Pērā i te maha o ngā whenua, kua roa a Ahitereiria e pāngia ana e te kore taurite o te tohatoha o te hunga mahi hauora, me te iti ake o ngā tākuta mō ia tangata i ngā wāhi tuawhenua, me te ia o te aro ki te tohungatanga teitei. Ko te Longitudinal Integrated Clerkship (LIC) he tauira mātauranga hauora e nui ake ana te tūponotanga ki te whakaputa i ngā tauira paetahi e mahi ana i ngā hapori tuawhenua, e tipu haere ana te tawhiti, me te tiaki tuatahi. Ahakoa he mea nui ēnei raraunga tauanga, kāore i te rawaka ngā raraunga motuhake ki te kaupapa hei whakamārama i tēnei āhuatanga.
Hei whakatika i tēnei āputa mātauranga, i whakamahia he huarahi hanga-ā-roto e ahu mai ana i te ariā kounga hei whakatau i te awe o te LIC taiwhenua whakauru o Te Whare Wānanga o Deakin ki ngā whakataunga mahi a ngā tauira kua puta i te kura (2011–2020) e pā ana ki te tohungatanga hauora me te tauwāhi matawhenua.
E toru tekau mā iwa ngā tauira tawhito i uru atu ki ngā uiuinga kounga. Kua whakawhanakehia he anga whakatau mahi LIC taiwhenua, e kī ana ko te huinga o ngā āhuatanga whaiaro me ngā āhuatanga kaupapa i roto i te ariā matua o te "whiriwhiri whai wāhi" ka pā ki ngā whakatau mahi ā-rohe me ā-mahi a ngā tauira, i te taha whaiaro me te taha mahi tahi. Kia whakauruhia ki roto i te mahi, ka whakanui ake ngā ariā o ngā pūkenga hoahoa ako me te whakangungu ā-papa i te whai wāhi mā te whakarato i te whai wāhitanga ki ngā kaiuru ki te wheako me te whakataurite i ngā marautanga tiaki hauora i roto i te huarahi whānui.
Ko te anga kua whakawhanakehia e whakaatu ana i ngā āhuatanga horopaki o te kaupapa e whakaarohia ana he whai mana ki ngā whakataunga mahi a ngā tauira kua puta i te kura. Ka whai wāhi ēnei āhuatanga, me te tauākī kaupapa o te kaupapa, ki te whakatutuki i ngā whāinga mahi ā-rohe o te kaupapa. I puta te panonitanga ahakoa i hiahia ngā tauira kua puta ki te whai wāhi ki te kaupapa, kāore rānei. Ka puta te panonitanga mā te whakaaroaro, e wero ana, e whakaū ana rānei i ngā whakaaro o mua o ngā tauira kua puta mō te whakatau mahi, ā, mā reira ka whai mana ki te hanganga o te tuakiri ngaio.
Pērā i te maha o ngā whenua, kei te pāngia a Ahitereiria e ngā taupatupatu roa, pumau hoki o te tohatoha o te hunga mahi hauora [1]. E kitea ana tēnei e te iti o te maha o ngā tākuta mō ia tangata i ngā rohe taiwhenua me te ia o te whakawhiti mai i te tiaki tuatahi ki te tiaki tino motuhake [2, 3]. Ina huihuia, ka pā kino ēnei āhuatanga ki te hauora i ngā rohe taiwhenua, inā koa nā te mea ko te tiaki hauora tuatahi te mea nui ki te hunga mahi hauora o ēnei hapori, e whakarato ana i ngā ratonga tiaki hauora tuatahi me te tiaki tari ohorere me te hōhipera [4]. ]. Ko te Longitudinal Integrated Clerkship (LIC) he tauira mātauranga hauora i whakawhanakehia tuatahitia hei huarahi ki te whakangungu i ngā ākonga hauora i roto i ngā hapori taiwhenua iti, ā, i hangaia hei whakatenatena i te mahi i roto i ngā hapori rite [5, 6]. Ka tutuki tēnei wawata nā te mea he nui ake te tūponotanga o ngā tauira kua puta i ngā LIC taiwhenua ki te mahi i roto i ngā hapori taiwhenua, e tipu haere ana te tawhiti me te tiaki hauora tuatahi i ngā tauira kua puta i ngā rohe taiwhenua [7,8,9 ,10]. Ko te āhua o ngā tauira hauora ki te whiriwhiri mahi kua whakaahuatia he tukanga uaua e uru ana ki te maha o ngā āhuatanga o roto me waho, pērā i ngā kōwhiringa momo noho me te hanganga o te pūnaha tiaki hauora [11,12,13]. Kāore i te tino arohia ngā āhuatanga o roto i ngā whakangungu hauora paetahi ka awe pea i tēnei tukanga whakatau.
