Abstracts for Concurrent Sessions 21st and 22nd October 2021

Abstracts

           for

   Concurrent Sessions

21st and 22nd October 2021

1. Maternal MH & Post Natal Depression; Kim Myhill & Cleo Jay

2. Beware of the goats; Michelle Rodda, NP

Cranford hospice provides and supports specialist palliative care in Hawkes Bay. This
includes to our rural areas of Wairoa in the north and Central Hawkes Bay in the south.
Accessing equitable palliative care across New Zealand is an ongoing issue. Our rural
centers are resourceful and resilient, they are keen to look after their own, to do this
they need support, skills and knowledge. There are several challenges identified within
rural areas, our model was about empowering staff to look after their own and to
minimise the impact of some of these challenges that includes changing health
professionals, staff shortages, poor health literacy and ability to access services to
name a few. Utilising the role of Nurse Practitioner to work with rural areas enabled
capacity to reach out and appropriately support these areas as NPs are uniquely placed
to work with both nursing and medical teams. We have worked together to create a
consultancy partnership. This included acknowledging what they were already doing,
gently identifying gaps and building on what was already there. And included backing
this up with consistency and commitment to regular visiting and policy to
support/enable this working relationship. And of course avoiding those goats !!!

3. Diabetes in youth and emerging adults; Vickie Corbett, NP

The incidence of diabetes in young people

Key findings:
We estimate 2300 emerging adults live with diabetes in New Zealand. Specialist
diabetes services across the country differ in resources so some emerging adults have
limited access to interdisciplinary teams with psychological, social and cultural
support. Adolescents transitioning to adult health services or moving areas disengage
when the process is improperly co-ordinated and managed.
Technology in managing Type 1 diabetes continues to evolve with trials in ‘closed loop’
insulin delivery systems which have the ability to improve glycaemic control is
currently taking place in New Zealand. Although insulin pumps and continuous and
intermittent glucose monitoring have been available in New Zealand for some time,
access has been limited due Pharmac funding criteria, financial cost, education and
support.
We hope adolescents and emerging adults at risk of Type 2 Diabetes may be diagnosed
earlier if new local guidelines are implemented as their disease is more severe with
rapid progression.    Those >18years will have access to newly funded effective
medication under special authority criteria but there is no safety data for youth. There
is no programme in New Zealand that focuses on lifestyle management in adolescents
or emerging adults, despite obesity being a well-known public health issue.
Conclusion:
Despite evolving technology in managing Type 1 diabetes and exciting medications for
Type 2 diabetes becoming available in New Zealand, diabetes health services need to
be aware of the barriers, inequities and circumstances faced by this population.

4. Growing nurse practitioners; Amelia Howard-Hill, NP

The Pegasus Health 24 Hours Surgery, (24Hrs) is a large Christchurch based urgent
care facility operating 24 hours a day, 365 days a year. In 2020, the 24Hrs embarked
on a journey to systematically develop an advanced nursing practice (ANP) framework
within the 24 Hour Surgery.
The ANP framework involves registered nurses (RNs) developing the knowledge and
skills required to provide patient care activities that are traditionally within the realm

of other health professions such as medicine. ANP is a spectrum, with the complexity
of a nurse’s patient care activities increasing as their knowledge, skills and experience
increases. The most autonomous of NZ’s ANP roles is that of the NP. Other ANP roles
developed were registered nurse authorised prescriber (RNDP) roles.
Aim:
The purpose of the ANP framework was to develop an ANP workforce capable of
delivering the very best care, in partnership with patients in a collaborative and
evolving clinical environment.
The key deliverables expected were; satisfied staff, satisfied patients and a high
functioning team.
Methods:
The 24 Hours ANP development programme utilised the Plan Do Check Act (PDCA)
framework.
Planning involved systematically considering the needs of the service and hiring a lead
NP to develop the ANP framework and recruit the team.
Implementation occurred in four phases; NP recruitment, Piloting a RNDP role,
establishment of NP internship positions and developing RNs to start the journey to
ANP.
Checking the efficacy of the ANP service involved auditing clinical documentation,
complaints, patient and staff satisfaction surveys and monitoring NP/RNDP
productivity.
Findings:
Developing an ANP framework was essential to provide a tethering post to ensure all
ideas, processes and team members were cohesively aligned.
Developing an ANP team involves the whole team not just the select few who engage
in the journey to NP
Focussing on ensuring all team members (regardless of discipline) are able to work to
the top of their scope if foundational to ANP development
Conclusion:
NP’s and RNDP’s provide quality care, with high patient satisfaction. Team members
found working with a NP or RNDP a positive experience and considered them a
valuable addition to the clinical team. Experienced NP’s were comparably productive

to their medical colleagues. Therefore, the work to systematically create an ANP
framework was justified.

