<p style="text-align: center;"><em><span style="font-size:12px">Tapuhi T&#363; Toa Intervention research lead, Dr Heather Gifford and auditor, Lynley Cvitanovic discuss the Audit Report recommendations.</span></em></p>

<p>&nbsp;</p>

<p>Dr Heather Gifford has welcomed Whakauae&rsquo;s recent release of the Tapuhi T&#363; Toa Audit Report. The Report covers the factors that contributed to the pilot M&#257;ori student nurses smoking cessation intervention gaining limited traction in targeted schools of nursing in 2016 and what may need to happen if the Intervention is to be successfully delivered in the future. The pilot Intervention model was developed by Whakauae, and its research partners, as an outcome of an HRC-funded study in 2014 - 2015. That research explored nurses smoking cessation attitudes and behaviours along with the impact of smoking on their professional identities as health workers.</p>

<p>The Implementation model was feasibility tested with nursing tauira, during Te R&#363;nanga New Zealand Nurses&rsquo; Organisation (NZNO) hui, who strongly supported implementation of the intervention. On the strength of these results, Whakauae funded the necessary intervention research to be carried out through targeted schools of nursing. &ldquo;Understanding why the intervention failed to gain traction was a major concern for me as well as for those who had worked hard trying to make it happen&rdquo; lead researcher, Dr Gifford explained.</p>

<p>Audit findings highlight that the model itself was widely supported by a range of stakeholders. The model incorporated components considered integral to supporting nursing tauira on a cessation journey. The audit evidence identifies that the primary barriers to implementation lie not within the model itself but in the realities of the schools of nursing delivery context. Whilst institutional barriers present as the primary impediment to the successful implementation of Tapuhi T&#363; Toa, the Research Team&rsquo;s need to conclude the study by the end of 2016 also figures.</p>

<p>Findings highlight too the multiple, competing demands and stresses which students are juggling daily, often including study as well as wh&#257;nau and paid work commitments, and the difficulties this posed for additionally participating in the Intervention study. The Research Team&rsquo;s under-estimation of the challenges of working across sectors (research, health and tertiary education), especially when timeframes are tight and the complexities of the tertiary education environment are not adequately factored in, were also noted. For the already stretched staff in schools of nursing, facilitating the participation of tauira in the Tapuhi T&#363; Toa Intervention was not necessarily a priority.</p>

<p>The robust and intensive work undertaken by the Intervention Coordinator, who was contracted to get the Intervention &lsquo;off the ground&rsquo; in six schools of nursing over the course of the year, was identified. She consistently demonstrated flexibility, resourcefulness and the willingness to seek and take the advice of the Research Team where appropriate. The universal view was that the work that the Coordinator had carried out, in difficult circumstances, could not be faulted.</p>

<p>Future successful facilitation of the Intervention in schools of nursing settings would mean better timing of delivery along with linking tauira participation to the gaining of credits towards completion of a formal assessment. Putting the Intervention &lsquo;on the map&rsquo; for tertiary institutions and their tauira well in advance was also critical along with having a well-grounded working knowledge of how tertiary institutions operate, and of their operational contexts. Audit Report recommendations included that culturally appropriate alternative sites for implementation of the model, outside the boundaries of tertiary institution schools of nursing, be seriously considered.</p>

<p>At its recent final hui, the Research Advisory Group, which included both tertiary institution staff and Te R&#363;nanga (NZNO) representatives, endorsed the audit findings. Despite the work that remains to be done to successfully negotiate barriers to Intervention implementation, the Group expressed their continued confidence in the potential of the Intervention to make the necessary impact on M&#257;ori student nurses smoking rates. The hui concluded with Te R&#363;nanga representatives agreeing to investigate trialling the Intervention model, under the umbrella of their regional organisational structure in a targeted rohe, in 2018. This approach to implementing the model would bring together M&#257;ori nursing students from across several tertiary institutions bypassing some of the complexities of delivery within schools of nursing themselves.</p>

<p>&nbsp;</p>

<p><a href="/publications/technical-reports/5/">The full Tapuhi T&#363; Toa Audit Report is now available here.</a></p>

<p>&nbsp;</p>