He rerekē te whakaakoranga o te LIC i te hurihanga poraka tuku iho i roto i te hanganga me te whakatakotoranga [5, 14, 15, 16]. Ko ngā pokapū taiwhenua iti-moni kei roto i ngā hapori taiwhenua iti me ngā hononga haumanu ki te mahi whānui me ngā hōhipera [5]. Ko tētahi o ngā mea matua o te LIC ko te ariā o te "haere tonu," e āwhinahia ana e te piripono roa, e āhei ai ngā ākonga ki te whakawhanake i ngā whanaungatanga roa ki ngā kaiwhakahaere, ngā tīma tiaki hauora, me ngā tūroro [5,14,15,16]. Ka ako ngā ākonga LIC i ngā akoranga i roto i te whānui me te wā kotahi, he rerekē ki ngā kaupapa raupapa poto-wā e tohu ana i ngā hurihanga poraka tuku iho [5, 17].
Ahakoa he mea nui ngā raraunga tauanga mō te hunga mahi LIC ki te aromatawai i ngā putanga o te kaupapa, kāore he taunakitanga motuhake hei whakamārama he aha ngā tauira LIC o te taiwhenua e nui ake ai te tūponotanga ki te mahi i ngā wāhi taiwhenua me ngā wāhi tiaki tuatahi ki te whakataurite ki ngā tauira mahi hauora kua puta mai i ētahi atu tauira mahi karaka [8, 18]. I whakahaerehia e Brown et al (2021) tētahi arotake whānui mō te hanganga tuakiri mahi i ngā whenua iti te whiwhinga moni (tāone me te taiwhenua) me te kī he mea nui ake ngā mōhiohio mō ngā āhuatanga horopaki e āwhina ana i te mahi iti te whiwhinga moni hei whakarato māramatanga ki ngā tikanga e awe ana i ngā whakatau a ngā tauira mō te mahi [18]. Hei tāpiri, me mārama whakamuri ki ngā whiringa mahi a ngā tauira LIC, me te whakauru i a rātou i muri i te noho hei tākuta whai tohu ki te whakatau i ngā whakatau ngaio, nā te mea he maha ngā rangahau kua arotahi ki ngā tirohanga me ngā whāinga o ngā ākonga me ngā tākuta iti [11, 18, 19].
He mea whakamere te ako i te awe o ngā kaupapa whānui ā-whenua a LIC ki ngā whakataunga mahi a ngā tauira kua puta i te whare wānanga e pā ana ki te tohungatanga hauora me te tauwāhi whenua. I whakamahia he huarahi ariā hangahanga hei whakautu i ngā pātai rangahau, hei whakawhanake hoki i tētahi anga ariā e whakaahua ana i ngā āhuatanga o te mahi a ngā kaimahi i awe i tēnei tukanga.
He kaupapa ariā hanga-āhua tēnei. I kitea koinei te huarahi ariā whenua tino tika nā te mea (i) i kitea te whanaungatanga i waenga i te kairangahau me te kaiuru i hanga hei pūtake mō te kohikohi raraunga, i hangaia ngātahitia e ngā taha e rua (ii) i whakaarohia he tikanga tika mō te rangahau tika pāpori. , hei tauira, te tohatoha tika o ngā rauemi hauora, me te (iii) ka taea te whakamārama i tētahi āhuatanga pēnei i te "mea i tupu" kaua ki te tūhura me te whakaahua noa [20].
I te tau 2008 i tukuna te tohu Tākuta Rongoā (MD) o Te Whare Wānanga o Deakin (i mua ko te Paetahi Rongoā/Paetahi Pokanga). Ko te tohu Tākuta Rongoā he kaupapa whakauru paerua e whā tau te roa e tukuna ana i ngā tāone nui me ngā tāone tuawhenua, ko te nuinga i te taha hauauru o Wikitōria, Ahitereiria. E ai ki te pūnaha whakarōpūtanga tawhiti whenua o te Tauira Monash Whakarerekētia o Ahitereiria (MMM), ko ngā wāhi akoranga MD ko te MM1 (ngā rohe tāone nui), MM2 (ngā pokapū rohe), MM3 (ngā tāone nui tuawhenua), MM4 (ngā tāone iti tuawhenua) me te MM5 (ngā tāone iti tuawhenua) [21].