5. New Children’s Hospital in the Home service; Virgina Moore, NP (via
   Zoom from the Gold Coast, Australia)

Gold Coast Health set up a new Children’s Hospital in the Home (CHITH) service in
late 2018. Chronic respiratory patients were a large cohort admitted on this
program, however no formal pathways for review during or at completion of
treatment were established.
Methodology:
The nurse practitioner who case manages this cohort collaborated with the CHITH
team about the gap in service, identifying who was the most appropriate staff
member with availability to manage these admissions. It was identified that the
nurse practitioner had the appropriate skills and knowledge to collaboratively
manage clinical assessments, reviews, CVAD cares, therapeutic drug management
and discharge planning for this cohort.
Retrospective audits were carried out to compare this model of care to standard
inpatient care.
Results:
The CHITH service, with NP collaborative management was non-inferior to inpatient
admission, based on lung function, weight and length of stay.
Conclusions:
Within this cohort in this HHS, collaborative NP-led care is safe and effective for
children admitted to hospital in the home.
Implications:
Nurse practitioner models of care can and should evolve to meet the needs of
patients in a complex and ever-changing health care system.

6. Community health of older people initiative; Zaffer Khan Cusi Malik,
   NP

Primary care in Wellington, New Zealand expressed need for timelier responsiveness
from secondary care service for frail/complex older people. There is a national
imperative for increased integration between primary and secondary services.
Aim
Provide timelier and collaborative service to primary care supporting older people to
remain healthier and live in their own homes through a person-centred integrated
model that enriches the scope of primary care, responding quickly to the acute frail
person, and promoting proactive approaches to optimise the functional trajectory of
older people.
Methods
The initiative commenced in August 2019 in Capital & Coast District Health Board
(CCDHB). Recruitment of 0.5FTE Geriatrician and 2 full-time Nurse Practitioners (NP)
embedded in an existing multidisciplinary Older Adults and Rehabilitation (ORA) team.
NPs provide same-day in-home response to urgent and complex geriatric referrals.
NPs work within a collaborative model approach which is an inter-professional
cooperation that commonly includes a primary or tertiary care team working with
allied health professionals – such as dieticians, physiotherapists or mental health
professionals – or medical specialists which aim is to improve patient journey and
outcomes.
Results/Key Learning Points:
Data indicates timely assessments and geriatric support for patients and GP practices.
The NP links to GP practices are strong and patients are prioritised to be seen in their
homes the same-day or next from receipt of referral.
Conclusions: Most patients are assessed by the NP on the same day and benefitted
from a strong and robust care management providing home support and preventing
admissions to hospital.
Implications:
A formal appraisal is underway which includes a qualitative study of the impact on
primary care clinicians, people and families. Provisional data shows that this model of

care has prevented admissions and reduced the need for patients to see their GP or
present to the ED resulting in significant savings from both the patient and health
sector perspective. It is anticipated that the model will be rolled out across the whole
DHB.

7. Out of a crisis, new opportunities emerge; Paddy Holbrook, NP

The ‘Health Assessment and Advanced Nursing Practice’ paper is a foundational
course for those on the Nurse practitioner pathway. The primary aim of the paper is
to enhance nurses’ skills in health assessment across the lifespan and advance their
clinical reasoning and clinical decision-making. Despite this focus, the educators have
observed that during the lab sessions the nurses seem intently focused on how to
pass the final Objective Structured Clinical Exam (OSCE) rather than the acquisition
of physical examination skills to inform their decision-making in clinical practice.
Although we were already questioning how to address this observation, Covid 19
presented us a unique challenge. That is, how can we teach physical examination
skills and assess a nurse’s competence when socially distanced?
Aim: This presentation will describe how we taught and assessed our students’
competence in physical examination during Covid 19 lockdown and the impact of
these changes for future educational practice.
Outcomes: A greater understanding of pedagogical paradigms and its application to
clinical skills acquisition, clinical reasoning and clinical decision-making. Our
response to Covid 19 serves as a reminder that out of crisis, new opportunities
emerge when educators question traditional teaching methods, and collectively
problem solve.
Conclusion: The OSCE might not be the problem but rather the teaching and learning
approach.

