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An Evaluation of Southlink Health's Practice Nurse Education Strategy

Southlink Health (SLH) is the largest Independent Practitioners Association in New Zealand’s South Island. About 24 months ago SLH identified the need for regular independent practice nurse education and implemented a practice nurse education strategy.

This study aimed to assess SLH’s practice nurse education strategy. A list of 150 of the 350 SLH practice nurses was randomly generated. The nurses were contacted by telephone and asked a series of questions that covered demographic details and involvement in, accessibility to and needs for ongoing nursing education. Results were coded and cross-tabulated using the SPSS statistical analysis programme.

Ninety-six nurses agreed to take part in this study. Forty-seven nurses did not take part in the study and seven either did not exist or appeared twice on the list.

The most significant findings were that nurses with less experience were less likely to attend education sessions, but when they did go, found the sessions more useful than the more experienced nurses.  Accessibility was limited by poor timing, being too busy, location, finding a locum, and financial constraints.  In particular, more than 50% of nurses from Southland, Queenstown, Waitaki, and the West Coast said the location of the education sessions was too far away.  Nurses from the West Coast and Central Lakes regions were less likely to attend any education sessions.  Nurses aged less than 40 were significantly more interested in internet education than older nurses. 

We have included a list of recommendations to SLH following the findings of this study.

Authors of Report

Sumitra Shankar, Glenys Tayles, Thuhairah Abdul Rahman, Saxon Smith, Matthew Boyd, Damir Azhar, Brian Scrimshaw

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Changing Times - Factors Which Influence Registrars' Decisions to Change Routine Clinical Practice

The aim of this study was to determine what factors influence registrars’ decisions to make changes to their routine clinical practice.

56 registrars employed by Health Care Otago were interviewed regarding changes they made to their routine clinical practice in the last six months, and the reasons that led them to change.  We also asked about their satisfaction with their clinical practice prior to, and after they made changes.

The registrars described 136 changes in seven areas, and gave 209 reasons which fell into 14 different categories.  The most common reasons were education (34%), professional contact (25%), clinical experience (20%), and organisational factors (9%). More than half (51%) of changes resulted in a practice that was more satisfying and only 10% resulted in less satisfying practice.

These results are discussed with respect to the literature.  Possible explanations and future research directions are also proposed.

Authors of Report

Craig Collie, Anna Gilmour, Hamish Gray, Tineke Iversen, Gillian Mann, Neil Price, Angela Thomson, Fiona Wilson

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Evaluation of the Otago Diabetes Guidelines

In May 1999 the Otago Diabetes Team project introduced guidelines for the management of four core aspects of diabetes management in primary care.

To investigate the acceptability and perceived value of these guidelines we conducted a postal survey of general practitioners and general practice nurses in the Otago region, including North and South Otago as well as the Lakes Districts. A total of 240 practitioners were identified and after 14 exclusions, 226 possible respondents were left.

A total response rate of 71% was achieved with 160 responses from 226 eligible health practitioners.  Responses from general practitioners comprised 57.5% of the responses.

Detailed analysis of the results are available in Section 7. Salient features of the results included:

  • most general practitioners and practice nurses were aware of the ODT guidelines
  • of those who were aware of the guidelines, most reported a reduced degree of difficulties managing diabetic patients after receiving the guidelines
  • of those possessing the guidelines, more than half used the guidelines at least every month
  • of the practitioners using the guidelines, most reported some difference between the guidelines and their prior clinical practice. Furthermore, there was a perceived improvement in the health of diabetic patients following the introduction of the guidelines
  • practitioners generally approved of the guidelines’ format and content

Authors of Report

James Bradshaw, Paul Jones, Saurabh Prakash, Jonathan Smiles, Andrew Tucker, Anna Walker, Haur Sen Yew

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Factors Influencing Trainee Intern Career Choices

Aims

There are 2 aims in our study, aim 1 is to update recruitment trends into specialties highlighted by the research undertaken in 1994 and aim 2 is to determine the main factors influencing career choices in future medical graduates.

Methods

For aim 1, we collected Medical Council of NZ data from annual questionnaires.  The group selected for analysis comprised all doctors enrolled in vocational training programmes in 1998 excluding general practitioners. We also contacted the Clinical Training Agency and selected Australasian specialist colleges to provide information on the numbers of trainees registered in NZ. 

For aim 2, a general questionnaire about career choices, levels of debt and decisions about working overseas was sent to all trainee interns in the year 2000 from Auckland, Christchurch, Wellington and Dunedin medical schools.  Those students currently on elective and overseas government sponsored students were excluded.  This left 231 students in total.

Results

Recruitment into Specialty Training

We have found that females are grossly under-represented in all specialties except for obstetrics and gynaecology, paediatrics and pathology. We have also found that the number of overseas graduates in our training programmes has risen from 40% between the years of 1990-94 to just under 50% in 1998.  The highest proportion of overseas graduates was in psychiatry.

Factors influencing career choice of trainee interns

Results show that the most important reasons why a trainee interns chose a specialty were: the ability to help people, lifestyle and prestige.  Financial reward, interesting and challenging work, potential for debt repayment and personal capability were less likely to influence the trainee interns’ choice of specialty. We also found that psychiatry was not a popular career choice for trainee interns, although there was a positive perception of many aspects of this career.  A majority of TIs intended to travel overseas to work, with those with higher debt more likely to leave within 2 years of graduation.