I whakahaerehia ngā tau tuatahi e rua o te wāhanga haumanu-mua (papamuri hauora) ki Geelong (MM1). I te tau tuatoru me te tau tuawhā, ka whai wāhi ngā ākonga ki te whakangungu haumanu (mahi ngaio i roto i te rongoā) i tētahi o ngā kura haumanu e rima i Geelong, Eastern Health (MM1), Ballarat (MM2), Warrnambool (MM3) te kaupapa LIC – Rural Community Clinical Schools (RCCS) rānei; ), e mōhiotia whānuitia ana ko te Kaupapa IMMERSE (MM 3-5) tae noa ki te tau 2014 (Pikitia 1).
E 20 pea ngā ākonga e whakaurua ana e te RCCS LIC i ia tau, e mahi ana i roto i te rohe o Grampians me te Tonga Hauāuru o Wikitōria i roto i tō rātou tau tuatoru o te MD. Ko te tikanga whiriwhiri he pūnaha whiriwhiri e whiriwhiri ai ngā ākonga i tētahi kura haumanu i roto i tō rātou tau tuarua. Ka whakaaetia e te kaupapa ngā ākonga me ngā momo whiriwhiringa mai i te tuatahi ki te tuarima. Kātahi ka tohaina ngā tāone motuhake i runga i te hiahia o ngā ākonga me te uiuinga. Ka tohatohahia ngā ākonga puta noa i ngā tāone i roto i ngā rōpū o te rua ki te whā tāngata.
Ka mahi tahi ngā ākonga me ngā Tākuta Whānui (GP) me ngā ratonga hauora taiwhenua o te rohe, me te tākuta whānui hei kaitirotiro matua.
He rerekē ngā papamuri me ngā mahi a ngā kairangahau tokowhā e whai wāhi ana ki tēnei rangahau, engari he rite tonu te hiahia ki te mātauranga hauora me te tohatoha tika o te hunga mahi hauora. Ina whakamahia e mātou te ariā hangahanga, ka whakaarohia e mātou ō mātou papamuri, wheako, mōhiotanga, whakapono, me ngā hiahia hei awe i te whanaketanga o ngā pātai rangahau, te tukanga uiui, te tātari raraunga, me te hanga ariā. He kairangahau hauora taiwhenua a JB me te wheako ki te rangahau kounga, e mahi ana i LIC me te noho i te rohe taiwhenua o te rohe whakangungu a LIC. He kaiwhakaora mātauranga a LF me te kaiwhakahaere haumanu o te kaupapa LIC i Te Whare Wānanga o Deakin, ā, e whai wāhi ana ia ki te whakaako i ngā ākonga LIC. He kairangahau taiwhenua a MB rāua ko HB me te wheako ki te whakatinana i ngā kaupapa rangahau kounga me te noho i ngā rohe taiwhenua hei wāhanga o tā rāua whakangungu LIC.
I whakamahia te whakaaroaro me te wheako me ngā pūkenga o te kairangahau hei whakamārama me te kimi i te tikanga mai i tēnei huinga raraunga whai rawa. I roto i te tukanga kohikohi me te tātari raraunga, he maha ngā kōrero i puta, inā koa i waenganui i a JB rāua ko MB. I tautoko a HB rāua ko LF i tēnei tukanga, tae atu ki te whakawhanake i ngā ariā me ngā ariā matatau.
Ko ngā kaiuru he tauira hauora kua puta i Te Whare Wānanga o Deakin (2011–2020) e haere ana ki te LIC. I tukuna he pōwhiri ki te whai wāhi ki te rangahau e ngā kaimahi ngaio o te RCCS mā te karere kuputuhi whakauru. I tonoa ngā kaiuru hiahia ki te pāwhiri i te hononga rēhita me te whakarato i ngā kōrero taipitopito mā te rangahau Qualtrics [22], e tohu ana (i) kua pānuihia e rātou he kōrero reo māmā e whakamārama ana i te kaupapa o te rangahau me ngā whakaritenga mō te kaiuru, ā, (ii) e hiahia ana ki te whai wāhi ki te rangahau. I whakapā atu ngā kairangahau ki a rātou ki te whakarite i tētahi wā tika mō ngā uiui. I tuhia hoki te wāhi whenua o ngā mahi a ngā kaiuru.