8. Youth and porn; Nicky Denham from the Light Project in HB

9. Equitable medicine access and quality use for older Maori; Joanna
   Hikaka (Ngāruahine) BPharm, PGDipClinPharm, MPA, Doctoral
   Candidate School of Pharmacy, Faculty of Medical and Health
   Sciences, University of Auckland

Inequities in access and quality of healthcare exist across a range for clinical context,
including medicines access in Aotearoa, with Māori being disadvantaged compared to
non-Māori. Optimal medicines use requires access to medicines which provide
maximum therapeutic benefit with minimal harm. To ensure this, partnership
between health providers and patients is essential, as is understanding the multi-
dimensional impact of medicines.
Objective: To explore equity of medicines access in older New Zealanders and present
a case study highlighting the importance of holistic care to improve access to
medicines and health services.
Method: A narrative review was conducted to examine ethnic variation in medicines
utilisation and associated clinical outcomes, between Māori and non-Māori older
adult populations in NZ.
Results: 22 studies were included in the review. There is ethnic variation in the access
to medicines in NZ, with Māori older adults often having reduced access to particular
medicine types, or in particular disease states, compared with non-Māori older adults.
Māori older adults are less likely than non-Māori to be prescribed medicines
inappropriately (as defined by standardised tools) however, inappropriate prescribing
is more strongly associated with adverse outcomes for Māori than non-Māori.
The case study examines a Māori gentleman with diabetes, the need for review of
multiple dimensions of health and wellbeing, and the impact that health practitioners
can have to improve access to care when this is done.
Conclusion: Understanding inequities in medicines access, and the need for holistic
approaches to improve access, provide a starting point to develop pro-equity
solutions.

10. Breadth of the NP role in rural primary health care; Kate Stark, NP

Having qualified as an NZRN in 1988, I have worked in rural primary health care since
2006 and qualified as a nurse practitioner in 2016. Along my journey I have embraced
the challenge of implementing the NP role and recognise the evolving value that the
role has in rural areas where recruitment and retention of medical staff is ever
challenging.
Since qualifying I have implemented the NP role in three rural settings and my new
role where I have worked since July 2020 is the epitome of being a Nurse Practitioner
with a combination of both clinical work and leadership within a team.
The essence of my role includes holistic patient care across the life span including the
management of acute and chronic health conditions as well as a clinical governance
role within the practice.
The practice a Trust owned sole clinician practice with 1400 patient covering a large
rural area in Central Otago.
As well as working in the clinical role, my appointment was seen as a way to develop
some consistency of care, through longevity of the NP role, when retaining a GP has
proved to be extremely difficult. Anecdotally lack of continuity over the last 10 years
has resulted in a community that has developed poorly managed chronic illness. I see
patients as the GP does, in 15 minute appointment times and have collegial
relationships with referring hospitals and community services.
I have also been asked to provide clinical governance to review systems within the
practice to ensure we are working in a way that provides our patients with the best
possible care, while encouraging the staff to work at the top of their scope of practice
as well as adopting measures that ensure workforce development and sustainability.
As well as my 3 clinical days per week (which often rolls into Day 4 and 5 working
remotely on governance issues), I work as part of the on call roster for PRIME (Primary
Response in a Medical Emergency), a role I have done for 15 years.
The role is varied and challenging and pushes me to the top of my scope while
providing a learning curve that keeps me stimulated and on my toes. There are no
patients that I don’t see in my clinic, but utilise the resources I have access to and the

experience and complementary skills/knowledge of the GP to review cases and
scenarios encountered on the two days I work totally autonomously.
I would love the opportunity to show case my role utilising examples of my
experiences to demonstrate the breadth of the NP role in rural primary health care.

