DQ 2-1 responses 55. The Change Theory was a three-stage model o.docxelinoraudley582231
DQ 2-1 responses 5
5. The Change Theory was a three-stage model of change developed by Kurt Lewin. This model was also known as the unfreezing-change-refreezing model that can be used by health care professionals when making discussing treatment for patients (Manchester, et al, 2014). The unfreezing process involves making it possible for people to change their mind. This can be done by helping them overcome a resistance or introducing new information. It is a way to increase the driving forces away from the current situation, such as encouraging a patient to have a diagnostic heart catheter after they have had several episodes of chest discomfort, but is afraid of going to the hospital for a procedure. Change is when there is a change of thought, behavior, or something that moves one from their current or frozen situation. This can be described as the patient agreeing to proceed with the heart catherization, getting on appropriate medication, and following a healthier lifestyle. The Refreezing is established after then change has happened and there is a new habit. For example, after the patient has the heart catheterization, he or she adopts a healthier lifestyle by being compliant with medication and the physician’s treatment recommendations, eating a heart-healthy diet, and exercising.
Communication is more than sending a message from one person to another. Communication involves nonverbal communication such as tone, body language, dialect, paralanguage, proximity, touch, eye contact, gestures, posture, and more. Nonverbal communication between a physician and patient influences patient perception, such as patient satisfaction (Montague, Chen, Xu, Chewning, & Barrett, 2013). Verbal and nonverbal communication barriers such as healthcare jargon, language barriers, emotional barriers, differences in perception and view point, and physical disabilities. Environmental barriers can also disrupt and distort messages. To minimize disruptions and distortions in communication, health care professionals should eliminate noise distractions by taking the patient to a quiet room or closing the door to the exam room or hospital room for privacy. One should speak clearly and slowly, checking for understanding before moving on to the next part of the message. Health care professionals should use a medical certified translator when there is a language barrier or hearing impairment. Reading the patient’s body language can also suggest if the patient is understanding and following along. Cell phones ringers should be turned off to not interrupt the communication. Eye contact demonstrates listening and understanding for both parties. Touch can be clinical and social (Montague, Chen, Xu, Chewning, & Barrett, 2013). A clinician must touch to the patient to assess, diagnose, and treat. However, touching through a handshake, hug, or pat on the back, can be social, therapeutic, and healing. The important part of communication is to make sure one’s message is recei.
Anthropological and bioethics study of clinical research in Malawiwellcome.trust
Presented by Joseph Mfutso-Bengo PhD (Centre for Bioethics in Eastern and Southern Africa) at the Public Engagement Workshop, 2-5 Dec. 2008, KwaZulu-Natal South Africa, http://scienceincommunity.wordpress.com/
Impact of Intervention Program on Quality of End of Life Care Provided by Ped...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
DQ 2-1 responses 55. The Change Theory was a three-stage model o.docxelinoraudley582231
DQ 2-1 responses 5
5. The Change Theory was a three-stage model of change developed by Kurt Lewin. This model was also known as the unfreezing-change-refreezing model that can be used by health care professionals when making discussing treatment for patients (Manchester, et al, 2014). The unfreezing process involves making it possible for people to change their mind. This can be done by helping them overcome a resistance or introducing new information. It is a way to increase the driving forces away from the current situation, such as encouraging a patient to have a diagnostic heart catheter after they have had several episodes of chest discomfort, but is afraid of going to the hospital for a procedure. Change is when there is a change of thought, behavior, or something that moves one from their current or frozen situation. This can be described as the patient agreeing to proceed with the heart catherization, getting on appropriate medication, and following a healthier lifestyle. The Refreezing is established after then change has happened and there is a new habit. For example, after the patient has the heart catheterization, he or she adopts a healthier lifestyle by being compliant with medication and the physician’s treatment recommendations, eating a heart-healthy diet, and exercising.
Communication is more than sending a message from one person to another. Communication involves nonverbal communication such as tone, body language, dialect, paralanguage, proximity, touch, eye contact, gestures, posture, and more. Nonverbal communication between a physician and patient influences patient perception, such as patient satisfaction (Montague, Chen, Xu, Chewning, & Barrett, 2013). Verbal and nonverbal communication barriers such as healthcare jargon, language barriers, emotional barriers, differences in perception and view point, and physical disabilities. Environmental barriers can also disrupt and distort messages. To minimize disruptions and distortions in communication, health care professionals should eliminate noise distractions by taking the patient to a quiet room or closing the door to the exam room or hospital room for privacy. One should speak clearly and slowly, checking for understanding before moving on to the next part of the message. Health care professionals should use a medical certified translator when there is a language barrier or hearing impairment. Reading the patient’s body language can also suggest if the patient is understanding and following along. Cell phones ringers should be turned off to not interrupt the communication. Eye contact demonstrates listening and understanding for both parties. Touch can be clinical and social (Montague, Chen, Xu, Chewning, & Barrett, 2013). A clinician must touch to the patient to assess, diagnose, and treat. However, touching through a handshake, hug, or pat on the back, can be social, therapeutic, and healing. The important part of communication is to make sure one’s message is recei.
Anthropological and bioethics study of clinical research in Malawiwellcome.trust
Presented by Joseph Mfutso-Bengo PhD (Centre for Bioethics in Eastern and Southern Africa) at the Public Engagement Workshop, 2-5 Dec. 2008, KwaZulu-Natal South Africa, http://scienceincommunity.wordpress.com/
Impact of Intervention Program on Quality of End of Life Care Provided by Ped...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
Impact of health education on tuberculosis drug adherenceSkillet Tony
Adherence is defined as the extent to which patients follow the instructions they are given for prescribed treatments. Until recently, adherence expertise was hard to find, assemble and empower. The study shall solely aim at investigating the influence of patients’ health education on Tuberculosis drug adherence. It will be guided by the following specific objectives; to identify the level of adherence among TB patients at MTRH, to assess the level of patient’s health education on TB drugs, to identify barriers of TB education, to investigate the challenges facing TB patients on treatment and to determine the level of training given to health workers on TB drug adherence. These objectives will enable the researcher to elaborate more on the topic and ensure that those who read through this research shall have a better perspective on the effects of health education on tuberculosis drug adherence. It will take place between the months of July and August. The study will target 17 doctors, 119 nurses and 143 patients of Tuberculosis. The study will employ a case study research design. The case study will enable the researcher be able to collected detailed information as to the influence of patients’ health education on TB drug adherence. The study will employ purposive sampling to sample the doctors and simple random sampling to select both the nurses and the patients who will participate in the study. The researcher will use one research instrument to collect data from the respondents selected to participate in the study which is a questionnaire that will be issued to the respondents on the day of the data collection.
The purpose of this Health Policy Study is to better understand adolescents’ views on what are considered core components of the medical home and identify barriers to promoting adolescent health in relation to the medical home.
