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Vol 17 No 4 Baby Friendly Aotearoa Sun Safety ACC and Summer injuries Focus on ring blocks Christmas Poem NETP nurses Rural Muster Insulin Guidelines
LOGIC is the Official Journal of the New Zealand
College of Primary Health Care Nurses, NZNO.
December 2018 Vol 17 No 4
Editor Yvonne Little In this issue….
Publisher Celeste Gillmer, 021 245 0587, Chair’s Report………………………………………….…………2
celeste.gillmer@gmail.com Editor’s Report .................................................. 5
RURAL MUSTER #8 ............................................ 7
Editorial Committee
A Christmas Story by Anne Elf ......................... 10
Celeste Gillmer, Emma Hickson, Irene Tukerangi, Ring Blocks ...................................................... 12
Annie Tyldesley, Erica Donovan Tall Poppy award 2018 .................................... 15
Reflection........................................................ 18
Circulation New member of the New Zealand College of PHC
Nurses, NZNO .................................................. 19
To full members of the NZNO New Zealand College of A regional approach to nurse prescribing practice
Primary Health Care Nurses and other interested – the South Island story .................................. 20
subscribers, libraries and institutions. Sun safety advice from the Cancer Society ...... 23
Investing in a well child nursing workforce;..... 25
Editorial Matter
USE OF PREMIX INSULIN GUIDELINES .............. 28
Prepared by the Editorial Committee and the Editor ACC and Summer Injuries ................................ 29
from submitted and invited material. Whilst every Feeding Our Community at Christmas and
effort is made to ensure the accuracy of this throughout the year ........................................ 32
information, the Publisher take no responsibility New grads exploring the aged care environment:
Presbyterian Support Central (PSC) Enliven ..... 35
whatsoever for errors, omissions or any
consequences of reliance on this material or the New Zealand College of Primary Health Care
Nurses Regional Network Contacts ................. 38
accuracy of the information. The inclusion or
Managing a busy District Nursing Team – the
exclusion of any product or advertisement in no way
changing needs of a dynamic environment ..... 39
means the Publisher or the New Zealand College of
‘Sleep On Side’ campaign for pregnant women
Primary Health Care Nurses advocate or reject its use
launched ......................................................... 42
in any way.
Sleep on Side - Pamphlet for Health Prof ........ 44
Correspondence Sleep on Side - Pamphlet for Parents .............. 46
The experiences of a NETP nurse working at Te
The Editorial Committee welcomes all Waiora Community Health Services ................ 48
correspondence intended for publication. NEW ZEALAND WOUND CARE SOCIETY............ 49
Correspondence should be addressed to: A Baby Friendly Aotearoa Programme ............. 51
Eczema ............................................................ 53
Yvonne Little: logiceditorcphcn@gmail.com
Information for General Practice ..................... 57
The NZNO Library ............................................ 58
Please ensure the writer’s name appears on the title
page of any article or letter intended for publication.
Copyright
This publication is copyright in its entirety. Material
may not be printed without the written permission
of theDecember 2018
New Zealand College of Primary Health Care
L.O.G.I.C
Nurses, NZNO. 1
ISSN 2463-5642
Chair’s Report
Celeste Gillmer
Chairperson
Tēnā Koutou katoa
I thought I’ll look up some the Bay of Islands in 1814 is
2018 will be a year to be
interesting information about often cited as the first in New
remember! We, NZ nurses,
Christmas in New Zealand for Zealand, but did a French priest
made history this year and
this edition and found the travelling with Jean François
hopefully for Primary Health
following interesting Marie de Surville in 1769 beat
Care nurses, 2019 will be a year
information: him to it?
where our government and
Ministry of Health will focus on Christmas comes to New New Zealand's Christmas tree
our workforce. Enabling us to Zealand
provide the best possible care
for our patients at the right time
and at the right place. We will
wait in anticipation for updates
from the Federation of Primary The beautiful pohutukawa is
In 1642, Abel Tasman's crew regarded as New Zealand’s
Health Care and for the
celebrated the first Christmas iconic Christmas tree. The
outcomes of the review of the
dinner in New Zealand – freshly pohutukawa also holds a
NZ Health and Disability Sector.
