapists at Cavit ABI centres in Wellington and Auckland on admission and again at six weeks into the rehabilitation programme. Outcome measures were examined in relation to a set of specified criteria, and feedback regarding the performance of each outcome measure was collected from each therapist using a staff questionnaire. The results of the study show that there does not seem to be one adequate outcome measure currently available for use within post-acute brain injury rehabilitation settings Although the FIM + FAM was found to contain a number of strengths particularly in assessing physical independence, the MPAI-4 was found to be more useful in identifying goals related to activity limitations and participation restrictions, which was the key area of focus.
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    Reframing everydayness: a grounded theory study of women's perceptions of the contribution of cardiac rehabilitation to their recovery from a heart attack : a thesis submitted in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University
    (Massey University, 2003) Day, Wendy K
    Coronary heart disease (CHD) is a serious health issue for women but, in the past, women have been under-represented in research related to this condition. Instead, research using male populations has been used as a basis for the diagnosis and treatment of CHD in women. This has resulted in men and women being treated the same despite the presence of physiological and social differences. To ensure future diagnosis and treatment is based on appropriate research related to women and CHD. Grounded theory was used to explore women's perceptions of the contribution of cardiac rehabilitation to their recovery from a heart attack. The constant comparative method of data analysis was used to develop categories from the data. Overall the experience of suffering a heart attack caused disruption to everyday life and functioning. This included interruption to activities and social roles and shock at having suffered a heart attack. Recovery was characterised by 'reframing' their lives based on the alterations caused by their heart attack experience. The women in this study attempted to return to their everyday roles and responsibilities through the basic social process of "regaining everydayness". Most women did not recognise that they had received phase one cardiac rehabilitation, and although phase two cardiac rehabilitation met some of the education needs of the women in this study, it did not provide the support that all participants required. For some participants social needs were met by attending cardiac rehabilitation sessions. Phase two cardiac rehabilitation attendance was affected by transport, time, family and social issues, such as work commitments. Although some aspects of cardiac rehabilitation were beneficial for most participants, it did not appear to aid recovery for all of them.