In addition, this study sought to better understand the needs and challenges in providing adolescents with access to medical homes—from the perspective of both adolescents and experts in adolescent health and medical home policy. To accomplish these goals, researchers conducted focus groups with adolescents, presented these findings to experts, and gathered experts’ reactions to the adolescents’ perspectives. This report includes a detailed description of the methods used for this study, followed by a summary of key focus group findings and the expert reactions to these findings.
Dr. Ameri and class,After reflecting over the course of Advanced.docxmadlynplamondon
Dr. Ameri and class,
After reflecting over the course of Advanced Clinical Diagnosis and Practice Across the Lifespan, the student identified achievements of the course outcomes. This course had a few specific areas that the student reflected on that assisted her in preparing for the Master of Science program outcome #4, the Master of Science in Nursing (MSN) Essential IV, and the Nurse Practitioner Core Competency #7.
The professional outcome #4 is to “Integrate professional values through scholarship and service in health care.” This outcome was achieved by taking the week 4 APEA predictor exam. As the student studied for the exam, she identified several areas of improvement. By reviewing a wide knowledge base of concepts seen in the primary care setting the student was to identify her areas of strengths and weaknesses. The test was broken down into categories and assisted the student to find her professional identity. Another way the student found her professional identity was through clinicals. The preceptor pushed autonomy and let the student formulate the treatment plan while she would offer suggestions and advice. The student realized that in a few short months that she would be in practice with varying levels of guidance depending on job location. The student identified her professional identity in the clinic which will aide her in her next rotation and future practice.
The MSN Essential IV is “Translating and integrating scholarship into practice recognize that the master’s prepared nurse applies research outcomes within the practice setting, resolves practice problems, works as a change agent, and disseminates results.” Over the course, the student achieved the MSN Essential IV by discussion in week 6 mental health presentation and in the clinical setting. The student is accustomed to seeing a lot of mental health patients but sometimes has difficulty categorizing the present illness. The week 6 presentation allowed each student to formulate a patient scenario with a diagnosis provided by the instructor. The student saw how mental illness was related, but also how it differed form patient to patient. This assignment assisted the student in identifying patient’s chief complaints, differentiate from different ailments, educate and act as a change agent, and evaluate results over time. In the clinical setting, the student was able to educate teens about IUDs. The NP she followed at the FQHC would insert IUDs that lasted for 5 years for $20. Many teenage girls would come to the clinic and admit to being sexually active without the use of protection or teenagers that already had a few kids would come in asking for birth control options. The student felt as if she was able to minimize teenage pregnancy or unwanted pregnancies by providing patients with the appropriate knowledge and offer an affordable pregnancy prevention method.
The Nurse Practitioner Core Competency #7 is geared towards Health Delivery System Competen ...
Objective: To evaluate the utility of a targeted lecture in improving FP awareness amongst clinicians.
Design: This is a dual institution, prospective survey-based study assessing if an educational lecture can increase the likelihood of FP consideration, discussion, and referral.
SAAD COLLEGE OF NURSING AND ALLIED HEALTH SCIENCESUNIVERSI.docxrtodd599
SAAD COLLEGE OF NURSING AND ALLIED HEALTH SCIENCES
UNIVERSIY OF ULESTER
Student name: Fatimah Aldawood
ID number: SNC:136193
Cohort: (Year 4 semester 2)
Course Title: BSc (Hons) in Nursing Studies
Module Title: Developing research proposal
Module Code: NUR 585 CRN: 59060
Words Count:
Date:
Lecturer responsible for unit:
List of content:
The content
Pages
Table of content
2
Acknowledgment
3
Abstract
4
Literature review
5-
Significant of the study
Aim, Objectives and Research question
Methodology
Setting
Population
Sampling
Tools for data collection
Robustness of the study
Ethical consideration
Pilot study
Data analysis
Process of data collection
Outcomes
Time scale
Budget
Appendix A: information leaflet
Appendix B: consent forms
Appendix C questionnaire part1
Appendix C: interview questionnaire part2
Reference
Acknowledgement:
First of all, I would like to thank my mother and my sister to their emotional support, they encourage drove me into this level. Then I have to say thanks to my teachers for their good learning to me. Finally, I hope that my research study stimulates nurses to give more and understand the importance of great nursing profession.
The Effective of Nursing Education and Attitude to Improve Knowledge in Palliative Care of Hospital- internationally.
Abstract:
This research going to describe the effect of nursing education and attitude to improve knowledge in palliative care of hospital- internationally. The palliative is medical specialty caring for people with chronic and serous disease. This type of care concentrate on rest of patient from the symptoms and stress diseases. The aims is to improve clarity of life for both the patient and their family. However nursing education and attitude have real affect on patient health, by improve nursing education patient care can improved. Even if the nurse dos not have enough education she can progress himself by continuous learning. "The 2011 Public Opinion Strategies found that most Americans believe that palliative care should be made available to all hospitals "(Center to Advance Palliative Care [CAPC], 2011).
Background: Long work in medical area can affect in the Knowledge and attitude for the nurse it could in bad or good way, So the nurse have to improve himself to achieve the standard of care for patient in Palliative Care. Because of around the world the numbers of patients who`s need palliative care is increased, and the nurse come from the first line of patient care.
Method: A quantitative study will used to explore the determine the knowledge and attitude of Saudi nurse who is provide care for palliative patient.
Data collection:
Data collection is "the process of gathering and measuring information on variables of interest, in an established systematic fashion that enables one to answer stated research questions, test hypotheses, and evaluate outcomes". The data collection compo.
Dental Myth, Fallacies and Misconceptions and its Association with Socio-Dent...DrRipika Sharma
Introduction: It is important to know about the myths and misconceptions, especially in India, where general and oral health is
embroiled in various myths and ritualistic practices.
Objectives: The purpose of this study is aimed at assessing the prevalence of dental myth and utilizes socio-dental impact
locus of control scale (SILOC) health model, as the theoretical framework to understand the dental myth and belief and possible
reasons for noncompliance with recommended health action.
Materials and Methods: A cross-sectional study was conducted by the out-patients attending dental institute, in Bengaluru
city. A total of 150 individuals were included, data were collected using a pretested and validated three-part questionnaire
including demographic data, questions regarding dental myth, and seven items SILOC. Data obtained were statistically analyzed
using descriptive statistics, t-test, and spearman’s rank correlation.
Results: Almost all the participant believed in one or more dental myth. About 71.3% of the participant had high (≥11) SILOC
scores. Statistically significant difference (P < 0.001) was found between mean SILOC scores and gender with males having
a lower mean score (14.94) as compared to females (18.62). When SILOC scores and myth scores were compared against
socioeconomic status, it showed statistically significant difference (P < 0.001), between them. The SILOC scores highly correlated
with myth scores.
Conclusion: Various dental myth and false perception still lurk in the minds of the population, to discourage the unhealthy
practices; we the health professionals have to provide intensive health education and promote the adoption of healthy practices.