Conclusion

Recruitment into Speciality Training

The future workforce in the health system would be hard to predict as we could not find any explanations for the different career choices between men and women.  It is also difficult to predict the numbers of overseas graduates who will choose to practise here.  Presently these graduates make up a substantial proportion of the NZ medical workforce and this trend is likely to continue.

From the results of the survey, we concluded that student debt does not play a major role in career choices, although it does influence the decision to practise outside NZ within two years of graduation.  We have also predicted that there will still be a lack of psychiatrist in the future because of the lack of enthusiasm for the specialty.

Authors of Report

Yvonne Anderson, Rachel Kan, NickKkenning, Amanda Landers, Glen Lightbody, Haida Leung, Nik Ahmad Zahar Nik Yah, Anna Skinner, Paul Stevenson

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Family Violence, An Outrageous Crime: Would a Protocol be Useful?

Objective

This paper outlines the methods used and descriptive data collected from a sample of NZ emergency departments and GP groups, as well as local emergency departments and community groups, as to their experience of health professional response to the issue of family violence.

Methods

The project was divided into 3 stages.  Stage 1, 27 emergency departments and 66 GP groups throughout NZ were contacted and surveyed about family violence in their practices.  Stage 2, 45 Dunedin Public Hospital Emergency Department staff were surveyed as to their experience dealing with those affected by family violence.  In Stage 3, 13 community groups were contacted and semistructured interviews about their experience of health professionals and family violence were carried out.

Results

Of the emergency departments contacted, 15 answered the survey and 15 of 66 GP groups completed the survey.  Very few had protocols in place to deal with the issue of family violence and estimates of contact with those affected by family violence ranged from 1% to 10%.   Locally in Dunedin Public Hospital Emergency Department, 17 staff participated. Multiple barriers were identified to preventing staff dealing effectively with this issue.  Eleven community groups were interviewed and highlighted the lack of effective response by health professionals dealing with family violence. 

Conclusions

Of those surveyed and interviewed with all 3 stages of this project there was support for the introduction of protocols/guidelines and education within the health sector in an effort to improve outcomes for those affected by family violence.

Authors of Report

Brendon Ah-Chan, Liza Edmonds, Kushlani Kumarasinghe, Boris Mak, Aidalina Mahmud, Jamie Shepherd, Gee-Hing Wong

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Portrait of a Gambler: Point Prevalence and Demographic Correlates of Pathological Gambling Amongst Dunedin Casino Attendees

Aims

  • To establish the point prevalence of Pathological Gambling in the population of people who attend the Dunedin Casino, as defined by the "8-Screen" questionnaire.
  • To establish which demographic attributes of attendees make them more likely to score highly on the "8-screen".
  • To ascertain whether there are any factors, such as time of day or frequency of visits, which make people more likely to score highly.

Authors of Report

Duncan Blaikie, Shaun Grant, Nigel Henderson, Chris Jackson, Sachin Mathur, Craig Pelvin, Heidi Ward

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The Physical Health of People With Serious Mental Illness in Dunedin

Introduction

The aim of our project was to identify the range of physical illnesses and risk behaviours in people with serious mental illness (SMI) in Dunedin.  Considerable overseas research has identified that patients with serious mental illness are at significantly higher risk of mortality from both natural and unnatural causes. They are also more likely to suffer physical morbidity due to an array of complex and interacting factors.

Methods

We randomly selected a sample of 150 patients from the population of 1000 patients with SMI in Dunedin.  Patients were interviewed about their health perception, past medical history, current symptoms, exercise, sexual health, smoking, alcohol and drug use and GP attendance. Patients underwent a physical examination including  weight, blood pressure, cardiovascular and respiratory systems, visual acuity, hearing and capillary glucose.

Results

A total of 59 patients were interviewed, a 42% response rate.  Our sample had significantly higher levels of poor health perception, smoking and obesity than the general population. Despite a high level of General Practitioner attendance we detected considerable numbers of patients with untreated symptoms and adverse examination findings.

Conclusion


There are physical health needs in the SMI community which are not being adequately addressed at present. Therefore, our population is at risk of excess mortality and morbidity. There is potential for improvement through adequately funded primary health care designed specifically to meet the needs of this group.

Authors of Report

Jun Lee, Annuar Mohd Kamal, Los Vincent Newton, Judith Penney, Gerald Waters, Sara Whimster, Nur Yazmin Yaacob

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Why is the Nutrition of New Zealanders a Public Health Concern?

Specifically we planned to:

  • Measure the nutritional knowledge of menu planners based on proven assessment criteria.
  • Gain an understanding of the priorities of menu planners in Dunedin and what part nutrition plays in these priorities.
  • Assess what menu planners perceive as barriers to providing nutritious food on Dunedin menus.

Authors of Report

Graeme Bain, Damon Bell, Patrick Beverley, Philip Conaglen, Chris Jones, Matthew Lo, Andrew Lucas, Chris Luey

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