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NZ Healthcare - 1970's and Now
 

NZ Healthcare - 1970's and Now

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  • There have been huge technological developments in the healthcare system between the 1970’s and now. We’re going to look at some of these changes, how they have effected the role and knowledge of staff as well as the impact of technological changes on the patient.
  • Film usedProcessed film manually in theatreHad automatic processors but often had problems with machines jammingTook approximately 3 minutes to develop a filmSingle phase generators with line voltage compensators that had to be adjusted manually.
  • No other modalities in Radiology DepartmentSpecialised rooms for angriography ( Carotid, Renal, Aortic, Femoral,etc).Room for Air Enceplograms was (air was injected through a lumbar puncture needle into the ventricles of the brain).Air encephalograms now defunct due to introduction of CT
  • Nuclear medicine first used in 1950’s to demonstrate thyroid function.1970s – visualisation of organs beside the thyroid including the liver, spleen and brain tumour localization.1980s – nuclear medicine used to diagnose heart diseaseNow – over 100 types of different examinations can be performed.
  • High frequency and constant potential generators in common usage. 1973 – George Luckey invented phosphor imaging plates1983 – First CR units were commercialised by KodakLate 1980’s CR accepted by medical communityLatest CR readers take 5 seconds to read a 35 X 43 imaging plate. Equipment generally smaller and lighterDR virtually instant
  • 1972 – Hounsfield and Cormack invented CT (awarded Nobel prize in 1979 for invention)1974 – first medical equipment manufacture of CT equipment1989 – first spiral CT machine in routine operation
  • 1946 – Bloch & Purcell independently discovered the magnetic resonance phenomenon. 1973 – MRI of test tube1977 – first MRI of entire human body1980 - First commercial scanner developed1993 – functional MRI developed
  • Still require the same background knowledge to perform most tasksNew knowledge is required to operate machinery Loss of some skills as some processes become automated. E.g. When not taking blood pressure manually become less proficient.
  • Changes in exposure factors are not as evident in CR systems so MRTs loose understanding of the affect of changing exposure settings. Pre-set exposures also reduce need to thoroughly understand exposures. Not as obvious when consistently overexposing films. Exposure creep not good practice.
  • Technology should ensure patients receive better careAdvances in medical imaging provides more accurate diagnoses fasterBetter pain relief (local anaesthetic in dentistry)Increased accuracy of monitoring equipmentStaff have access to more knowledge, easily and quicklySimple procedures can be performed faster
  • Less understanding, procedures more foreign and confusing to the publicIncreased efficiency can make experience dehumanising.Monitoring done by interacting with machines, not patientEquipment can seem intimidating, claustrophobic and isolating. May have elevated expectations of what equipment is capable of
  • Advances being made in making medical imaging more patient friendly. Phillips has developed “Ambient Experience” technology for CT/MRI rooms Patient controls surroundings. E.g. the lighting, projected images and other elements of the exam room, giving them a greater sense of comfort and control over their experience

NZ Healthcare - 1970's and Now NZ Healthcare - 1970's and Now Presentation Transcript

  • New Zealand Healthcare A comparison between the 1970’s and Now
  • • Qualifications and Training • Health and Safety • Changes in Technology • Leave Entitlements • Patient Demographic • Patient Perception of Healthcare
  • Qualifications and Training
  • Studying 30 years ago Nurse • 3 years • Hospital based • Heavy workload and stress Dental Nurse • 2 years • Training schools Wellington, Christchurch and Auckland • Principal (dentist) dental tutor sisters (dental nurses) Radiographer • Hospital based • Theory and practical study
  • Studying now Nurse • 3 year course • Train in polytechnics Dental Therapist • Changes occurring • Otago and Auckland University now offer dual qualification • “phantom heads” , treat pt’s under supervision Radiographer • 3 year course • Train in polytechnics
  • Restrictions 30 years ago Nurses • Able to do most things under supervision • Not involved in childbirth • Only watch theatre cases Dental Nurses • Complete supervision • Everything checked off Radiographers • Watched in theatre until almost fully qualified • Given a lot of dirty jobs e.g barium enemas
  • Restrictions Now Nurse • Supervised with medications, ecg • Not allowed to give meds to minors • Can’t carry out any procedures that requires further study Dental Therapist • 1st year :work solely on phantom heads, • 2nd and 3rd year :pt’s under supervision Radiographer • Supervised by Qualified • Films must be checked off • Not able to do morgue, NAI cases.