It would be prudent to familiarize professionals to understand these myths and beliefs as they act as barriers toward seeking
treatment.
Key words: Culture, Gender, Internal-external control, Oral health, Social class
Laws concern to administration of Medication by Nursemanisha kulkarni
Objectives:
a) Define role nurse and medication in patient care
b) To collect maximum information on laws concern to administration of medication by nurse.
c) Acquire skills of preparing project on given topic as partial fulfillment of said course.
d) Read the cases related to concern topic
Obtaining Patient Information and Anxiety in Novice Nursing Students ,Article...jour644
Obtaining Patient Information and Anxiety in Novice Nursing Students , Obtaining Patient Information and Anxiety , During the First Clinical Rotation Journal of Comprehensive Nursing Research and Care ,Obtaining Patient Information and Anxiety, Obtaining Patient Information and Anxiety in Novice Nursing , Obtaining Patient Information , Anxiety in Novice Nursing Students ,
https://gexinonline.com/uploads/articles/article-jcnrc-143.pdf
Obtaining Patient Information and Anxiety in Novice Nursing Students , Obtaining Patient Information and Anxiety ,
During the First Clinical Rotation
Department of Nursing, Biola University, 13800 Biola Avenue, La Mirada, California 90639, USA
Journal of Comprehensive Nursing Research and Care
Essay On Sports And Games. Essay on Sport SampleJennifer Holmes
5 Paragraphs Essay About Sports & Its Importance In Our Lives. Importance Of Games And Sports Narrative Essay - PHDessay.com. Essay On Sports And Games | Sports And Games Essay for Students and .... Essay on Sports | Sports Essay for Students and Children in English - A .... 1000 Words Essay on Importance of Games and Sports | Sports. 003 Value Of Games And Sports Essay Example ~ Thatsnotus. Essay on importance of sports || Importance of games and sports essay. importance of sports and games | write essay on importance of sports .... Write a short essay on Sports and Games | Essay Writing | English - YouTube. Remarkable Essay About Importance Of Sports ~ Thatsnotus. Essay On Importance Of Games And Sports In 250 Words. Essay on Importance of Sports in English | essay importance of games. Sports and Games Essay for Class 10th & 12th with Quotation. Essay On Sports [Short And Long]. Sports And Games Essay in English {Outstanding}. Essay on Sport Sample. essay sports and game with quotations 10th class |outstanding essay .... Importance of Games and sports : Essay for 12th. Essay Topics Sports And Games. Essay on Sports and Games for Students and Children | 500+ Words Essay. Sports and Games Essay With Quotations For 2nd Year. Write an essay on " important of games and sports" - Brainly.in. Write an essay on My favorite Sport | Essay Writing | English. Sports and Games Important Essay with Quotes | Essay Quotation | Essays For Matric and Inter Student. Sports and Games essay | World largest Online Book Store. Top 40 Quotations For Essay Sports and Games - FSC Notes - Ilmi Hub. Essays On Sports And Games. Essay#2 | Sports and Games - YouTube. Write a essay on games and sports - Brainly.in. 021 Essay Example About Sports Interesting Argumentative Topics .... Sports and sportsmanship short essays.
Transgender Essays. Lgbt rights essay. LGBT Rights Argumentative Essay: Grea...Jennifer Holmes
⇉Dangers of Being Transgender Essay Example | GraduateWay. Transgender Female Athletes Face Hurdles to Acceptance With the Public. Transgender Identities and Feminism - Free Essay Example - 1816 Words .... Transgender Essay 2 .docx - May 19 2022 Soc 301 Transgender Is Defined .... Transgender essay writing. lgbt-essay 1 .pdf - LGBT essay LGBT is a community which consist of .... Transgender Discrimination Essay | 76088 - Discrimination and the Law .... Order essay online cheap the world of transgender, homosexual, and .... Sadie, 11-Year-Old Transgender Girl, Writes Essay In Response To Obama .... LGBTQ Essay | PDF | Lgbt | LGBTQIA+ Studies. The Society Acceptance of LGBT - Free Essay Example | PapersOwl.com. Anti LGBT Discrimination - Free Essay Example | PapersOwl.com. (PDF) LGBT rights in Southeast Asia: one step forward, two steps back?. Transgender Essay Topics - 2021 | TopicsMill. Essay on gender identity. Transgender 11-Year-Old Sadie Croft Writes Essay Revising Obama's Speech. LGBT Movement/History - Williams Institute Reading Room: Lesbian, Gay .... lgbtq revised essay | Homelessness | Lgbt. lbc reflective essay 2 | Lgbt | LGBTQ Rights. Transgender Essay: How to Transit into the Opposite Sex?. 006 Essay Example Human Right Transform National Conference On .... ⇉History of the Transgender Movement in North America Essay Example .... Transgender Youth Issues - Free Essay Example | PapersOwl.com. LGBT essay.docx | Lgbt | LGBTQ Rights | Free 30-day Trial | Scribd. Developing a Strong Argument in a Transgender Essay Sample. Transgender Athletes Essay - Cohn 1 Caitlyn Cohn WRT 205 21 January .... Online Essay Help | amazonia.fiocruz.br. How To Write A Gender Bias Essay - Acker Script. Are transgender operations ethical - A-Level Psychology - Marked by .... Three Teacher-Tested Ways to Encourage Your Students to Follow Current .... Understanding transgender people Free Essay Example. Short Essay-Transgender.docx. essay | Lgbt Parenting | Same Sex Relationship. Transgender essays - Reasearch & Essay Writings From HQ Writers. ⭐ Lgbt rights essay. LGBT Rights Argumentative Essay: Great Tips For ... Transgender Essays Transgender Essays. Lgbt rights essay. LGBT Rights Argumentative Essay: Great Tips For ...
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Impact of health education on tuberculosis drug adherenceSkillet Tony
Adherence is defined as the extent to which patients follow the instructions they are given for prescribed treatments. Until recently, adherence expertise was hard to find, assemble and empower. The study shall solely aim at investigating the influence of patients’ health education on Tuberculosis drug adherence. It will be guided by the following specific objectives; to identify the level of adherence among TB patients at MTRH, to assess the level of patient’s health education on TB drugs, to identify barriers of TB education, to investigate the challenges facing TB patients on treatment and to determine the level of training given to health workers on TB drug adherence. These objectives will enable the researcher to elaborate more on the topic and ensure that those who read through this research shall have a better perspective on the effects of health education on tuberculosis drug adherence. It will take place between the months of July and August. The study will target 17 doctors, 119 nurses and 143 patients of Tuberculosis. The study will employ a case study research design. The case study will enable the researcher be able to collected detailed information as to the influence of patients’ health education on TB drug adherence. The study will employ purposive sampling to sample the doctors and simple random sampling to select both the nurses and the patients who will participate in the study. The researcher will use one research instrument to collect data from the respondents selected to participate in the study which is a questionnaire that will be issued to the respondents on the day of the data collection.
