title: Exploring patient experiences and power dynamics in an acute general surgical ward: A mixed methods study exploring patient and staff
perceptions of the inpatient experience at Waikato Hospital

authors: Drake, Emma Rose

subjects: Nursing

abstract: Background: Alongside health outcomes, patient experiences are considered crucial in identifying the quality of a health care setting. General surgery comprise the largest range of pathologies and accounts for the highest number of patient discharges of any surgical specialty. As a way to address the power imbalance between healthcare staff and patients, patient-centred models of care are increasingly being adopted and implemented within hospitals including surgery. This study aims to investigate the current experiences of acutely admitted patients in a general surgical ward at Waikato Hospital, including opportunities for and challenges to improvement initiatives. Furthermore, the study examines relevant staff members perspectives of the inpatient experience and seeks to determine the efficacy of a proposed intervention focusing on empowering patients and their families.
Methods: The study was a mixed method design involving two phases. Phase I obtained qualitative data from semi-structured interviews with six patients and twelve staff members. Themes which emerged from the qualitative data in phase I were used to inform the development of phase II, as well as to inform a proposed patient self- assessment intervention. Phase II obtained quantitative data through Likert scale response surveys provided to acute patients on, or near to, their day of discharge from the surgical ward over a two month period.
Results: A total of six patients and 12 healthcare staff (senior registered nurses, n=3; surgical registered nurse managers, n=2; surgical fellows, n=2; surgical registrar, n=1; dietitian, n=1; social worker, n=1; occupational therapist, n=1; and physiotherapist n=1) were involved in phase I. A total of 53 surveys were returned from patients in Phase II (63.1% response rate). Qualitative data from phase I was analysed using a general inductive approach. This revealed three themes including power and control concerns for patients, the hierarchy of the health care team and the surrounding stressors of the organisation and environment. Analysis of the quantitative data collected descriptive statistics and calculated chi-squares. Of note were the statistically significant differences particularly between patients of Māori ethnicity comparatively to non-Māori, and according to gender and reason in hospital. There were no statistically significant differences for patients according to age group.
Conclusion: This study identified both the experiences of patients and staff in an acute general surgical context. The study found that the proposed patient self- assessment intervention was not immediately recommended. This was due to the current recommendations from patients who identified their strong preference was for face-to-face communication with staff. It was also due to staff members identification of a perceived inability to consistently provide person-centred care which corresponded with the patient self-assessment data. Acute general surgical care needs of patients were perceived by staff as taking precedent and current workplace stressors, including staffing and skill mix deficits and perceived lack of staff wellbeing supports, were strong inhibitors for staff to provide their preferred capacity of patient-centred care.

text: Exploring patient experiences and power dynamics in an acute general surgical ward: A mixed methods study exploring patient and staff
perceptions of the inpatient experience at Waikato Hospital Background: Alongside health outcomes, patient experiences are considered crucial in identifying the quality of a health care setting. General surgery comprise the largest range of pathologies and accounts for the highest number of patient discharges of any surgical specialty. As a way to address the power imbalance between healthcare staff and patients, patient-centred models of care are increasingly being adopted and implemented within hospitals including surgery. This study aims to investigate the current experiences of acutely admitted patients in a general surgical ward at Waikato Hospital, including opportunities for and challenges to improvement initiatives. Furthermore, the study examines relevant staff members perspectives of the inpatient experience and seeks to determine the efficacy of a proposed intervention focusing on empowering patients and their families.
Methods: The study was a mixed method design involving two phases. Phase I obtained qualitative data from semi-structured interviews with six patients and twelve staff members. Themes which emerged from the qualitative data in phase I were used to inform the development of phase II, as well as to inform a proposed patient self- assessment intervention. Phase II obtained quantitative data through Likert scale response surveys provided to acute patients on, or near to, their day of discharge from the surgical ward over a two month period.
Results: A total of six patients and 12 healthcare staff (senior registered nurses, n=3; surgical registered nurse managers, n=2; surgical fellows, n=2; surgical registrar, n=1; dietitian, n=1; social worker, n=1; occupational therapist, n=1; and physiotherapist n=1) were involved in phase I. A total of 53 surveys were returned from patients in Phase II (63.1% response rate). Qualitative data from phase I was analysed using a general inductive approach. This revealed three themes including power and control concerns for patients, the hierarchy of the health care team and the surrounding stressors of the organisation and environment. Analysis of the quantitative data collected descriptive statistics and calculated chi-squares. Of note were the statistically significant differences particularly between patients of Māori ethnicity comparatively to non-Māori, and according to gender and reason in hospital. There were no statistically significant differences for patients according to age group.
Conclusion: This study identified both the experiences of patients and staff in an acute general surgical context. The study found that the proposed patient self- assessment intervention was not immediately recommended. This was due to the current recommendations from patients who identified their strong preference was for face-to-face communication with staff. It was also due to staff members identification of a perceived inability to consistently provide person-centred care which corresponded with the patient self-assessment data. Acute general surgical care needs of patients were perceived by staff as taking precedent and current workplace stressors, including staffing and skill mix deficits and perceived lack of staff wellbeing supports, were strong inhibitors for staff to provide their preferred capacity of patient-centred care.