E toru ngā wāhanga o te kimi i ngā kaiuru: ko te wāhanga tuatahi mō ngā tauira kua puta i te tau 2017–2020, ko te wāhanga tuarua mō ngā tauira kua puta i te tau 2014–2016, me te wāhanga tuatoru mō ngā tauira kua puta i te tau 2011–2013 (Pikitia 2). I te tīmatanga, i whakamahia te tauira whai take hei whakapā atu ki ngā tauira kua puta i te hiahia me te whakarite i te kanorau o ngā mahi. Ko ētahi tauira i whakaatu i te hiahia ki te whai wāhi ki te rangahau kāore i uiuitia nā te mea kāore i whakautu mai ki te tono a te kairangahau mō te wā hei uiuitia. Nā te tukanga kimi tauira kua whakaritea i taea ai te tukanga kohikohi me te tātari raraunga, te tautoko i te tauira ariā, te whakawhanaketanga me te whakapai ake i ngā ariā, me te whakaputa ariā [20].
Kaupapa kimi kaiuru. Ko ngā tauira kua puta i te LIC he kaiuru ki te Kaupapa Mahi Kaimahi Whakauru Roa. Ko te tikanga o te tauira whai take ko te kimi i tētahi tauira kanorau o ngā kaiuru.
Nā ngā kairangahau a JB rāua ko MB i whakahaere ngā uiui. I whiwhi whakaaetanga ā-waha mai i ngā kaiuru, ā, i hopukina te oro i mua i te tīmatanga o te uiui. I whakawhanakehia tuatahitia he aratohu uiui hanganga-haurua me ngā rangahau e pā ana hei ārahi i te tukanga uiui (Ripanga 1). I muri mai ka whakahoutia te pukapuka ā-ringa, ā, ka whakamatautauria mā te kohikohi raraunga me te tātari hei whakauru i ngā tohutohu rangahau ki te whanaketanga ariā. I whakahaerehia ngā uiui mā te waea, i hopukina te oro, i tuhia te kupu, ā, i hunaia te ingoa. I waenga i te 20 ki te 53 meneti te roa o te uiui, me te roa toharite o te 33 meneti. I mua i te tātari raraunga, i tukuna atu ki ngā kaiuru he kape o ngā tuhinga uiui kia taea ai e rātou te tāpiri, te whakatika rānei i ngā mōhiohio.
I tukuna ngā tuhinga uiui ki roto i te kete pūmanawa kounga QSR NVivo putanga 12 (Lumivero) mō Windows hei tāpiri atu ki te tātari raraunga [23]. I whakarongo, i pānui, ā, i waehere takitahi ngā kairangahau a JB rāua ko MB i ia uiui. He maha ngā wā ka whakamahia te tuhipoka hei tuhi i ngā whakaaro ōkawa mō ngā raraunga, ngā waehere, me ngā kāwai ariā [20].
Ka puta ngātahi te kohikohinga me te tātari raraunga, me ia tukanga e whakamōhio ana i tētahi ki tētahi. I whakamahia tēnei huarahi whakatairite tonu puta noa i ngā wāhanga katoa o te tātari raraunga. Hei tauira, te whakatairite i ngā raraunga ki ngā raraunga, te wetewete me te whakahou i ngā waehere hei whakawhanake i ngā huarahi rangahau anō e ai ki te whanaketanga o te ariā [20]. I tūtaki pinepine ngā kairangahau a JB rāua ko MB ki te matapaki i te waehere tuatahi me te tautuhi i ngā wāhanga arotahi i te wā o te tukanga kohikohi raraunga auau.
I tīmata te mahi waehere mā te waehere tuatahi, rārangi-i-rārangi, i reira ka "wehewehea" ngā raraunga, ā, ka tohaina ngā waehere tuwhera e whakaahua ana i ngā mahi me ngā tukanga e pā ana ki "ngā mea e tupu ana" i roto i ngā raraunga. Ko te wāhanga e whai ake nei o te waehere ko te waehere waenga, e arotakehia ana, e whakatauritea ana, e tātarihia ana, e whakaarohia ngātahitia ana ngā waehere rārangi-i-rārangi hei whakatau ko ēhea ngā waehere e tino whai tikanga ana ki te tātari mō te whakarōpū i ngā raraunga [20]. Hei whakamutunga, ka whakamahia te waehere ariā whānui hei hanga ariā. Kei roto i tēnei ko te matapaki me te whakaae ki ngā āhuatanga tātari o te ariā puta noa i te rōpū rangahau katoa, me te whakarite kia mārama te whakamārama i te āhuatanga.