The purpose of this Health Policy Study is to better understand adolescents’ views on what are considered core components of the medical home and identify barriers to promoting adolescent health in relation to the medical home.
In addition, this study sought to better understand the needs and challenges in providing adolescents with access to medical homes—from the perspective of both adolescents and experts in adolescent health and medical home policy. To accomplish these goals, researchers conducted focus groups with adolescents, presented these findings to experts, and gathered experts’ reactions to the adolescents’ perspectives. This report includes a detailed description of the methods used for this study, followed by a summary of key focus group findings and the expert reactions to these findings.
Dr. Ameri and class,After reflecting over the course of Advanced.docxmadlynplamondon
Dr. Ameri and class,
After reflecting over the course of Advanced Clinical Diagnosis and Practice Across the Lifespan, the student identified achievements of the course outcomes. This course had a few specific areas that the student reflected on that assisted her in preparing for the Master of Science program outcome #4, the Master of Science in Nursing (MSN) Essential IV, and the Nurse Practitioner Core Competency #7.
The professional outcome #4 is to “Integrate professional values through scholarship and service in health care.” This outcome was achieved by taking the week 4 APEA predictor exam. As the student studied for the exam, she identified several areas of improvement. By reviewing a wide knowledge base of concepts seen in the primary care setting the student was to identify her areas of strengths and weaknesses. The test was broken down into categories and assisted the student to find her professional identity. Another way the student found her professional identity was through clinicals. The preceptor pushed autonomy and let the student formulate the treatment plan while she would offer suggestions and advice. The student realized that in a few short months that she would be in practice with varying levels of guidance depending on job location. The student identified her professional identity in the clinic which will aide her in her next rotation and future practice.
The MSN Essential IV is “Translating and integrating scholarship into practice recognize that the master’s prepared nurse applies research outcomes within the practice setting, resolves practice problems, works as a change agent, and disseminates results.” Over the course, the student achieved the MSN Essential IV by discussion in week 6 mental health presentation and in the clinical setting. The student is accustomed to seeing a lot of mental health patients but sometimes has difficulty categorizing the present illness. The week 6 presentation allowed each student to formulate a patient scenario with a diagnosis provided by the instructor. The student saw how mental illness was related, but also how it differed form patient to patient. This assignment assisted the student in identifying patient’s chief complaints, differentiate from different ailments, educate and act as a change agent, and evaluate results over time. In the clinical setting, the student was able to educate teens about IUDs. The NP she followed at the FQHC would insert IUDs that lasted for 5 years for $20. Many teenage girls would come to the clinic and admit to being sexually active without the use of protection or teenagers that already had a few kids would come in asking for birth control options. The student felt as if she was able to minimize teenage pregnancy or unwanted pregnancies by providing patients with the appropriate knowledge and offer an affordable pregnancy prevention method.
The Nurse Practitioner Core Competency #7 is geared towards Health Delivery System Competen ...
Objective: To evaluate the utility of a targeted lecture in improving FP awareness amongst clinicians.
Design: This is a dual institution, prospective survey-based study assessing if an educational lecture can increase the likelihood of FP consideration, discussion, and referral.
SAAD COLLEGE OF NURSING AND ALLIED HEALTH SCIENCESUNIVERSI.docxrtodd599
SAAD COLLEGE OF NURSING AND ALLIED HEALTH SCIENCES
UNIVERSIY OF ULESTER
Student name: Fatimah Aldawood
ID number: SNC:136193
Cohort: (Year 4 semester 2)
Course Title: BSc (Hons) in Nursing Studies
Module Title: Developing research proposal
Module Code: NUR 585 CRN: 59060
Words Count:
Date:
Lecturer responsible for unit:
List of content:
The content
Pages
Table of content
2
Acknowledgment
3
Abstract
4
Literature review
5-
Significant of the study
Aim, Objectives and Research question
Methodology
Setting
Population
Sampling
Tools for data collection
Robustness of the study
Ethical consideration
Pilot study
Data analysis
Process of data collection
Outcomes
Time scale
Budget
Appendix A: information leaflet
Appendix B: consent forms
Appendix C questionnaire part1
Appendix C: interview questionnaire part2
Reference
Acknowledgement:
First of all, I would like to thank my mother and my sister to their emotional support, they encourage drove me into this level. Then I have to say thanks to my teachers for their good learning to me. Finally, I hope that my research study stimulates nurses to give more and understand the importance of great nursing profession.
The Effective of Nursing Education and Attitude to Improve Knowledge in Palliative Care of Hospital- internationally.
Abstract:
This research going to describe the effect of nursing education and attitude to improve knowledge in palliative care of hospital- internationally. The palliative is medical specialty caring for people with chronic and serous disease. This type of care concentrate on rest of patient from the symptoms and stress diseases. The aims is to improve clarity of life for both the patient and their family. However nursing education and attitude have real affect on patient health, by improve nursing education patient care can improved. Even if the nurse dos not have enough education she can progress himself by continuous learning. "The 2011 Public Opinion Strategies found that most Americans believe that palliative care should be made available to all hospitals "(Center to Advance Palliative Care [CAPC], 2011).
Background: Long work in medical area can affect in the Knowledge and attitude for the nurse it could in bad or good way, So the nurse have to improve himself to achieve the standard of care for patient in Palliative Care. Because of around the world the numbers of patients who`s need palliative care is increased, and the nurse come from the first line of patient care.
Method: A quantitative study will used to explore the determine the knowledge and attitude of Saudi nurse who is provide care for palliative patient.
Data collection:
Data collection is "the process of gathering and measuring information on variables of interest, in an established systematic fashion that enables one to answer stated research questions, test hypotheses, and evaluate outcomes". The data collection compo.
Dental Myth, Fallacies and Misconceptions and its Association with Socio-Dent...DrRipika Sharma
Introduction: It is important to know about the myths and misconceptions, especially in India, where general and oral health is
embroiled in various myths and ritualistic practices.
Objectives: The purpose of this study is aimed at assessing the prevalence of dental myth and utilizes socio-dental impact
locus of control scale (SILOC) health model, as the theoretical framework to understand the dental myth and belief and possible
reasons for noncompliance with recommended health action.
Materials and Methods: A cross-sectional study was conducted by the out-patients attending dental institute, in Bengaluru
city. A total of 150 individuals were included, data were collected using a pretested and validated three-part questionnaire
including demographic data, questions regarding dental myth, and seven items SILOC. Data obtained were statistically analyzed
using descriptive statistics, t-test, and spearman’s rank correlation.
Results: Almost all the participant believed in one or more dental myth. About 71.3% of the participant had high (≥11) SILOC
scores. Statistically significant difference (P < 0.001) was found between mean SILOC scores and gender with males having
a lower mean score (14.94) as compared to females (18.62). When SILOC scores and myth scores were compared against
socioeconomic status, it showed statistically significant difference (P < 0.001), between them. The SILOC scores highly correlated
with myth scores.