year: 2022

title: Population diversity in Aotearoa New Zealand: Insights from the CaDDANZ research programme

authors: Stone, Geoff

abstract: CaDDANZ was a New Zealand Government-funded project studying the impacts of growing population diversity in Aotearoa New Zealand. The project ran from 2014 to 2020 and was extended to March 2021 due to the effects of the global COVID-19 pandemic. Staffed by a multidisciplinary team of researchers, CaDDANZ aimed to identify changing demographics and the impacts of ethnic and demographic diversity on aspects of economic and social change. This report has synthesised a bundle of key insights that could only have surfaced through the reflection on the interplay between the research questions that the original bid set out to address. While we, as a project team, did not intend to produce transdisciplinary or even interdisciplinary work on migration, diversity or the diversity dividend, setting a goal to synthesise something from the project as a whole has produced this report. Using social cohesion as a sorting mechanism for the insights has meant this overview is selective and high level. Not all the projects can be read against a social cohesion or even social inclusion lens. In particular, many of the econometric outputs explicitly addressed aspects of diversity as an economic dividend and that work is not highlighted in the synthesis. 
Three broad themes are addressed 
1. Immigration and diversity – understanding population trends 
2. [Re] conceptualising ethno-demographic diversity in Aotearoa – Tangata whenua perspectives 
3. Diversity in context – in different settings and over time 
The report concludes with four high-level insights 
1. Immigration policy needs to re-examine its position in relation to Tiriti o Waitangi where any Crown partnership relationship is currently lacking. 
2. Despite social cohesion being a negotiated term, its use as a framing for the impacts of migration on both the host country and individual migrant lives is underpinned by its use in the Royal Commission of Inquiry into the terrorist attack on Christchurch mosques on 15 March 2019 and is preferable to the concept of a diversity dividend.1 
3. While ethnocultural diversity is the default for ‘diversity dividend’ research, the concept of the social organisation of difference has broader relevance to social justice-oriented policy development.2 
4. The use of wide range of different methodologies is vital for the production of wellevidenced, theory-informed strategies and policies.