I kohia ngā raraunga taupori mā te rangahau taupū ipurangi i mua i ia uiuinga hei whakarite i te whānuitanga o ngā kaiuru, hei tāpiri atu hoki ki te tātaritanga taupū. Ko ngā raraunga i kohia ko: te ira tangata, te tau, te tau i puta ai te tohu, te takenga mai i te taiwhenua, te wāhi mahi o nāianei, te tohungatanga hauora, me te wāhi o te kura haumanu tau tuawhā.
Mā ngā kitenga nei ka whakawhanakehia he anga ariā e whakaatu ana i te awe o ngā whare wānanga o te taiwhenua ki ngā whakataunga mahi ā-rohe me ā-mahi a ngā tauira kua puta i te kura.
E toru tekau mā iwa ngā tauira kua puta i te tohu LIC i uru atu ki te rangahau. I roto i te poto, 53.8% o ngā kaiuru he wāhine, 43.6% nō ngā tāone iti, 38.5% i mahi i ngā tāone iti, ā, 89.7% kua oti i a rātou tētahi tohungatanga hauora, whakangungu rānei (Ripanga 2).
E arotahi ana tēnei anga whakatau mahi LIC taiwhenua ki ngā āhuatanga o tētahi kaupapa LIC taiwhenua e awe ana i ngā whakatau mahi a ngā tauira, e kī ana ko te huinga o ngā āhuatanga takitahi me ngā āhuatanga kaupapa i roto i te ariā matua o te "whiriwhiri whai wāhi" ka awe pea i te tauwāhi matawhenua o ngā tauira. hei whakatau mahi ngaio, ahakoa takitahi, ahakoa mahi tahi (Pikitia 3). Ko ngā kitenga kounga e whai ake nei e whakaahua ana i ngā āhuatanga o te anga, ā, kei roto ko ngā kōrero a ngā kaiuru hei whakaatu i ngā pānga.
Ka oti ngā mahi kura haumanu mā te pūnaha whiriwhiri, kia taea ai e ngā kaiuru te whiriwhiri i ngā kaupapa i roto i ngā huarahi rerekē. I roto i te hunga i whiriwhiri ingoa ki te whai wāhi, e rua ngā rōpū o ngā tauira kua puta: ko te hunga i whiriwhiri ā-tauira ki te whai wāhi ki te kaupapa (i whiriwhiria e rātou anō), me te hunga kāore i whiriwhiri engari i tukuna ki te RCCS. Ka kitea tēnei i roto i ngā ariā o te whakatinanatanga (rōpū whakamutunga) me te whakaū (rōpū tuatahi). Kia whakauruhia ki roto i te mahi, ka whakanui ake ngā ariā o ngā pūkenga hoahoa ako me te whakangungu i te papaanga i te whai wāhi mā te whakarato i te whai wāhi ki ngā kaiuru ki te wheako me te whakataurite i ngā kaupapa tiaki hauora i roto i te huarahi whānui.
Ahakoa te taumata o te whiriwhiri i a rātou anō, i te nuinga o te wā i pai ngā whakaaro o ngā kaiuru mō ō rātou wheako, ā, i kī rātou ko te LIC he tau ako whakawhanake, ehara i te mea i whakauru noa i a rātou ki te taiao haumanu, engari i whakarato hoki i te haere tonu o ā rātou akoranga me te turanga pakari mō ā rātou mahi. Mā te huarahi whakauru ki te whakahaere i te kaupapa, i ako rātou mō te oranga taiwhenua, te rongoā taiwhenua, te mahi whānui me ngā momo tohungatanga hauora.
I kōrero ētahi o ngā kaiuru mēnā kāore rātou i tae atu ki te kaupapa, ā, kāore hoki i oti i a rātou ngā whakangungu katoa i roto i te tāone nui, kāore rawa rātou i whakaaro, i mārama rānei me pēhea te whakatutuki i ō rātou hiahia whaiaro me ō rātou hiahia ngaio i roto i te rohe taiwhenua. Nā tēnei ka hua ake he huihuinga o ngā āhuatanga whaiaro me ngā āhuatanga ngaio, pērā i te momo tākuta e hiahia ana rātou kia noho, te hapori e hiahia ana rātou ki te mahi, me ngā āhuatanga o te noho pērā i te urunga atu ki te taiao me te urunga atu ki te oranga taiwhenua.
