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: Listening at dawn: Trans* storywork for all my relations

authors: Luna-Pizano, Rafaela

subjects: Transgender

abstract: This is a love letter to trans* people: a reminder of our place and legacy of trans*formation. In the form of collaborative and ceremonial research, this PhD with creative practice component is an affirmation of embodied, elemental storytelling as a necessary practice for unearthing and grounding the traditional knowledge that Indigenous-Trans* (Indigi-Trans*) people carry within our body-spirits. This creative practice (co)research uplifts liminal states of being, as given to us by our elemental ancestors, in the decolonial project of Indigenous (encompassing Black and Trans*) body-land reclamation and restoration. By recognizing and nourishing the power of the between, this thesis remembers practices of place that are rooted in the body, often our last piece of ancestral land as displaced and diasporic Indigi-Trans* people. Spanning the coasts of Aotearoa-NZ to the west coast of Ixtlán (Turtle Island-US), this creative project listened to the somatic presence of Indigi-Trans* creators (co-researchers) who are in varying states of connection to their ancestral lands and traditions. To account for sudden and extreme shifts in safety and access due to the COVID-19 pandemic, I created online and on-site rituals to sustain connection and retrace our ancestors’ techniques of time and space travel. By engaging with body-awareness practices or ritual performances offered in this project, co-researchers and storytellers were able to experiment with ‘knew’ ways of engaging the ancestral power of place. As a member of the communities contributing to this project, I witnessed an important transformation within co-researchers from a sense of landlessness to a sense of infinite place. This transformation gave co-researchers and storytellers a new source of power, strengthening their spiritual-mental capacity to receive and grow (especially during the height of the COVID-19 pandemic). In a political climate of increasing backlash to trans* and Indigenous sovereignty, this creative project is a unique contribution to the kete, or basket of knowledge that we offer to the coming generations of trans*formational practitioners and scholars.
Situated within the realms of Indigenous, Queer, Xicana and Critical Black Trans* Feminist theories, this creative project also draws upon performance, sound, and poetic practice to hatch another creative methodology that centers place-based ritual. As I created this thesis in a liminal waterscape, crossing back and forth between Aotearoa and Ixtlán, colliding with the onset of the COVID-19 pandemic, I opened myself to theories generated by the lands that nourished me. Thus, a Kaupapa Māori and Mana Wahine informed approach emerges as the prow of this banka, or canoe that carries other Black, Indigenous and Trans* lineages of scholarship. From this fluid place of theory, my practice as an Indigi-
Trans* ritualist, poet, and sound artist grounds these theories in my body and the body-lands of my co-researchers. Together, we create a Kappi (Ilocano crab motif referencing Maui’s fishing up of our islands) methodology, or the underwater reflections of celestial movement as mapped by Indigi-Trans* freedom strategies. As the co-researchers and storytellers of this project demonstrate, many Indigi-Trans* people are (re)birthing and (re)creating life and possibility just by existing. Our power of place, in body and land, can link and strengthen all Indigenous sovereignty movements when our communities take up the call to foster each person’s fluid potential.
Although this entire project is creative, as a PhD with creative practice component, this project is an ebb and flow of written and other media components. Most of the ‘creative component’ occurred during the co-research stage of this thesis and has been documented via photographs, video, participant testimony, soundscapes, and poetry on a separate, companion website (https://transjoy.cargo.site/). These artifacts of ritual research are also discussed within the harvest (data) section of the written portion, but reader/listeners are encouraged to view the website in tandem. Poetry, narrative, and soundscapes (hyperlinks or bone icons) weave throughout the written portion to create a multi-sensory experience that privileges my roots in aural tradition. Together, the performances, website, poetry, and soundscapes constitute roughly thirty percent of the final thesis, weighing more heavily on a written portion of seventy percent. Listener/readers are encouraged to experience the written and multi-media portions in tandem, cycling back and forth in a playful spirit as the next step of creative practice: listener participation. Please enter this project with the care and excitement invited of all listeners when the storyteller asks, “are you ready to hear a story?”