11. Guardians of skin; Helen August, NP

Ambulatory sensitive Hospitalisations (ASH) are mostly acute admissions that are
considered potentially reducible through prophylactic or therapeutic interventions
deliverable in a primary care setting. Key risk factors for ASH include lack of early
detection, lack of treatment of acute conditions and inadequate control of chronic
conditions. In New Zealand children, ASH accounts for approximately 30 percent of all
acute and arranged medical and surgical discharges with the most contributing
conditions including upper respiratory tract infections, cellulitis and skin infections.
Hawke’s Bay has a 0-19 year old population 2% above the national average and a
Maori population 10.4% above national average. In response to reduce ASH rates the
Hawke’s Bay District Health Board (HBDHB) Child Health Team decided to front a Skin
Programme that aims to raise awareness, prevent and provide early intervention and
management of skin problems. With the addition of an NP on the team the CHT can
provide a targeted approach which includes home visits and whole family care,
providing appropriate visual resources on healthy skin management, working with
early childhood centres, schools and the community.

The skin programme continues to grow and develop with the needs of the community.
•   The PHNs are able to work in consultation and utilise standing orders issued by the
    NP to provide early intervention treatment.
•   There is training for ECEC, Te Kohanga Reo, and Pacific Language Nests kaimahi at
    regular health promotion events.
•   Recently a DHB governance group formed which includes clinical leaders (NPs) is
    working on blending respiratory and skin infection work together.

•   Resources have been developed following surveys with the ECEC’s providing tailor
    made resources. PHN’s provide teaching to the teachers and support who then
    share with parents and caregivers.
•   We are currently auditing and analysing ASH rates and looking at the correlation
    between skin, housing, rheumatic fever and respiratory conditions. Geographical
    mapping is providing us with clear target areas within Hawkes Bay

12. Primum non nocere: prescription drug overuse; Karyn Whatson, NP
   & Dr D.Goel, Psychiatrist

President Obama of the United Sates called for the ‘end the war on drugs and start
the war on addictions’ in 2010 after data showed more people died of overdoses than
motor vehicle accidents; with the majority on prescription medications. The rise of
prescriptions have directly contributed to the prevalence of opioid addictions and fatal
overdoses; which often starts with a single script post-surgery or hospitalisation left
unchecked and without a discontinuation plan in the community (1-2).
New Zealand has not been spared from this epidemic, with evidence of the severity
available to compare with each region. Large quantities of opioids and
benzodiazepines are often dispensed at one time which further contributes to the
problem. Seemingly well-adjusted people from all backgrounds can find themselves
seeing multiple prescribers to ensure a supply, leading to a perilous downward spiral.
Local case presentations vividly shows the consequences of ‘mindless’ prescribing that
can lead to real harm or an avoidable loss of life. Benzodiazepines and hypnotic drugs
continue to be inappropriately prescribed by well-meaning prescribers, and at times
on demand by distressed patients; despite the evidence of having poor long term
efficacy, increased tolerance and dependence issues as well as the increased risk of
motor vehicle accidents and other ‘harms’(3-4). It is our responsibility as safe
prescribers to know the evidence behind the clinical decisions that influence our
prescribing and to recognise the red flags to avoid doing harm.

13. NP role in rest homes in rural settings; Rebecca Grant, NP

The rural township of Wanaka lies 4 hours from the nearest tertiary hospital and 1.5
hours from a base hospital. There are two rest homes with approximately 90
residents. These rest homes also include palliative beds and a D4 level dementia unit
with 20 beds. To be seen by specialists these patients have to either travel to Dunstan
(1 hour away) or Dunedin (4 hours away).
The increasing number of Nurse Practitioners in the region has now enabled these
patients and their families to have access to specialized services that work
collaboratively. The combination of a General practice Nurse Practitioner, Hospice
Nurse Practitioner and Mental Health Nurse Practitioner all working together to
improve the care management of this population.
The role of the nurse practitioner in the rest home has already been recognized as a
way of improving health care to this population of patients. The study undertaken by
Peri, Boyd, Foster & Stillwell (2013) identified that the Nurse Practitioner “Improved
timeliness and access to care and a care coordination approach that transcended the
boundaries of primary and secondary services” (p6)
This study was just looking at the role one nurse practitioner has when based in the
rest home setting. This presentation is going to describe how the rest home residents
and staff benefit from having the input of three specialised nurse practitioners in their
care.
This presentation aims to understand the roles of these nurse practitioners and
includes feedback from the rest homes. It will also discuss options for improving this
service in the future.