Ki taku whakaaro, mehemea i noho noa ahau ki X [whare taone nui] me tētahi mea pērā rānei, kua noho noa iho pea mātou ki te wāhi kotahi, kāore au i te whakaaro kua oti i a mātou (ngā hoa mahi) tēnei mahi, kāore tēnei peke (ki te mahi i ngā wāhi taiwhenua) e hiahiatia kia pēhia (kaituhituhi mahi whānui, mahi taiwhenua).
Mā te whai wāhi atu ki te kaupapa ka whai wāhi koe ki te whakaaroaro me te whakaū i ngā hiahia o ngā tauira kua puta ki te mahi i ngā wāhi taiwhenua. He maha ngā wā ka puta tēnei nā te mea i tipu ake koe i te wāhi taiwhenua, ā, e hiahia ana koe ki te mahi tauira i tētahi wāhi ōrite i muri i te whakawhiwhinga tohu. Mō ngā tauira i whakaaro tuatahi ki te uru atu ki te mahi whānui, i mārama hoki kua tutuki i ō rātou wheako ā rātou tumanakohanga, ā, kua whakakaha ake i tō rātou whakapau kaha ki te whai i tēnei ara.
Nā te mea (i roto i te LIC) i whakaū ake i taku i whakaaro ai ko taku hiahia, ā, i tino hiritia te whakaaetanga, ā, kāore au i whakaaro ki te tono mō tētahi tūranga metro i taku tau mahi tauira, kāore hoki au i whakaaro ki te mahi i roto i te metro (tākuta hinengaro, whare hauora taiwhenua).
Mō ētahi atu, i whakaū te whai wāhi atu kāore te oranga/hauora o te taiwhenua i tutuki i ō rātou hiahia whaiaro me ā rātou hiahia ngaio. Ko ngā wero takitahi ka puta te tawhiti mai i te whānau me ngā hoa, tae atu ki te urunga atu ki ngā ratonga pēnei i te mātauranga me te hauora. I kite rātou ko te auau o ngā mahi waea e mahia ana e ngā tākuta taiwhenua he aukati i tā rātou mahi.
Kei te whakapā atu tonu taku kaiwhakahaere tāone. Nō reira, ki taku whakaaro kāore tēnei momo noho e tika ana mōku (tākuta whānau i te whare hauora whakapaipai).
Ka pāngia ngā whakataunga mahi e ngā whai wāhitanga whakamahere ako me te hanganga ako a ngā ākonga. Ko ngā āhuatanga matua o te haere tonu me te whakaurunga o te LIC ka hoatu ki ngā kaiuru te mana motuhake me te whānuitanga o ngā whai wāhitanga ki te whai wāhi kaha ki te tiaki tūroro, ki te whakawhanake i ngā pūkenga, me te whakahaere i te kitenga me te whakatairite i ngā momo mahi hauora i te wā tūturu e hototahi ana ki ō rātou hiahia whaiaro me ngā hiahia ngaio.
Nā te mea he whānui te whakaakoranga o ngā kaupapa hauora o te akoranga, he nui te mana motuhake o ngā kaiuru, ā, ka taea e rātou te whakahaere me te kimi i ā rātou ake whai wāhitanga ako. Ka tipu haere te mana motuhake o ngā kaiuru i te roanga o te tau i a rātou e whiwhi ana i te māramatanga ā-roto me te haumaru i roto i te hanganga o te kaupapa, ka whiwhi i te kaha ki te whai wāhi ki te tūhuratanga hōhonu i roto i ngā momo taiao haumanu. Nā tēnei i taea ai e ngā kaiuru te whakataurite i ngā marautanga hauora i te wā tūturu, e whakaata ana i tō rātou hiahia ki ngā wāhanga haumanu motuhake e whiriwhiria ana e rātou hei tohungatanga.
I te RCCS ka wawe ake te ako i ēnei kaupapa matua, ā, ka nui ake te wā hei aro atu ki ngā kaupapa e tino hiahia ana koe, nō reira, kāore e maha atu ngā ākonga o te rohe e whai wā ki te whiriwhiri i ō rātou wā me ō rātou wāhi. Inaa, ka haere ahau ki te hōhipera i ia rā… ko te tikanga ka nui ake taku wā i roto i te rūma ohorere, ka nui ake taku wā i roto i te rūma pokanga, me te mahi i ngā mea e tino hiahia ana ahau (kaiwhakaora mamae, mahi taiwhenua).