Conclusion: Various dental myth and false perception still lurk in the minds of the population, to discourage the unhealthy
practices; we the health professionals have to provide intensive health education and promote the adoption of healthy practices.
It would be prudent to familiarize professionals to understand these myths and beliefs as they act as barriers toward seeking
treatment.
Key words: Culture, Gender, Internal-external control, Oral health, Social class
Laws concern to administration of Medication by Nursemanisha kulkarni
Objectives:
a) Define role nurse and medication in patient care
b) To collect maximum information on laws concern to administration of medication by nurse.
c) Acquire skills of preparing project on given topic as partial fulfillment of said course.
d) Read the cases related to concern topic
Obtaining Patient Information and Anxiety in Novice Nursing Students ,Article...jour644
Obtaining Patient Information and Anxiety in Novice Nursing Students , Obtaining Patient Information and Anxiety , During the First Clinical Rotation Journal of Comprehensive Nursing Research and Care ,Obtaining Patient Information and Anxiety, Obtaining Patient Information and Anxiety in Novice Nursing , Obtaining Patient Information , Anxiety in Novice Nursing Students ,
https://gexinonline.com/uploads/articles/article-jcnrc-143.pdf
Obtaining Patient Information and Anxiety in Novice Nursing Students , Obtaining Patient Information and Anxiety ,
During the First Clinical Rotation
Department of Nursing, Biola University, 13800 Biola Avenue, La Mirada, California 90639, USA
Journal of Comprehensive Nursing Research and Care
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Applying A Maori-Centred Consultation Approach For Engaging With Maori Patients An Undergraduate Medical Student Case Study
1. 254 VOLUME 6 • NUMBER 3 • SEPTEMBER 2014 JOURNAL OF PRIMARY HEALTH CARE
MĀORI PRIMARY HEALTH CARE TREASURES
Pounamu (greenstone) is the most precious of stone to Māori.
‘Ahakoa he iti, he pounamu’
(Although it is small, it is valuable)
Pounamu
CONTINUING PROFESSIONAL DEVELOPMENT
POUNAMU
Applying a Māori-centred consultation
approach for engaging with Māori patients:
an undergraduate medical student case study
Rhys Parry MBChB;1
Bernadette Jones RGON, DPH;2
Ben Gray MBChB, MBHL FRNZCGP;3
Tristram
Ingham MBChB2
CORRESPONDENCE TO:
Bernadette Jones
Department of
Medicine, University
of Otago Wellington,
POB 7343, Wellington
South, Wellington
6242, New Zealand
bernadette.jones@
otago.ac.nz
J PRIM HEALTH CARE
2014;6(3):254–260.
1
University of Otago
Wellington, Wellington,
New Zealand
2
Department of Medicine,
University of Otago
Wellington, Wellington
3
Department of General
Practice and Primary Health
Care, University of Otago
Wellington, Wellington
Introduction
For some years now the dominant text for teach-
ing consultation skills has been ‘patient-centred
medicine’.1
Although this method is used interna-
tionally, it was developed in Canada, with a strong
cultural bias towards Western European patients,
and its very title, as a method, is at odds with
a traditional Māori way of viewing the world.2
There are indications that, for Māori, inaccurate
and inappropriate medical assessment can lead to
misdiagnosis and mistreatment and thus can con-
tribute to existing health inequalities in a number
of areas.3
There is also evidence that, while most
clinicians engage with patients with good intent,
knowingly or unknowingly, they can contribute
to negative patient experiences and ethnic/racial
disparities in health.4
In order to prevent this and
to ensure positive health experiences for Māori, it
is vital to learn culturally appropriate and effec-
tive methods of engaging with Māori patients.5
As part of the curriculum at the University of
Otago, Aotearoa/New Zealand, undergraduate
medical students learn the Calgary–Cambridge
guide to medical interviewing.6
As well as this,
they combine their biomedical knowledge with
Hauora Māori (Māori health) principles and apply
these using a Māori patient long-case interview.
The main focus of this long-case is to apply an
holistic approach to interviewing Māori patients,
based on the combination of the Hui Process (a
Māori communication and patient engagement
process)5
and the Meihana Model (an holis-
tic Māori model of health).3
The Hui Process
provides a Māori-centred approach to history-
taking, developed from the customary Māori
practices that are observed at hui (meetings). This
is initially taught during a marae-based (Māori
meeting place), cultural immersion programme
to fourth-year medical students, who learn a
culturally competent way to interview Māori
patients following a four-step process.7
Dur-
ing this immersion programme, these students
are also taught the Meihana Model, a clinically
focused Māori model of health, as a framework
for history taking.3
This model was designed to
synthesise clinical and cultural competencies,
to better serve Māori within a clinical setting.
Whānau (extended family) are identified at the
centre of the interview, and this model challeng-
es the student/practitioner to explicitly engage
with the whānau as part of the interview and any
subsequent treatment plan.
The following is a description of the practical
application of these Hauora Māori principles in
a clinical hospital setting, including excerpts
from a case assignment written by a fourth-year
student, after conducting an interview with a
Māori patient.
The first step, the mihimihi (greeting), begins
with the student introducing themselves, ex-
2. VOLUME 6 • NUMBER 3 • SEPTEMBER 2014 JOURNAL OF PRIMARY HEALTH CARE 255
CONTINUING PROFESSIONAL DEVELOPMENT
POUNAMU
plaining their role, confirming patient details,
including ethnicity, stating the reason for
the interview, and obtaining fully informed
consent. Use of basic te reo (Māori language)
is encouraged, as appropriate, during this step
and throughout the interview. This use of
te reo has been recognised as a contributing
factor in building a trusted patient–doctor
relationship.8
The second phase, the process of whakawha-
naungatanga or the building of a relationship,
follows the exchange of mihimihi, and continues
throughout the interview. Whakawhanaun-
gatanga is a critical concept of demonstrated
relevance to both culturally appropriate research,9
and clinical encounters with Māori patients.10
It is grounded in the key cultural principle
of acknowledging the interconnectedness and
interdependence of an individual, members of the
whānau, immediate and extended family, com-
munity and wider society. In the clinical context,
whakawhanaungatanga has a purposeful focus
directed towards the health professional estab-
lishing a cultural connection with the patient,
thus distinguishing it from basic rapport.11
The
process provides a holistic context that permits
the student to place the information gathered
within a cultural framework, ensuring a more
accurate interpretation and understanding of the
patient.12
A vital part of this step is the student’s
sharing of appropriate stories and information, so
as to balance the interview and avoid a one-sided
interrogation scenario.
Excerpts from the student case study
The process of whakawhanaungatanga, or the
building of the relationship, was initiated by the
exchange of mihi, the sharing of our stories. This
exchange took place before any thought was given
to the ‘information gathering’ biomedical approach,
oft practised in Western Medicine. We exchanged
stories about where we’d come from: JT (the
patient) talked of her childhood; being raised by
her grandfather, and how she spoke te reo at home.