14. The clinic in the home; Jenae Valk, NP

The     Starship Community      is a multidisciplinary team of professionals   providing
nursing, allied health, technical and cultural support to children, young people and
their families living within the Auckland DHB area. In 2016 we embarked on a journey
in collaboration with the Starship Nurse Director and Service Clinical Director of

General Paediatrics to formalise an NP intern programme in Starship Community to
further support the community service model which includes “Clinic in the Home”.
Objectives:
Internship objectives include:
   -   A supported academic pathway
   -   Protected NP intern employment contract with transition into an NP contract
   -   Strong focus on mentorship and clinical supervision from established NP roles
       and General Paediatric Consultants
   -   Experiential learning individualised to the interns needs
   -   Completion of NCNZ NP Portfolio and successful transition to NP role

Overarching Service Delivery objectives:
   -   Improved access to care
   -   Whānau-centred approach that tackles unmet health and social needs
   -   Elimination of inequities in achieving health and wellbeing outcomes for Māori
       and other priority populations with high health and/or social needs
   -   Knowing and working closely within the community
   -   Continuum of care between secondary and primary health services
   -   Improved service design through triaging, pathways and interdisciplinary
       relationships
Outcomes:
A team of 5 qualified NP’s providing a “Clinic in the Home” approach that brings expert
assessment and intervention of a range of child health issues directly to the home
environment with direct access to secondary care via the General Paediatric service.
This provides an alternative to secondary models of care including outpatient clinics.

15. De-prescribing education and practice in NZ ; Betty Poot, NP & Dr
   Denise Taylor

The practice of deprescribing in New Zealand (NZ) is seemingly in its infancy, with
policy briefing provided by the Royal NZ College of General Practitioners to guide its
members on the possible components of addressing a prescribing cascade in older

people, but by no other professional groups.1 This documents highlights the need for
a considered, systematic and multidisciplinary approach to deprescribing, including
“close collaboration” between doctors and pharmacists”, for best outcomes for the
patient. With increasing numbers of nurse prescribers, there is a need to develop
multidisciplinary frameworks which are inclusive and supportive.
Methods: Nurses and pharmacists were recruited to one of six focus groups or seven
individual interviews. Participants included prescribing and non-prescribing registered
nurses (RNs), nurse practitioners (NPs); non-prescribing hospital and community
pharmacists (HCPs) and prescribing pharmacists (PPs). Interviews and focus groups
were digitally recorded and transcribed verbatim. An iterative approach to thematic
analysis was taken for each professional group with an overarching analysis across
groups. Victoria University of Wellington Human Ethics research approval 0000026829
granted 30/11/18.
Study Aim: To explore educational and support needs of nurse and pharmacy professionals
for deprescribing.
Results: A total of 35 participants took part, including 17 registered nurses (seven NPs;
ten RNs) and 18 pharmacists (six PPs; 12 HCPs & CPs). Results identified the perceived
need for a holistic approach to clinical pharmacology education on the use of
medication in prescribing and deprescribing to start from the very first day of
undergraduate nursing, with increasing complexity of education to support
confidence in their prescribing and deprescribing practice from the provision of
postgraduate education. Need for a multidisciplinary networks and mentorship to
support their deprescribing practice were also identified.
Implications for Practice and Policy: Multidisciplinary guidance on best practice within and
across professional groups in needed to support the safer practice of deprescribing in NZ.