Mā te hanganga o te kaupapa ka taea e ngā ākonga te tūtaki ki ngā tūroro kāore i rerekē te āhua, me te whakarato i tētahi taumata haumaru o te mana motuhake ki te tiki i tētahi hītori haumanu, te whakawhanake i ngā pūkenga whakaaro haumanu, me te whakaatu i tētahi tātaritanga rerekē me te mahere maimoatanga ki te tākuta. He rerekē tēnei mana motuhake ki te hokinga ki te hurihanga poraka i te tau tuawhā, ina kitea he iti ake ngā whai wāhitanga ki te awe i ngā tūroro kāore i rerekē te āhua, ā, ka hoki anō ki te tūranga tirotiro. Hei tauira, i kī tētahi ākonga mēnā ko tā rātou wheako haumanu anake i roto i te mahi whānui he hurihanga tau tuawhā kua herea te wā, i whakaahuahia e ia he kaitirotiro, kāore ia i te mārama ki te whānuitanga o te mahi whānui, ā, i kī ia kia whai whakangungu i tētahi atu tohungatanga.
Ā, kāore i pai taku wheako (te huri i ngā poraka GP). Nō reira, ki taku whakaaro mehemea koinei anake taku wheako i roto i te mahi whānui, tera pea kua rerekē taku whiringa mahi… Ki taku whakaaro he moumou taima noa iho tēnei i te mea kei te mātakitaki noa ahau (GP, mahi taiwhenua) me pēhea tēnei wāhi mahi.
Mā te piri roa ka taea e ngā kaiuru te whakawhanake i ngā whanaungatanga tonu ki ngā tākuta e mahi ana hei kaiārahi me hei tauira. I rapu kaha ngā kaiuru i ngā tākuta, ā, i noho roa ki a rātou mō ngā take maha, pērā i te wā me te tautoko i whakaratohia e rātou, te whakangungu mō te mōhio, te wātea, te mihi ki tā rātou tauira mahi, me ō rātou tuakiri me ngā uara. Te hototahi ki a koe anō, ki ētahi atu rānei. Te hiahia ki te whanake. Ehara i te mea ko ngā kaiuru anake i tohua hei tauira/kaiārahi i raro i te tirotiro a te Tākuta Matua, engari ko ngā māngai hoki mai i ngā momo tohungatanga hauora, tae atu ki ngā tākuta, ngā taote pokanga me ngā kaiwhakamoe.
He maha ngā mea. Kei te wāhi X ahau (te wāhi LIC). I reira tētahi tohunga whakamoe i whakahaere ā-kore i te ICU, ki taku whakaaro i tiaki ia i te ICU i te hōhipera X (tuawhenua) ā, he marino tōna āhua, ko te nuinga o ngā tohunga whakamoe i tūtaki ahau he marino ō rātou whakaaro mō te nuinga o ngā mea. Ko tēnei āhua marino te mea i tino pā ki ahau. (kaiwhakamoe, tākuta tāone)
I whakaahuahia te māramatanga pono ki te hononga o ngā oranga ngaio me ngā oranga whaiaro o ngā tākuta hei whakarato i ngā tirohanga whai hua ki ō rātou momo noho, ā, i whakaponohia ka akiaki i ngā kaiuru ki te whai i ngā ara ōrite. Tērā anō hoki te whakaaro pai ki te oranga o te tākuta, i ahu mai i ngā mahi pāpori o te kāinga.
I roto i te tau, ka whakawhanakehia e ngā kaiuru ngā pūkenga haumanu, whaiaro me te ngaio mā roto i ngā whai wāhitanga ako ā-ringa e whakaratohia ana mā roto i ngā whanaungatanga kua whakawhanakehia ki ngā tākuta, ngā tūroro me ngā kaimahi hauora. Ko te whanaketanga o ēnei pūkenga haumanu me te whakawhitiwhiti kōrero he maha ngā wā ka uru atu ki tētahi wāhanga haumanu motuhake, pērā i te rongoā whānui, te rongoā whakamoe rānei. Hei tauira, i roto i te maha o ngā wā, i whakaahuahia e ngā tohunga whakamoe kua puta me ngā tohunga whakamoe whānui ō rātou whanaketanga o ngā pūkenga taketake i roto i te kaupapa mai i tō rātou tau LIC, me te whai mana whaiaro i whakawhanakehia e rātou i te wā i kitea ai, i whakawhiwhia ai hoki ō rātou pūkenga matatau ake. Ka whakapakarihia tēnei kare ā-roto me ngā whakangungu e whai ake nei, ā, ka whai wāhi anō hoki mō te whanaketanga.