Her iwi heritage gave an opportunity to create a
common bond, as my wife has ancestry to the same
iwi. Whakawhanaungatanga is an ongoing process
and was maintained and reinforced throughout our
kōrero (talk) through:
(1) an emphasis on seeing JT as a whole person, in
contrast with the reductionist focus-on-the-medi-
cal-condition approach; and
(2) through reference back to the information
shared in our mihi.
It was evident throughout our kōrero that a connec-
tion had been made and this was reinforced when,
at the end of our two-and-a-half hours together, JT
gave me her contact details and asked me to make
sure that I keep in touch. We were not time-pres-
sured and this allowed space for the conversation
to go places that it likely would not have if I was
the house surgeon admitting JT or the GP [general
practitioner] seeing her in clinic. This raises the
question of the adequacy of 15-minute GP appoint-
ments, or biomedically/tinana (physical health)–
only focused consultations to facilitate conversation
that has the ability to promote real consideration of
one’s health status and behaviours.
In the clinical context, whakawhanaungatanga has
a purposeful focus directed towards the health
professional establishing a cultural connection with
the patient, thus distinguishing it from basic rapport
The third step of the Hui Process is the kaupa-
pa—the main purpose/reason for the interview is
largely dependent on the effectiveness of the first
two steps. In order to be able to obtain in-depth
information, it is important that the patient feels
at ease and can trust the student/clinician with
sharing their sensitive personal information.
For many Māori, this information is viewed as a
taonga (treasure) belonging not only to them as
individuals but also intrinsically linked to their
tı̄puna (ancestors) with whom they remain con-
nected to through the generations.
As we got to talking and I actually listened (as op-
posed to charging in with question after question), I
began to discover a lovely and vibrant, but ‘broken’
lady. The interview progressed in a semi-struc-
tured kind of way, loosely following the pattern
described above and that of the Meihana Model,
where health is seen as encompassing six different
3. 256 VOLUME 6 • NUMBER 3 • SEPTEMBER 2014 JOURNAL OF PRIMARY HEALTH CARE
facets (tinana—physical health; whānau—the fam-
ily aspect; hinengaro—mental health; wairua—spir-
itual health; taiao—the environmental aspect; and
iwi katoa—the wider health system context).
Tinana (physical health)
JT was admitted to the respiratory ward, where she
spent six days receiving treatment for pulmonary
oedema. When visited by the respiratory nurse at
her home (five days ago), she was found to be breath-
less, unable to complete full sentences, and ‘gasping
for air’. An ambulance was called and she was taken
to the emergency department for assessment. She
had recently been discharged following a similar
episode. An occasional unproductive cough and
some pain associated with this was reported but oth-
erwise nil of note. She had a number of comorbidi-
ties, including: congestive heart failure; ischaemic
heart disease, with previous non-ST elevation myo-
cardial infarction; chronic obstructive pulmonary
disease; asthma; obesity hypoventilation syndrome;
Type 2 diabetes (insulin dependent); paroxysmal
atrial fibrillation; and osteoarthritis of both hips,
for which she was awaiting total hip replacements.
She regularly took multiple medications: insulin;
salbutamol; fluticasone/salmeterol; simvastatin;
metoprolol; quinapril; frusemide; and fluoxetine.
She had been seeing a dietician and felt her diet was
good, with plenty of fruit and vegetables. JT is an
ex-smoker, with a 15 pack–year history.
Whānau (family/social supports)
JT is one of 16 children; she has four children of
her own and eight mokopuna (grandchildren). Both
her parents died early but she had little information
to give about their health. JT lives at home with her
partner who is also unwell, but has good support
from her children who live close by. She has some
home help. No whānau were present during our
kōrero (talk) but she mentioned that they are quite
worried about her health. JT discussed her iwi
(tribe), hapū (sub-tribe), and marae (meeting house)
affiliations, along with her maunga (mountain),
the basis of her sense of connectedness. She has no
marae involvement in Wellington but is involved
with a number of kaumātua (elder) groups. JT is
now retired but used to work as a social worker,
and was involved with the policy board for a local
health provider and a number of other groups.
Hinengaro (psychological/emotional)
Regarding her beliefs about medication and adher-
ence, JT had an ‘I just do as I’m told’ attitude, and
felt her control of diabetes was a good example of
success. Enforced bed-rest has afforded JT the time
to reflect and given the benefit of hindsight she
sees herself as being mostly responsible for her poor
health. This made her feel unhappy:
[The] truth hurts. [Expletive] does it ever!
An hour into our kōrero, I said to JT that it seemed
as if she had come to a point of realisation and that
she was starting to take ownership of her own
health. This seemed to resonate with her, as she
broke down in tears, agreeing that this was exactly
how she felt and it had taken her a very long time
to come to this realisation.
Wairua (spiritual/connectedness)
With reference to Wairua, JT’s comment was that
she believes in a Māori model of health, by which
she was referring to the Whare Tapa Whā model.13
A Catholic nun had visited her today to take her
through a karakia (prayer/incantation), but in gen-
eral she felt that she didn’t really take great care of
her wairua, her spiritual health.
Taiao (environment)
JT and her partner live in a modified home on a flat
section (her previous home had steps) with a wet
shower area, a handle above the bed and a number
of other modifications. Due to her immobility
(both hip osteoarthritis and obesity-related), she
uses a walking frame when outside the house. Some
home help is currently provided and this is being
reviewed with a view to increasing this service.
Iwi Katoa (health systems)
JT has her own GP and felt that she had easy and
good access to health care, but thought this was
likely related to her position as a social worker (pre-
viously) and her role with the local health provider.
She said that she knew many Māori who don’t
know where to go when they have health concerns,
and therefore don’t seek help.
CONTINUING PROFESSIONAL DEVELOPMENT
POUNAMU
4. VOLUME 6 • NUMBER 3 • SEPTEMBER 2014 JOURNAL OF PRIMARY HEALTH CARE 257
Māori cultural beliefs and values
JT describes Māori as ‘the same but different’, in
that those from different iwi and hapū often have
different beliefs about health. For example, talking
about different aspects of health is tapu (sacred/
restricted) for some and there can therefore be a
reluctance to seek help. Māori are whakamā (embar-
rassed/shy) when talking about certain sensitive
body parts. She said that she loves the cervical
screening television advertisements for Pacific
women (shown on New Zealand television) but
wished there was something similar for Māori. JT
felt it was important for the elders in the commu-
nity to stand up and model good health practices
to the younger generations—she said that she felt
she hasn’t done a great job of doing this so far, but
plans to change that.