16. NP forensic examiners – the dream; Lei Johnson, NP

In 2008 I had a dream to facilitate nurse led clinics in sexual health as an RN. Ten years
down the track I landed myself in Auckland training with a room full of medical
colleagues in how to become a forensic examiner for people who have experienced
sexual violation. I am Lei Johnson, Lead Clinician for HB Sexual Assault Service, New

Zealand’s first MEDSAC accredited forensic examiner for sexual assault, and a Police
Medical Officer. Two significant roles that have historically only ever been held by
medical practitioners.
The Dream, the journey, the role development, began when I first trained as an RN to
assist forensic examiners in the collection of forensic specimens after sexual assault. I
knew I wanted to be ‘The forensic examiner’. I wanted nurses to be seen to be leading
the way. I craved the prestige of becoming New Zealand’s first forensic examiner, to
be able to showcase the magnitude of the role of the NP and explore how it would
better ensure people affected by sexual assault had timely equitable access to high
quality medical and medico-legal services.
MEDSAC Aotearoa are committed to improving the wellbeing of survivors and are
acknowledged as the expert body in NZ in sexual assault medicine. MEDSAC have
guided and supported the journey I was tasked with. It has been a successful
pioneering journey navigating a new pathway for not only myself but for those ahead
of me who choose this area of practice. Becoming an accredited forensic examiner
ultimately laid the foundations for me to become another first, a ‘Police medical
officer’ for NZ Police.
NP’s are now being recognised as the experts we are in both sexual assault medicine
and judicial proceedings. Where is this going, there is still room to grow with new
legislation around non-fatal strangulation, watch this space – this is my next journey.

17. Heart failure pharmacotherapy titration and the NP role; Andy
   McLachlan, NP

Heart failure with reduced ejection fraction (HFrEF) is associated with poor outcomes.
While several medications are beneficial, achieving optimal HF pharmacotherapy is
difficult. COVID offered an opportunity to explore new ways of delivering care.

Methods
Fifty patients were identified following hospital discharge and taught to identify fluid
congestion and monitor their vital signs using BP monitors & electronic scales, with

NP led telephone support. Up titration was facilitated by eprescriptions and
elabforms. Quantitative data was collected and a patient experience telephone
interview was performed. Medication changes were notified to primary care in real
time using an electronic template.
Results
Fifty patients (mean age 59yrs; male, 76%; Maori or Pacific, 58%) were entered into
the trial. The majority (76%) had a new diagnosis of HFrEF with 90% having an ejection
fraction

BPAD remains subject to controversy, the general consensus is that they are distinct
disorders (7).
Our intention is to stimulate debate, present the evidence and explore the overlapping
symptoms between BPD and BPAD; with a focus of what are the best evidenced based
recommendations and how our services can ensure the needs are being met while
acknowledging resource inadequacies in the face of ‘doing no harm’. The comparison
between guidelines depending on clinicians’ geographic or academic alignment
further ads to the debate within treatment teams; whereas the ‘wastebasket’
perception of having the diagnosis, lends to a sense of hopelessness. The questions
remain:
   a) Does a diagnosis of borderline personality disorder help or hinder?
   b) Is it time to shift the focus to the severity of dysfunction to inform a tailored
       response?
   c) Are we over diagnosing or under recognising either BPD or BPAD in this
       population?
   d) What is the evidence to support our clinical decisions?

19. Sexual Health Update: Dr. Simon Snook

20. A “shocking” audit; Jo-Ann Downie, NP

Non valvular atrial fibrillation and flutter (AF) are the most frequent arrhythmias
effectively treated with electrical cardioversion. Traditionally cardioversion for elective
non valvular AF at Taranaki District Health Board has been carried out by medical staff,
mainly Cardiologists who are under significant time restraints, also there was no clear
pathway for referring or following up patients.
Several studies have documented that nurse – led cardioversion service is safe,
effective, more economically viable, and achieves patient satisfaction.
A NP fully nurse-led service was developed (initial consultation, DCCV itself, and follow
up).