He tino rawe. Me mahi au i ngā intubations, i ngā anesthesia tuaiwi, me ētahi atu mea, ā, i muri i te tau e tū mai nei ka oti i ahau te whakaora ... te whakangungu anesthesiology. Ka noho ahau hei anesthesiologist whānui, ā, ki taku whakaaro koinei te wāhanga pai rawa atu o taku wheako ki te mahi i reira (kaupapa LIC) (kaituhi rehitatanga whānui, te mahi i te rohe taiwhenua).
I whakaahuatia ngā āhuatanga whakangungu i te papaanga, ngā āhuatanga kaupapa rānei, he pānga ki ngā whakataunga mahi a ngā kaiuru. I whakaahuatia ngā horopaki hei huinga o ngā horopaki taiwhenua, ngā mahi whānui, ngā hōhipera taiwhenua me ngā horopaki haumanu motuhake (hei tauira, ngā whare pokanga) me ngā horopaki rānei. Ko ngā ariā e pā ana ki te wāhi, tae atu ki te wairua hapori, te whakamarie o te taiao, me te momo whakaaturanga haumanu, i awe i ngā whakataunga a ngā kaiuru ki te mahi i ngā rohe taiwhenua me/ranei te mahi whānui.
Nā te wairua o te hapori i awe ngā whakatau a ngā kaiuru ki te haere tonu ki te mahi whānui. Ko te mea e pai ai te mahi whānui hei umanga, he mea hanga he taiao hoahoa me te iti o te hiranga, ka taea e ngā kaiuru te taunekeneke me te mātakitaki i ngā tākuta me ngā GP e ahua pai ana ki tā rātou mahi, ā, e whiwhi ana i te wairua makona.
I kite hoki ngā kaiuru i te hiranga o te hanga hononga ki te hapori tūroro. Ka tutuki te makona whaiaro me te makona ngaio mā te mōhio ki ngā tūroro me te whakawhanake i ngā hononga tonu i roto i te wā i a rātou e whai ana i ō rātou ara, i ētahi wā i roto i te mahi whānui anake, engari he maha ngā wā puta noa i ngā horopaki haumanu maha. He rerekē tēnei ki ngā manakohanga iti ake te pai mō te tiaki wā poto, pērā i ngā tari ohorere, i te wā kāore pea he porowhita kati o ngā putanga whai muri i te tūroro.
Nō reira, ka tino mōhio koe ki ō tūroro, ā, ki taku whakaaro, ko te mea tino pai ki ahau mō te noho hei Tākuta Whānui ko te whanaungatanga tonu kei a koe me ō tūroro… me te hanga i taua whanaungatanga ki a rātou, kaua i ētahi wā i ngā hōhipera me ētahi atu tohungatanga motuhake, ka taea e koe… te kite i a rātou kotahi, e rua rānei ngā wā, ā, he maha ngā wā kāore koe e kite anō i a rātou (tākuta whānui, whare hauora tāone nui).
Nā te whai wāhi atu ki ngā mahi whānui me te whai wāhi atu ki ngā kōrerorero tahi i mārama ai ngā kaiuru ki te whānuitanga o te rongoā tuku iho Hainamana i roto i ngā mahi whānui, inā koa i ngā mahi whānui o te taiwhenua. I mua i te noho hei tauira, i whakaaro ētahi o ngā kaiuru ka uru atu rātou ki ngā mahi whānui, engari he maha ngā kaiuru i noho hei tākuta whānui i kī i te tīmatanga kāore rātou i te tino mōhio mēnā ko te tohungatanga te whiringa tika mā rātou, i te whakaaro he iti ake te koi o te āhua haumanu, nō reira kāore e taea te pupuri i ō rātou hiahia ngaio mō te wā roa.
Nā te mea kua mahi au i te mahi a te Tākuta Whānau hei ākonga rumaki, ki taku whakaaro koinei taku wā tuatahi ki te kite i te whānuitanga o ngā Tākuta Whānau, ā, i whakaaro ahau ki te uaua o ētahi tūroro, te kanorau o ngā tūroro, me te whakamere o ngā Tākuta Whānau (GP), he mahi whakamīharo tēnei.
Wā tuku: Hurae-31-2024