text: Listening at dawn: Trans* storywork for all my relations This is a love letter to trans* people: a reminder of our place and legacy of trans*formation. In the form of collaborative and ceremonial research, this PhD with creative practice component is an affirmation of embodied, elemental storytelling as a necessary practice for unearthing and grounding the traditional knowledge that Indigenous-Trans* (Indigi-Trans*) people carry within our body-spirits. This creative practice (co)research uplifts liminal states of being, as given to us by our elemental ancestors, in the decolonial project of Indigenous (encompassing Black and Trans*) body-land reclamation and restoration. By recognizing and nourishing the power of the between, this thesis remembers practices of place that are rooted in the body, often our last piece of ancestral land as displaced and diasporic Indigi-Trans* people. Spanning the coasts of Aotearoa-NZ to the west coast of Ixtlán (Turtle Island-US), this creative project listened to the somatic presence of Indigi-Trans* creators (co-researchers) who are in varying states of connection to their ancestral lands and traditions. To account for sudden and extreme shifts in safety and access due to the COVID-19 pandemic, I created online and on-site rituals to sustain connection and retrace our ancestors’ techniques of time and space travel. By engaging with body-awareness practices or ritual performances offered in this project, co-researchers and storytellers were able to experiment with ‘knew’ ways of engaging the ancestral power of place. As a member of the communities contributing to this project, I witnessed an important transformation within co-researchers from a sense of landlessness to a sense of infinite place. This transformation gave co-researchers and storytellers a new source of power, strengthening their spiritual-mental capacity to receive and grow (especially during the height of the COVID-19 pandemic). In a political climate of increasing backlash to trans* and Indigenous sovereignty, this creative project is a unique contribution to the kete, or basket of knowledge that we offer to the coming generations of trans*formational practitioners and scholars.
Situated within the realms of Indigenous, Queer, Xicana and Critical Black Trans* Feminist theories, this creative project also draws upon performance, sound, and poetic practice to hatch another creative methodology that centers place-based ritual. As I created this thesis in a liminal waterscape, crossing back and forth between Aotearoa and Ixtlán, colliding with the onset of the COVID-19 pandemic, I opened myself to theories generated by the lands that nourished me. Thus, a Kaupapa Māori and Mana Wahine informed approach emerges as the prow of this banka, or canoe that carries other Black, Indigenous and Trans* lineages of scholarship. From this fluid place of theory, my practice as an Indigi-
Trans* ritualist, poet, and sound artist grounds these theories in my body and the body-lands of my co-researchers. Together, we create a Kappi (Ilocano crab motif referencing Maui’s fishing up of our islands) methodology, or the underwater reflections of celestial movement as mapped by Indigi-Trans* freedom strategies. As the co-researchers and storytellers of this project demonstrate, many Indigi-Trans* people are (re)birthing and (re)creating life and possibility just by existing. Our power of place, in body and land, can link and strengthen all Indigenous sovereignty movements when our communities take up the call to foster each person’s fluid potential.
Although this entire project is creative, as a PhD with creative practice component, this project is an ebb and flow of written and other media components. Most of the ‘creative component’ occurred during the co-research stage of this thesis and has been documented via photographs, video, participant testimony, soundscapes, and poetry on a separate, companion website (https://transjoy.cargo.site/). These artifacts of ritual research are also discussed within the harvest (data) section of the written portion, but reader/listeners are encouraged to view the website in tandem. Poetry, narrative, and soundscapes (hyperlinks or bone icons) weave throughout the written portion to create a multi-sensory experience that privileges my roots in aural tradition. Together, the performances, website, poetry, and soundscapes constitute roughly thirty percent of the final thesis, weighing more heavily on a written portion of seventy percent. Listener/readers are encouraged to experience the written and multi-media portions in tandem, cycling back and forth in a playful spirit as the next step of creative practice: listener participation. Please enter this project with the care and excitement invited of all listeners when the storyteller asks, “are you ready to hear a story?”

year: 2023

title: Incorporating critical pedagogy into the scholarship of teaching and learning: making the journey alongside our students

authors: Grant, Suzanne Lisa Parker

subjects: management studies

abstract: In this paper we draw on our teaching and learning experiences in the management classroom, to illustrate how reflective teaching practices and experiential learning can be used to incorporate critical pedagogy into the SoTL. The exercise described within is one which, at first glance, appears very simple and straight forward, and is perhaps the most basic example of all our experiential practices. However, we found this simple exercise to have powerful learning and reflection effects for both the students and ourselves. This experience, and our subsequent pedagogical reflection, reaffirms the need for educators to remain present in the classroom, and reflective about the impacts of their teaching practices on students.

text: Incorporating critical pedagogy into the scholarship of teaching and learning: making the journey alongside our students In this paper we draw on our teaching and learning experiences in the management classroom, to illustrate how reflective teaching practices and experiential learning can be used to incorporate critical pedagogy into the SoTL. The exercise described within is one which, at first glance, appears very simple and straight forward, and is perhaps the most basic example of all our experiential practices. However, we found this simple exercise to have powerful learning and reflection effects for both the students and ourselves. This experience, and our subsequent pedagogical reflection, reaffirms the need for educators to remain present in the classroom, and reflective about the impacts of their teaching practices on students.

year: 2010