Objectives of Audit:
As nurse – led DC Cardioversion (DCCV) is a new service initiative at TDHB, this audit
assessed the processes, safety, factors contributing to success and non success, use of
antiarrhythmic therapy and anaesthetic considerations.
Method:
   •   Retrospective Audit from 1/1/2017-31/12/2019
   •   Patients admitted and coded with Cardiology - M10 (Total 60 patients)
   •   Inclusions – all patients DC Cardioverted by J Downie - Cardiac Nurse
       Practitioner
   •   Exclusions – any patients DC cardioverted by Consultant.
Conclusions:
This has been a safe, guideline directed service initiative with high patient satisfaction
reported. Amiodarone reduces need for DCCV and enhances success rates. Various
factors thought to contribute to low success rates in previous studies did not affect
outcomes, however obesity clearly did.
Recommendations:
   1. All patients for rhythm management be commenced onto antiarrhythmic
       therapy (Amiodarone or Sotalol [class III]) pre DCCV if no contraindications at
       time of cardioversion referral.
   2. Pre loading with Flecainide not recommended as per Dr Martin Stiles (EP
       Cardiologist – Waikato), but use post successful atrial fibrillation DCCV to
       reduce reoccurrence.
   3. All patients who have a BMI over 26 be strongly recommended to lose 10%
       body weight.
   4. All patients be safely cardioverted using Propofol alone.

21. No health without mental health; Jo Dickens, NP & Scarlet Teng

Primary care mental health nurse practitioners (NPs) provide a bridge between
primary care and secondary mental health, enabling clients to receive the best care.
Historically, primary care and secondary mental health services have been

considered as separate entities within the health system (Burlingham & Greenstone,
2019); with the only connection being referrals to specialist mental health services
and discharge letters to client’s primary care providers. The separation has led to
both groups of health professionals operating solely within their own system and
significant health impacts for clients. From a primary care perspective, the impact
has been a growing numbers of clients needing specialist mental health service who
do not meet specialist mental health service criteria, while clients under specialist
mental health services with significant physical health issues having had shortened
life expectancy due to a lack of physical health focus (Te Pou, 2017).
The role of NPs within both areas of health has resulted in positive outcomes. Our
role as NPs provides primary care with specialist mental health face-to-face
assessment and episodic care, to prevent worsening psychiatric symptoms and
promote recovery, and support in managing challenging clients and skills training.
Within secondary services, NPs can provide specialist support to monitor physical
health and promote healthy living.
With the provision of NP clinics and groups, there has been a noticeable reduction of
referrals to secondary mental health from primary care. Clinicians in secondary
mental health and clients have reported developing more awareness of physical
health, and healthy living engagement within Counties Manukau.

22. Down south they are doing it; Alison Stewart- Piere, NP

Southern DHB has the largest geographical spread of any DHB, creating difficulties in
providing equitable services across the region. We have excellent urban service
provision and a few rural clinics for under 25yr olds. There is no funded sexual or
reproductive health services in Queenstown or Wanaka, where there are high rates of
STIs and high numbers of transient youth in minimum wage jobs. We have high
unplanned pregnancy rates in rural Southland where access to contraception is very
limited.

So how do we take a traditional, urban Sexual Health Service, run in the medical
model, and provide equitable access to rural populations, without restricting service
for high need, urban populations?
Through working closely with Public Health Nurses, supporting and developing Youth
Health services in key rural areas, and capitalising on service synergies, we hope to
increase the level of care provision across the region, without having to increase
staff. PHNs already provide short acting contraception, some nurses are now also
inserting LARCs. Asymptomatic sexual health checks are standardly offered, increased
training will enable care of symptomatic people. Utilising standing orders, RN
prescribing, and the clinical oversite of a NP, the potential is there to greatly expand
care provision. With increasing skill of local nurses and use of telehealth, more
complex presentations can be managed remotely.
Introducing free online access to STI tests is expected to reduce asymptomatic testing
in clinics, freeing up clinic staff to respond to more complex presentations and to
support PHNs and Primary Care in managing their sexual and reproductive health
presentations.
Greater connections between Sexual Health and Public Health Nursing Services,
operating in a nursing framework has the potential to greatly improve sexual and
reproductive health outcomes across the Southern region.

23. Working with long-term conditions; Jennifer Baur, NP

My work involves running a long-term conditions clinic three days per week within a
busy primary health practice with approximately 16,000 patients. This presentation
will compare two very different case studies and how they both have positive
outcomes depending on who is measuring.
The complex nature of working with this cohort of patients is challenging and can be
frustrating at times. However, it can also bring such joy and satisfaction. It all depends
on how you view your role and the individuals you seek to help.