Poroporoaki
The final step of the Hui Process, the Poroporo-
aki (closing or concluding the encounter) is an
important part of the interview process. Evidence
shows that, for Māori, this part of the consulta-
tion can be suboptimal and incomplete at times,
and is an important part of a culturally appropri-
ate and effective health literacy approach with
patients.5
Case study: Poroporoaki
Poroporoaki is the process of farewell and con-
clusion of a meeting. It allows each party the
opportunity to share their thoughts regarding the
encounter and, in this context, ask questions and
to negotiate future plans. Our kōrero drew to a
close when JT again spoke of the sense that she felt
responsible for her ill health. She believed that she
had played a large part in her current poor health
state, saying that she had neglected to take care of
herself, and had deferred seeking help for health
concerns. We talked of the opportunity she now
had to take ownership of her health and she ex-
plained that her mokopuna were the motivation for
this. She felt that our conversation had allowed her
an opportunity to ‘get a load off her chest’ and that
she hoped ‘people would see a change in her’.
I asked JT for her opinion on what the causes were
for the discrepancies in health status between
Māori and non-Māori, to which she responded that
she felt many Māori need to take responsibility for
their own health. In addition, she added that non-
Māori doctors need to learn how to talk with Māori
patients so that they will be more likely to share
information about themselves.
I asked explicitly if she had any questions for me
and allowed space for her to consider her response.
JT’s only question was to ask that I keep in touch,
to which I promised to email and visit her again
during her stay in hospital (which I did the follow-
ing day). JT hoped that our meeting would be of
use to me in my medical training and she offered
this advice to me, as a doctor-in-training: ‘learn
well, do well, be true to yourself’ and asked me to:
‘give back to Māori’.
Student reflections
JT’s comments (regarding taking more responsi-
bility for their health) demonstrate a degree of
internalised racism, where many Māori blame
themselves to a greater or lesser extent for their
poor health outcomes. While individual, whānau
and community responsibility is undoubtedly im-
portant, this cannot occur in the absence of a high
level of health literacy and good access to preven-
tive and curative medicine, and while suffering
under a disproportionate burden of socioeconomic
and structural determinants of health. If accurate
history taking is a priority for forming correct
diagnosis and treatment of patients, then the lens
must also fall on the responsibility of health profes-
sionals to follow JT’s advice and simply ‘learn how
to talk with Māori patients’. Culturally validated
tools, such as the Hui Process, along with Māori
models of health, such as the Meihana Model,
exist not only for student doctors but for all health
professionals to utilise in order to reduce health
disparities in Aoteoroa/New Zealand.
My kōrero with JT was an enjoyable and rewarding
experience. I felt privileged to be a conduit for JT to
reflect on the state of her health and come to such
a revelation, and ultimately play a small role in her
healing process. Both the sessions on ‘Interviewing
a Māori patient’ and ‘Calgary–Cambridge meets
the Hui-Process’ at Ngātokowaru marae prepared
me well for this interview and I was able to loosely
follow the Meihana Model and the Hui Process
CONTINUING PROFESSIONAL DEVELOPMENT
POUNAMU
5. 258 VOLUME 6 • NUMBER 3 • SEPTEMBER 2014 JOURNAL OF PRIMARY HEALTH CARE
as a framework. Having utilised these tools now
will help to give shape and structure to my future
interactions with Māori patients.
Thought provoking episode report
Another aspect of the undergraduate medical
programme at the University of Otago Wel-
lington is the teaching of reflective practice.
Students are asked to write a ‘Thought Provoking
Episode Report’ (TPER), choosing an episode that
provokes their thinking and analysis regarding
the professional and ethical issues raised by the
episode. The following is an excerpt submitted
by the student while reflecting on his interview
using the Hui Process and Meihana Model.
This was an eye-opening and thought-provoking
experience. I was bemused and disappointed to
discover that I’d become so cynical as to want to
conduct an interview that took as little time as
possible in order to move on to the next item on my
list of things to do. This approach could not have
fostered the kind of relationship that allowed time
and space for openness, reflection and ultimately
healing. Fortunately the Hui Process, Meihana
Model, and a small measure of good sense, derailed
our conversation from the path it would likely have
taken. In the end, we were not time-pressured and
this allowed space for the conversation to go places
that it likely would not have if I was the house
surgeon admitting JT, the GP seeing her in clinic,
or indeed the medical student whose goal at the
outset was taking as little time to glean as much
information as possible. Taking the time to listen to
our patients is a critically important skill. Indeed,
it is likely the most important, and this has been
hammered home to me by this experience. In the
face of the busy medical student, house surgeon or
GP life, I must not forget that taking the time to
listen is a skill to be treasured and honed, and can
yield great results.
It strikes me that doctors hold a privileged position
in many people’s lives: on occasion patients will
share their most intimate thoughts and fears, and
often we will be the only party privy to these.
What a position of responsibility; what we do with
this information is surely of great importance.
We must deal with such matters sensitively and
endeavour to offer encouragement and hope where
possible, although often to just lend an ear will be
the best medicine.
I wonder if taking up JT’s request to keep in touch
via email was wise. As a general rule, I think that
this is not a good practice to get into the habit of
doing and flirts with the professional patient–doc-
tor boundary. However, in this context, given JT’s
cultural background and the nature of our conversa-
tion, I felt it appropriate to send an email encourag-
ing JT in her newfound desire to take ownership of
her health.
I find one of the difficulties of history taking is
having a hidden agenda—knowing I have to come
back to the next ‘tick-box’ on my list of must-ask
questions, instead of focusing on and really listen-
ing to the person in front of me. However, by the
same token, without an agenda (specifically the
Hui Process and Meihana Model in this instance),
I may not have asked the questions that provoked
such thought in JT and thus a different outcome
may have resulted. Having used these tools now
will help to give shape and structure to my future
interactions with both Māori and non-Māori
patients alike.
Overall, this experience was a threefold success,
in that: 1) it provided the opportunity to put into
practice the skills of taking a clinical history from
a patient using Māori-focused models; 2) it allowed
JT the chance to take stock of, and empowered her
to take steps toward regaining control over, her
health; and 3) it allowed me the chance to reflect
upon our interview and to rethink some of my
initial attitudes towards our meeting.
Discussion
In this case, a fourth-year undergraduate medical
student applied the Hui Process and Meihana
Model, two Māori-centred clinical interviewing
tools, to assist him to conduct a culturally ap-
propriate interview with a hospitalised Māori pa-
tient. In so doing, the student was able to achieve
a successful interview, and appreciate that using
these tools had allowed him to engage in a man-
ner, and on a level, that resonated deeply with
both him and the patient. While results may
vary depending on the expertise of the individual
student, it seems likely in this instance that the
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6. VOLUME 6 • NUMBER 3 • SEPTEMBER 2014 JOURNAL OF PRIMARY HEALTH CARE 259
Figure 1. Alignment of the Hui Process with the Calgary–Cambridge model
THE PATIENT INTERVIEW
Mihi Initiating the session
Whakawhanaungatanga Building the relationship
Kaupapa Gathering information
Poroporoaki
Explanation, planning
and closing session
CALGARY–CAMBRIDGE
THE
HUI
PROCESS
effectiveness of the consultation was significantly
enhanced by utilising this culturally congruent
methodology.