text: Population diversity in Aotearoa New Zealand: Insights from the CaDDANZ research programme CaDDANZ was a New Zealand Government-funded project studying the impacts of growing population diversity in Aotearoa New Zealand. The project ran from 2014 to 2020 and was extended to March 2021 due to the effects of the global COVID-19 pandemic. Staffed by a multidisciplinary team of researchers, CaDDANZ aimed to identify changing demographics and the impacts of ethnic and demographic diversity on aspects of economic and social change. This report has synthesised a bundle of key insights that could only have surfaced through the reflection on the interplay between the research questions that the original bid set out to address. While we, as a project team, did not intend to produce transdisciplinary or even interdisciplinary work on migration, diversity or the diversity dividend, setting a goal to synthesise something from the project as a whole has produced this report. Using social cohesion as a sorting mechanism for the insights has meant this overview is selective and high level. Not all the projects can be read against a social cohesion or even social inclusion lens. In particular, many of the econometric outputs explicitly addressed aspects of diversity as an economic dividend and that work is not highlighted in the synthesis. 
Three broad themes are addressed 
1. Immigration and diversity – understanding population trends 
2. [Re] conceptualising ethno-demographic diversity in Aotearoa – Tangata whenua perspectives 
3. Diversity in context – in different settings and over time 
The report concludes with four high-level insights 
1. Immigration policy needs to re-examine its position in relation to Tiriti o Waitangi where any Crown partnership relationship is currently lacking. 
2. Despite social cohesion being a negotiated term, its use as a framing for the impacts of migration on both the host country and individual migrant lives is underpinned by its use in the Royal Commission of Inquiry into the terrorist attack on Christchurch mosques on 15 March 2019 and is preferable to the concept of a diversity dividend.1 
3. While ethnocultural diversity is the default for ‘diversity dividend’ research, the concept of the social organisation of difference has broader relevance to social justice-oriented policy development.2 
4. The use of wide range of different methodologies is vital for the production of wellevidenced, theory-informed strategies and policies.

year: 2021

title: Surface Reconstruction by Triangular Mesh of Models with Uneven Density and with Hole

authors: Ye, Chen

subjects: reverse engineering

abstract: With the fast development of computer software, 3D computer aided design (CAD) and computer aided manufacturing (CAM) are being improved rapidly and have been commonly used in industry, especially in medical area and moulding field. 3D CAD/ CAM has greatly shortened the mould development time, thus it plays an important role in product development and automatic production.

It has been a serious topic about how to get the product design and also being manufactured in a short time to grasp the market opportunities in the competition of the developing manufacturing techniques, diversification and complexification of product demand. But not all the products have the design draft, for example, some of them were made by the mould of clay which came from craftsman by their hands. In order to conquer those problems, reverse engineering came into being. Reverse engineering could achieve a faster product design and manufacture, it also could be used in the field of vehicle components, home appliances, medical supplies (like human body measurement such as for artificial leg bones, tooth, etc.,), and rapid prototyping (such as precision casting products, industrial design, etc.). The so-called reverse engineering now targets to the existing mould (samples or manual model). It starts with the existing model, sampling surface data by data acquisition equipment (DAE) then acquire an ordered or unordered could of points. After that by the use of discrete geometry processing technology to get the CAD model of solid entity which computer could recognize. The following procedures of the CAD model could be redesigned or improved as required.

text: Surface Reconstruction by Triangular Mesh of Models with Uneven Density and with Hole With the fast development of computer software, 3D computer aided design (CAD) and computer aided manufacturing (CAM) are being improved rapidly and have been commonly used in industry, especially in medical area and moulding field. 3D CAD/ CAM has greatly shortened the mould development time, thus it plays an important role in product development and automatic production.

It has been a serious topic about how to get the product design and also being manufactured in a short time to grasp the market opportunities in the competition of the developing manufacturing techniques, diversification and complexification of product demand. But not all the products have the design draft, for example, some of them were made by the mould of clay which came from craftsman by their hands. In order to conquer those problems, reverse engineering came into being. Reverse engineering could achieve a faster product design and manufacture, it also could be used in the field of vehicle components, home appliances, medical supplies (like human body measurement such as for artificial leg bones, tooth, etc.,), and rapid prototyping (such as precision casting products, industrial design, etc.). The so-called reverse engineering now targets to the existing mould (samples or manual model). It starts with the existing model, sampling surface data by data acquisition equipment (DAE) then acquire an ordered or unordered could of points. After that by the use of discrete geometry processing technology to get the CAD model of solid entity which computer could recognize. The following procedures of the CAD model could be redesigned or improved as required.

year: 2015