Case study one: Maori gentleman in his 40’s with multiple co-morbidities,
polypharmacy, and a history of not attending booked appointments. Over several
months this gentleman took the initiative and prioritized a healthy lifestyle. He has
shown significant improvement in the measurable health parameters and is now
meeting several targets as set out by the Ministry of Health. Many would look at this
case as a success with clear evidenced positive outcomes.

Case study two: New Zealand European gentleman in his 60’s with multiple co-
morbidities, polypharmacy, and a history of not attending booked appointments. Over
several months this gentleman attended a second consultation and has started to take
some of his medications on a more regular basis. He does not meet any targets and
has not shown any improvement in the measurable health parameters.
On the face, these two case studies appear very similar with differing outcomes - one
a great success the other a failure. When we shift our perspective and focus back on
the individuals as opposed to the targets set, one could argue, both of these
gentlemen are showing substantial positive outcomes. For me, I experienced great joy
and satisfaction in working with both of these gentlemen.

24. TBC

25. Paeds session; TBC

26. MSK red flags; TBC

27. The early bird gets the worm; Emma Hedgecock, NP

Innovations in health care have resulted in New Zealanders living longer with terminal
illnesses; many of whom experience complex symptoms and decision making, whilst
receiving active treatments. Despite evidence that early palliative care has multiple
benefits, including significantly improving quality of life and reducing costs, traditional
models of specialist palliative care (SPC) provision remain the norm. In order to better
meet the SPC needs of patients in this changing landscape, it is essential SPC service

providers evolve and develop new models of equitable care; centered on a timely
consultation that is initiated by need, rather than life expectancy.

This presentation will provide an overview of the development and implementation
of two new models for early palliative care at Waitematā District Health Board
(WDHB); the ‘Supportive & Palliative Care Clinic’ (SPCC) and ‘Front Door Palliative
Care’.

SPCC – Hospice referral criteria is often restricted to patients within the last 12-24
months of life, meaning patients with chronic terminal illnesses, e.g. organ failure and
neurological conditions are unable to access SPC input earlier in their disease
trajectories. In response we have developed the first outpatient SPC service for WDHB.
The SPCC provides face-to-face and telehealth consultations from a Nurse Practitioner
or Senior Medical Officer, focusing on symptom management and supporting
discussions around Advance Care Planning.

Front Door Palliative Care – The number of patients with SPC needs presenting to
Emergency Departments (ED) is increasing and given clinical decisions made in ED
determine the trajectory of subsequent medical treatments, it is vital clinicians with
SPC expertise are easily accessible to aid decision making. Therefore, this new model
of “front door” palliative care was developed for WDHB. This model dedicates SPC
Nurse Practitioner time to work closely with ED/ADU focusing on providing clinical
support, rapid assessment, education, mentoring, and increasing engagement with
palliative care services.

28. IUCD tips – Rose Stewart from Family planning

29. Contemporary foot care; Podiatrist TBC

30. Stroke update; Lucy McLaren NP

31. Dermatology; TBC

32. Contemporary hand care; Choppa TBC

33. Mentoring - Why would you? Mentorees’ perspective of the process;
   Shannon Gibbs NP candidate & Karen Bradley NP candidate

To meet the competencies of a Nurse Practitioner there is an obligation to be involved
in educating and mentoring colleagues and students.
With the increasing emphasis on Nurse Practitioner contribution to the healthcare
system, every Nurse Practitioner will be involved in growing the next generation of
Nurse Practitioners in some way. For some the experience of being mentored is quite
a long way in the past, so we are offering an overview of what works and what has
been challenging from the perspective of mentorees in their internship year.
We will look at mentor mindset, balancing obligations and pearls gleaned from our
2021 cohort of NPI’s, presented as we panic over the impending NCNZ panel.

34. Wāihine Connect representative and Dr Cath Becker and Sandy
   Osler;
   https://www.wahineconnect.nz/

A national mentoring network for New Zealand women in health.
A community-developed and led programme to promote the wellbeing and
professional development of women in the NZ health sector.

We match women looking for support with volunteer mentors and provide a
structured mentoring programme.
Panel discussion on the subject of post NP registration support options.