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 CareNurses

• 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

• Advances being made in making medical imaging more patient friendly.

• “Ambient Experience” technology for CT/MRI rooms

• Patient controls surroundings

Future of Technology

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

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http://www.hdc.org.nz/theact/theact-thecodesummary

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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

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services.eng.uts.edu.au/StaffandAlumni/secure/StaffAnnualLeaveBalances.doc