  • Effect on Patient Care Nurses • Polytechnic training – consistency in training • More emphasis now on patient rights • 1970’s - pt’s communal showering • “Right to be Treated with Respect” • “Right to Dignity and Independence” (“HDC”, 2009)
  • Effect on Patient Care Dental Therapists • Very pt care orientated • “Need to like and care for people” • Their role health promotion in education, community development
  • Effect on Patient Care Radiographer • Tertiary education • Big emphasis on patient care -classes -tests e.g. CBA • Restrictions -supervision ensures positive/safe patient experience
  • HEALTH AND SAFETY
  • Questions • What health and safety issues were considered important when you entered your career? • What changes have there been in the way infectious patients are handled? • Have there been changes to do with health and safety?
  • Health and Safety issues • Changing of uniforms • Wearing of glove/ masks • Transferring patients
  • Uniforms • Radiographers wore a uniform which they could only change into while they were in the hospital • Now everyone is able to change into their uniforms at home and wear them into the hospital
  • Wearing gloves/ masks • Dental nurses didn’t wear masks or gloves when they worked on patients in the 1980’s • Now they always wear gloves, masks and protective glasses. Very infectious patients are now treated at the end of the day and Electrical safety is also very important
  • Transferring Patients • Staff often lifted using their back like a crane instead of using there legs. So a lot of health care workers often got chronic back problems. • Now new lifting techniques are enforced • Use slippery sams and Pat slides
  • Benefit to Patients • Health and safety has not only benefited the staff but the patient also…… • Hoist = moving patients safely onto examination tables • Wearing gloves/gowns with infectious patients=helps minimise the risk to the next patient of becoming infectious
  • Changes in Technology
  • 1970’s Radiography • Film used • Processed film manually in theatre • Automatic Processors • 3 minutes to develop film • Single phase generators with line voltage compensators that had to be adjusted manually.
  • 1970’s Radiography • No other modalities in Radiology Department • Specialised rooms • Air Encepholograms
  • Nuclear Medicine • 1950’s – first used • 1970s – visualisation of organs beside the thyroid i • 1980s – nuclear medicine used to diagnose heart disease • Now – over 100 types of different examinations can be performed.
  • General X-ray • High frequency and constant potential generators • 1973 – phosphor imaging plates • 1983 – First CR units were commercialised • Late 1980’s CR accepted by medical community • Latest CR readers take 5 seconds to read a 35 X 43 imaging plate. • Equipment generally smaller and lighter • DR virtually instant
  • Development of CT • 1972 – Hounsfield and Cormack invented CT • 1974 – first medical equipment manufacture of CT equipment • 1989 – first spiral CT machine in routine operation
  • MRI • 1946 – Magnetic resonance phenomenon discovered. • 1973 – MRI of test tube • 1977 – first MRI of entire human body • 1980 - First commercial scanner developed • 1993 – functional MRI developed
  • Other Changes... • Computers now used to quickly access and share patient information and radiological images. • Local anesthesia and high speed drills introduced into dental nursing since 1970’s • Electronic monitoring of blood pressure, pulse, oxygen levels adopted.
  • Impact of changes on staff • Still require the same background knowledge • New knowledge is required to operate machinery • Loss of some skills as some processes become automated.
  • Impact of changes on staff • Changes in exposure factors are not as evident in CR systems • Pre-set exposures also reduce need to thoroughly understand exposures. • Exposure creep
  • Benefits of technology to patients • Technology should ensure patients receive better care • Advances in medical imaging provides more accurate diagnoses faster • Better pain relief • Increased accuracy of monitoring equipment • Staff have access to more knowledge, easily and quickly • Simple procedures can be performed faster
  • Disadvantages to patients • Less understanding, procedures more foreign and confusing to the public • Dehumanization • Monitoring done by interacting with machines, not patient • Equipment can seem intimidating, claustrophobic and isolating. • May have elevated expectations
  • “They strapped me into this machine, I didn’t like it. It was really close to my face. I was alone, I did not know where they (the radiographers) had gone. It was noisy. I wouldn’t want another one.”
