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    Embodied Energy Consumption in the Residential Sector: A Case Study of Affordable Housing
    (MDPI (Basel, Switzerland), 2022-04-22) Anderson N; Wedawatta G; Rathnayake I; Domingo N; Azizi Z; Muldoon-Smith K; Kumar B; Singh SP
    Embodied energy has a significant effect on the total environmental impact of a project. However, emphasis is often placed primarily on operational energy, resulting in a knowledge gap about the current state of embodied energy use in affordable housing. To address this, the study investigates the level of embodied energy consumption in affordable housing, as well as the drivers, barriers, and techniques to reduce embodied energy. Based on a single embedded case study covering the period from cradle to end of construction, data were collected using embodied energy calculations of three affordable housing units in the project, semi-structured interviews with five design team members, and a cross-examination of findings with contract documents. The results were analysed using sensitivity analysis and thematic analysis. The findings revealed that all three house units fulfilled the baseline embodied carbon target of 800 kg CO2 /m2 and both detached properties fell within the LETI (2020) target of 500 kg CO2 /m2 . However, all three properties would fail to meet the RIBA or 2030 LETI target of 300 kg CO2 /m2 . This suggests that improvements are necessary to achieve future targets. The results show that financial capabilities and operational energy prioritisation act as the main enabler and barrier for reducing embodied energy. Local contractors/suppliers, minimising material use or intensity, and modular construction were highlighted as the key reduction techniques that can be used to help achieve future targets concerning embodied carbon in residential developments. The study contributes significantly to understanding the current state of embodied energy use in affordable housing and provides new insights on how to deal with embodied energy if we are to meet future energy targets.
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    The key factors driving successful improvement in primary care : a mixed methods investigation of the determinants of quality improvement success in Aotearoa New Zealand : a thesis with publication presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy, Massey University, Palmerston North, Aotearoa New Zealand
    (Massey University, 2023-11-30) Cullen, Jane
    Primary care is where the population receives most of their health care and where successful quality improvement (QI) can have the biggest impact on health, wellbeing, equity, and health system performance. A better understanding of the factors that influence QI in primary care is urgently needed to support a high-performing primary healthcare system. Most prior studies into the determinants of effective QI have focused on secondary care organisations and large-scale collaborative efforts. Primary care services such as general practice present a different set of challenges. Various key contextual factors have been identified in the literature, but few studies explain how they relate to each other and QI success. This study sought to answer the following questions: 1. What are the contextual factors influencing primary care improvement interventions? 2. How do the contextual factors, improvement content (topic and planned changes) and the implementation process influence each other and the improvement outcomes in primary care? 3. How applicable for primary care assessment is the Model for Understanding Success in Quality (MUSIQ), a tool for assessing modifiable contextual factors developed in secondary care? This research was an explanatory sequential mixed methods study based in the Aotearoa, New Zealand (NZ) primary care setting of general practice and Primary Health Organisations (PHOs). Amulti-case mixed methods approach was followed in the first stage. Mainly qualitative data were collected from primary care interviews guided by the Consolidated Framework for Implementation Research (CFIR). This was compared with quantitative data from the MUSIQ survey. The second stage consisted of a national survey where emerging theory was tested by partial least squares structural equation modelling (PLS-SEM). The findings revealed that most teams did not use formal QI methods, instead relying on their people-centred relationship skills and networks to drive QI via distributed leadership. Teams were intrinsically motivated by community and patient need and drew on strengths developed within the complexity and uncertainty of the primary care settings to drive QI. The collaborative skills which are increasingly required in the modern primary care setting support the shared social processes of sensemaking for enacting change. The key success factors driving QI in primary care are identified and how they relate to each other explained. A primary care adaptation of MUSIQ has been proposed that may aid improvement practitioners and researchers to assess primary care contexts. The key strengths should be developed and supported across primary care services and capability, capacity and resources supported centrally to increase the ability of primary care to improve services more easily and effectively.
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    Promoting nurses' and midwives' ethical responsibilities towards vulnerable people: An alignment of research and clinical practice
    (John Wiley and Sons, Ltd, 2022-10) Baldwin A; Capper T; Harvey C; Willis E; Ferguson B; Browning N
    AIM: To stimulate discussion and debate about the inclusion of vulnerable populations in primary research to inform practice change and improve health outcomes. BACKGROUND: Current research practices to safeguard vulnerable people from potential harms related to power imbalances may in fact limit the generation of evidence-based practice. EVALUATION: The authors draw on their experience working and researching with a recognized group of vulnerable people, incarcerated pregnant women, to provide insight into the application of ethics in both research and clinical practice. In a novel approach, the ethical principles are presented in both contexts, articulating the synergies between them. Suggestions are presented for how individuals, managers and organizations may improve research opportunities for clinical practitioners and enhance the engagement of vulnerable people to contribute to meaningful practice and policy change. KEY ISSUES: Ethical practice guidelines may limit the ability to create meaningful change for vulnerable populations, who need authentic system change to achieve good health outcomes. CONCLUSION: Inclusive research and practice are essential to ensuring a strengths-based approach to healthcare and addressing health needs of the whole population. Health systems and models of care recognizing the diverse lives and health needs of the broader population demand practical, sustainable support from clinical managers. IMPLICATIONS FOR NURSING MANAGEMENT: Practical suggestions for clinical managers to support point of care research is provided, embedding vulnerable voices in policy, practice development and care provision.