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

subjects: Patient-centred models of care

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: Multi-system geochronological and isotopic constraints on age and evolution of the Gaoligongshan metamorphic belt and shear zone system in western Yunnan, China

authors: Eroğlu, Sümeyya

subjects: Gaoligongshan

abstract: The Gaoligongshan metamorphic belt, located east of the Eastern Himalayan Syntaxis (EHS) in the Yunnan province, southwestern China, is a compelling region in which to determine temporal constrains on crustal dynamic processes related to the Himalayan orogeny. We applied multi-system geo- and thermochronology (900 °C to <50 °C) to orthogneiss and mylonites from a major shear zone in the southern Gaoligongshan in order to elucidate the magmatic, cooling and exhumation history of this belt.
Zircon U/Pb data reveal three magmatic events at ∼486 Ma, ∼136 Ma and ∼76 Ma. Similar ages are found in orthoderivative rocks of the neighboring Tengchong and Baoshan blocks, and the Gangdese batholith, suggesting that the southern Gaoligongshan is composed of an assemblage of Lhasa and Qiangtang terrane derived rocks. Muscovite Rb/Sr ages of 35–21 Ma are coeval with the onset of lateral crustal displacement along major shear zones in Eastern Tibet and Indochina, and with the post-collision volcanic activity in western Yunnan. Biotite Rb/Sr and mica 40Ar/39Ar ages provide evidence that mylonitization along the Gaoligongshan shear zone and crustal rotation of the Tengchong and Baoshan blocks proceeded during the Miocene, between 19 and 12 Ma, when the rocks rapidly cooled through the 350–280 °C temperature range. Almost identical 40Ar/39Ar ages reported for the Karakorum–Jiali–Parlung Fault system in Western Tibet suggest that the Gaoligongshan shear zone is the southeastern continuation of this fault, recording the eastward extrusion of Tibet and crustal movement around the EHS. The final stage of exhumation of the Gaoligongshan occurred between 8 and 5 Ma at an average exhumation rate of ∼3 km/Ma as documented by apatite fission-track and apatite (U–Th–Sm)/He data. This rapid exhumation was triggered by crustal root delamination and opening of the Andaman sea.
Our results clearly show that the complex tectonothermal evolution of the Gaoligongshan was influenced by Tibetan extrusion and escape tectonics associated with lower crustal flow around the EHS and the southeastward movement of Indochina and back-arc extension in response to Andaman seafloor spreading.

text: Multi-system geochronological and isotopic constraints on age and evolution of the Gaoligongshan metamorphic belt and shear zone system in western Yunnan, China The Gaoligongshan metamorphic belt, located east of the Eastern Himalayan Syntaxis (EHS) in the Yunnan province, southwestern China, is a compelling region in which to determine temporal constrains on crustal dynamic processes related to the Himalayan orogeny. We applied multi-system geo- and thermochronology (900 °C to <50 °C) to orthogneiss and mylonites from a major shear zone in the southern Gaoligongshan in order to elucidate the magmatic, cooling and exhumation history of this belt.
Zircon U/Pb data reveal three magmatic events at ∼486 Ma, ∼136 Ma and ∼76 Ma. Similar ages are found in orthoderivative rocks of the neighboring Tengchong and Baoshan blocks, and the Gangdese batholith, suggesting that the southern Gaoligongshan is composed of an assemblage of Lhasa and Qiangtang terrane derived rocks. Muscovite Rb/Sr ages of 35–21 Ma are coeval with the onset of lateral crustal displacement along major shear zones in Eastern Tibet and Indochina, and with the post-collision volcanic activity in western Yunnan. Biotite Rb/Sr and mica 40Ar/39Ar ages provide evidence that mylonitization along the Gaoligongshan shear zone and crustal rotation of the Tengchong and Baoshan blocks proceeded during the Miocene, between 19 and 12 Ma, when the rocks rapidly cooled through the 350–280 °C temperature range. Almost identical 40Ar/39Ar ages reported for the Karakorum–Jiali–Parlung Fault system in Western Tibet suggest that the Gaoligongshan shear zone is the southeastern continuation of this fault, recording the eastward extrusion of Tibet and crustal movement around the EHS. The final stage of exhumation of the Gaoligongshan occurred between 8 and 5 Ma at an average exhumation rate of ∼3 km/Ma as documented by apatite fission-track and apatite (U–Th–Sm)/He data. This rapid exhumation was triggered by crustal root delamination and opening of the Andaman sea.
Our results clearly show that the complex tectonothermal evolution of the Gaoligongshan was influenced by Tibetan extrusion and escape tectonics associated with lower crustal flow around the EHS and the southeastward movement of Indochina and back-arc extension in response to Andaman seafloor spreading.

year: 2013

title: What are the perceptions of Māori bilingual-educated families towards growing up and learning the Māori language?

authors: Hill, Richard Kenneth

abstract: The Māori language occupies an important place as New Zealand’s indigenous language. This is despite over a century  of attempts  to wipe it out. The revitalisation movement from the 1980s has made a significant contribution to raise its profile and ensure younger generations of primarily Māori students can grow up learning the Māori language through school. However, significant issues still exist, as low numbers of families take advantage of bilingual education options, and remain there to develop high levels of proficiency.


Attitudes of both Māori and non-Māori (Pākehā) populations towards the Māori language have been steadily improving in recent decades. There are increasing calls to make it a compulsory subject in all New Zealand schools. Whilst these are positive signs, the long term health of the Māori language is still precarious. Using the findings of recent studies into Māori bilingual school transitions, including Hill, Rameka and Skerrett (2017) and Hill (2014, 2016, 2017), this presentation seeks to unpack the perceptions of Māori students and their families from a range of programmes towards their languages (Māori and English) and their lives. The findings will illustrate that families within the Māori bilingual education context are enthusiastic about  Māori language learning and being educated bilingually. They are also resolute that bilingual education will help to prepare their children  for their world. However,  families often differ in the extent to which they commit to high immersion programmes, thus affecting the potential success of the Māori language revitalisation aim.

text: What are the perceptions of Māori bilingual-educated families towards growing up and learning the Māori language? The Māori language occupies an important place as New Zealand’s indigenous language. This is despite over a century  of attempts  to wipe it out. The revitalisation movement from the 1980s has made a significant contribution to raise its profile and ensure younger generations of primarily Māori students can grow up learning the Māori language through school. However, significant issues still exist, as low numbers of families take advantage of bilingual education options, and remain there to develop high levels of proficiency.


Attitudes of both Māori and non-Māori (Pākehā) populations towards the Māori language have been steadily improving in recent decades. There are increasing calls to make it a compulsory subject in all New Zealand schools. Whilst these are positive signs, the long term health of the Māori language is still precarious. Using the findings of recent studies into Māori bilingual school transitions, including Hill, Rameka and Skerrett (2017) and Hill (2014, 2016, 2017), this presentation seeks to unpack the perceptions of Māori students and their families from a range of programmes towards their languages (Māori and English) and their lives. The findings will illustrate that families within the Māori bilingual education context are enthusiastic about  Māori language learning and being educated bilingually. They are also resolute that bilingual education will help to prepare their children  for their world. However,  families often differ in the extent to which they commit to high immersion programmes, thus affecting the potential success of the Māori language revitalisation aim.

year: 2018