As an indigenous health framework, the Hui
Process and Meihana Model have been in practice
across the University of Otago for seven years. In
that time, they have been evaluated by medical
students, health practitioners, Māori patients and
whānau, and have been rated favourably, as clini-
cally relevant frameworks that support health
practitioners to work effectively with Māori
patients and whānau.14
The University of Otago has, in recent years,
adopted the Calgary–Cambridge guide to com-
munication skills for medical students.6
Although
this too comes from a ‘Western medicine’ cultural
background, many of the studies on which the
method was developed were derived from anthro-
pological and cross-cultural studies. Interestingly,
the Hui Process maps easily onto the Calgary–
Cambridge model, particularly if the text around
cultural diversity is applied.6
Figure 1 illustrates
that, although the two interviewing models dif-
fer significantly in their epistemological roots,
there are basic similarities in structure and intent,
which renders them mutually compatible.
Given the unequal health outcomes for Māori
and the burden of comorbidities this population
suffers, it is imperative that our future doctors
have the ability to identify and analyse contrib-
uting risk factors at both the individual patient
level and also at a broader health systems level.
It is all too easy as health professionals to point
the responsibility for poor health solely at the
individual patient and lifestyle factors, rather
than exploring the societal inequalities in health
determinants, the access to and quality of health
care, and thus, ignoring the impact of factors
generating and perpetuating health disparities.15
In a recent revision of the Meihana Model,14
further domains, such as Ngā Hau E Whā have
been added, incorporating aspects of external so-
cietal influences that may impact on the patient’s
health and wellbeing. Ngā Hau E Whā, literally
translated as ‘the four winds’, incorporates factors
such as colonisation, racism, marginalisation, and
migration, and discusses the potential impact of
these on the historical and current health of the
patient and whānau.
In the fifth-year undergraduate Hauora Māori
training, students repeat the case study process
outlined in this article, and are also required to
incorporate a critical analysis of the underly-
ing determinants of health that may have had
an impact on the presentation, and the role of
the health system in perpetuating or mitigat-
ing health inequalities. Such analysis would
involve recognition of the significant burden
of disease this patient faced, and consideration
of the contributions of low self-efficacy, health
literacy, intergenerational trauma, acculturation,
urbanisation/migration, socioeconomic depriva-
tion, differential life-opportunities, structural
discrimination, and the availability of Kaupapa-
Māori and/or culturally appropriate mainstream
primary care services.
A further relevant issue raised in this instance, is
the extent to which ethical values are culturally
bound. Teaching around ‘boundaries’ discour-
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7. 260 VOLUME 6 • NUMBER 3 • SEPTEMBER 2014 JOURNAL OF PRIMARY HEALTH CARE
ages students from sharing their personal stories
or continuing contact with a patient after seeing
them; however, implicit within the process of
whakawhanaungatanga, is the embodiment of
genuine interest, concern, and hence obligation
towards the patient. Ideally, this process requires
the student/doctor to demonstrate this com-
mitment through subsequent contact with the
patient and appropriate follow-up. Most students
who use this process manage to find ways to
discharge this obligation within the parameters
of an appropriate doctor/student–patient relation-
ship (e.g. sitting with the patient until they go to
theatre, coming back to the ward at a later time
to meet whānau members when they are visiting,
or ‘checking in’ with the patient daily for the
remainder of their hospital stay). In the case pre-
sented, the student made the right call in ‘flirting
with the patient contact boundary’ (that is, the
student’s email contact relating to the patient’s
health seems appropriate taking this into account,
although not usual practice).
If the outcome of a consultation with a Māori
patient can be improved by having a more cul-
turally congruent consultation model, to what
extent should this encourage all health profes-
sionals to re-evaluate their consultation model
with all their patients? If a broad view of culture
is taken, then the majority of our patients are
culturally different from ourselves and from the
dominant Western medical view of the world,
and perhaps it is time that the monochromatic
mantra of the standard history taking format6
be
recognised as too narrow and content-oriented.
Broader approaches that retain a purposive clini-
cal enquiry but better recognise the sociocultural
context of the patient (such as the Hui Process
and Meihana Model) need now to be accepted as
the new norm.
5. Lacey C, Huria T, Beckert L, Gilles M, Pitama S. The Hui Pro-
cess: a framework to enhance the doctor–patient relationship
with Māori. N Z Med J. 2011;124:72–8.
6. Silverman J, Kurtz SM, Draper J. Skills for communicating with
patients. 2nd ed. Oxford, UK: Radcliffe Medical Press; 2005.
7. Jones B, Ingham T. The use of research-based indigenous
case studies for teaching undergraduate medical students.
In: Leaders in Indigenous Medical Education Network (LIME)
Good practice case studies. Volume 2. Melbourne: Onemda
VicHealth Koori Health Unit, The University of Melbourne;
2013:24–8.
8. Pitama S, Ahuriri-Driscoll A, Huria T, Lacey C, Robertson
P. The value of te reo in primary care. J Prim Health Care.
2011;3:123–7.
9. Jones B, Ingham T, Davies C, Cram F. Whānau Tuatahi: Māori
community partnership research using a kaupapa Māori meth-
odology. Mai Review. 2010;3:1–14.
10. Cherrington L. Te Hohounga: Mai i te tirohanga Māori (The
process of reconciliation: towards a Māori view). Wellington,
NZ: Ministry of Social Development; 2009.
11. Ingham TR, Jones B. Engaging with a Māori patient: the
Hui Process in clinical practice. Hauora Māori Noho Marae.
Ōrongomai Marae, Upper Hutt: University of Otago Welling-
ton; 2013.
12. Bishop R. Freeing ourselves from neo-colonial domination in
research: a Māori approach to creating knowledge. Int J Qual
Stud Educ. 1998;11:199–219.
13. Durie M. Whaiora Māori Health Development. 2nd ed. Mel-
bourne, Australia: Oxford University Press; 1998.
14. Pitama S, Huria T, Lacey C. Improving Māori health through
clinical assessment: Waikare o te Waka o Meihana. N Z Med J.
2014;127:107–19.
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ACKNOWLEDGEMENTS
The authors would
like to thank JT for the
taonga of her kōrero. JT
subsequently passed away
prior to the publication
of this case study, so
our condolences and
thanks also go to JT’s
whānau for allowing her
story to be shared for
the benefit of improved
cultural competence of
medical students and
health professionals in
Aotearoa New Zealand.
He mihi poroporoaki
ki a koe e te Whaea.
Haere, moe mai, okioki.
We would also like to
acknowledge the staff
at the Māori Indigenous
Health Institute (MIHI)
of the University of
Otago Christchurch for
the initial development
of the Hui Process and
Meihana Model.
He mihi nui ki a koutou.
COMPETING INTERESTS
None declared.
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3. Pitama S, Robertson P, Cram F, Gillies M, Huria T, Dallas-Katoa
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