  • Technology and Patient Care • With support and education technology can be beneficial patients. • Need to remember that they don’t understand what is happening. • Risk of losing basic patient care skills and getting caught up in technology • Technology makes patient care more essential
  • Future of Technology • Advances being made in making medical imaging more patient friendly. • “Ambient Experience” technology for CT/MRI rooms • Patient controls surroundings
  • LEAVE
  • Leave Entitlements 30 years ago • 2 weeks of sick days • Maternity leave available: -not well promoted -smaller hospitals tended to accommodate for this more
  • Leave Entitlements Now • Long service leave introduced in private practices • Parental Leave (1987) • Paid parental leave (2002) • Minimum Annual Leave Entitlements (2007)
  • Leaves’ effect on Patient Care • Annual Leave “maintain health and well being and to achieve a work/life balance” (“Staff annual leave”, 2007) • Positive effect patient experience • Motivation • Higher quality performance
  • PATIENT PERCEPTION/ ILLNESS
  • Reasons for hospital admissions have not changed dramatically, however…… The public’s perception of certain jobs, The demographic of patients treated and What a staff member can/can not do has changed.
  • Hospital Admissions • Late 1980’s: • Accidents e.g. MVA, • arthritis, and rheumatism. • Followed by hearing and • eyesight difficulties. In 2002/2003: MVA were still one of the major causes of hospital admissions along with: -alcohol admissions, -strokes and arthritis
  • DEMOGRAPHIC OF PATIENTS TREATED Late 1980’s • Patients predominantly white • Trauma = young adults • Strokes = older people 2002/2003 • Females = 57.2% of hospital discharges, • 27.8% of patients discharged were 65years + • Maori accounted for 16% of total discharges
  • PUBLIC PERCEPTION TO DENTISTS Dental clinics were commonly called the murder house • Now parents now see them as being an important part of their child’s school life
  • WHAT STAFF CAN/CAN’T DO 20years ago MRTs were allowed to: •smoke in the staff rooms •read books or knit while they were on the job Now MRT’s are more focused on their career paths and have responsibilities
  • PATIENT CARE • Has changed for the better over the last few years. • Now treat a lot more Maori people • This has lead to continuing education on how to deal with different cultures
  • References FujiFilm Corporation. (2009). Innovation History. Retrieved June 01, 2009, from http://www.fujifilm.com/about/history/innovation_history/#content5c Health and Disability Commissioner. (2009). The HDC Code of Health and DisabilityServices Consumer’s Rights Regulation 1996. Retrieved June 4 2009, from http://www.hdc.org.nz/theact/theact-thecodesummary • History of Nuclear Medicine. (2008, June 10). Retrieved June 01, 2009, from http://www.imaginis.com/nuclear-medicine/nuc_history.asp Kodak. (2005, August). Kodak Continues With It’s Computed Radiography Innovation [PDF]. Available from http://www.shawinspectionsystems.com/products/kodak/datasheets/CR_history.pdf Medical Imaging Technology and Innovative Tools Improve Patient Experience. (2006, September 13). Retrieved June 01, 2009, from http://www.jobwerx.com/news/phg_medical_biz-id=948453_843.html Nagasaki University School of Medicine. (n.d.). Introduction to MRI – History. Retrieved June 01, 2009 from http://www.med.nagasaki- u.ac.jp/radiolgy/MRI%20of%20the%20FOOT/MRI-CDNUH/nf-history.html NDT Resource Centre. (n.d.). Present State of Radiography. Retrieved June 01, 2009 from http://www.ndt- ed.org/EducationResources/CommunityCollege/Radiography/Introduction/presentstate.htm Priority Improvements to Parental Leave (2007). Retrieved June 4, 2009, from http://74.125.155.132/search?q=cache:sXMHpYcCXBcJ:www.nacew.govt.nz/publications/files/parental- leave.doc+leave+entitlements+1980%27s&cd=2&hl=en&ct=clnk&gl=nz Santacroce, L. (2005, October 27). Mammogram. Retrieved June 01, 2009, from http://www.emedicinehealth.com/mammogram/article_em.htm Siemens Medical. (n.d.). Computed Tomography – It’s History and Technology [PDF]. Available from http://www.medical.siemens.com/siemens/zh_CN/gg_ct_FBAs/files/brochures/CT_History_and_Technology.pdf Staff Annual Leave Balances (2007). Retrieved June 6 2009, from services.eng.uts.edu.au/StaffandAlumni/secure/StaffAnnualLeaveBalances.doc