killed pork from the ship's prominent place in Maori
Thank you for everything that menagerie washed down with culture: an 800-year-old tree
you, as PHC nurses, do for the 'extra rations of wine'. In 1769 clinging to the cliffs of Cape
New Zealand community, we James Cook's crew marked the Reinga is reputed to guard the
don’t recognise your occasion by feasting on ‘Goose entrance to a sacred cave
importance and the work you pye’ (made with gannet). through which spirits pass on
do often enough. On behalf of their way to the next world.
The first sermon?
the New Zealand College of
Primary Health Care Nurses, Santa parades
thank you. Thank you for who
you are and for what you do.
Thank you for your contribution
to the health and well-being of
The Christmas Day service given
all New Zealanders!
by Church Missionary Society Santa or Christmas parades take
representative Samuel Marsden place throughout New Zealand
at Hohi (Oihi) Bay in in November or December each
December 2018 L.O.G.I.C 2
year. They began in the main uniform of shorts, jandals and T-
centres in the early 1900s. They shirts.
were established by Claus in stores
department stores to promote
the arrival of in-store Santas,
Before the time of computers
with the clear aim of drawing
and mass television people
customers directly into their
played all sorts of games around
stores.
Christmas time. Some of these
'Sticky Beak the kiwi' games, such as the ‘Light the Santa Claus made his
cigarette race’ and 'The Slave commercial debut in New
Market', haven’t stood the test Zealand in 1894 when he took
of time very well. his place, complete with tree
and toys, among the furniture in
Kiwi Christmas cards the Wellington DIC store on
Many traditional Christmas Lambton Quay. These days,
songs have been adapted for a children have the option of
New Zealand audience and sending Santa an email with
conditions. One of the most suggestions about preferred
popular New Zealand Christmas presents.
Historic Christmas cards
songs of the 1960s was 'Sticky
combine colourful imagery with Christmas in wartime
Beak the kiwi' – read the lyrics
reflections on contemporary
and listen to the song (a Web
events, such as overseas wars.
first recording?).
Familiar New Zealand symbols –
Santa goes to the Chathams tattooed Maori figures, kiwi, tiki
and ferns – add a distinctively
local flavour to traditional Christmas during wartime gave
Christmas greetings and soldiers a rare opportunity to
imagery. relax and enjoy themselves
away from the stresses and
Summer holidays
When Santa Claus visited the hardships of combat. It was also
remote Chatham Islands in 1951 a time of sadness for many New
he swapped his reindeer for a Zealanders, both overseas and
TEAL Solent flying boat. More back home, as they thought of
than 400 of the islands’ 500 their absent family, lovers and
inhabitants cheered him wildly friends far away.
Come late December and
as he stepped ashore from a
thousands of Kiwis get ready for
launch in Te Whanga Lagoon
their annual holidays. They look
with a huge sack of toys over his
forward to lazy days at the
shoulder.
beach or the bach (or crib),
Politically incorrect Christmas games of backyard cricket, food
games on the barbie and the holiday
December 2018 L.O.G.I.C 3
A day off for Christmas what do we treasure most?’ The
results show that dinner with
the family is still important to
Kiwis, but the Queen's message
is losing relevance.
Enjoy the festive season! For
It's hard for most of us today to
those of you on annual leave,
imagine Christmas Day not
enjoy the break and your time
being a holiday, but a day off on
with family and friends. For
25 December hasn't always
those of you working through
been a legal entitlement. An
this Christmas period, thank
1841 newspaper for 25
you!
December doesn't even
mention Christmas, and the day Merry Christmas!
only became a formal public Meri Kirihimete!
holiday in 1910.
Celeste
Auckland's giant Santa
In 1960 Farmers erected a giant
Santa on their Hobson Street
department store in Auckland.
He appeared above the store
each Christmas for almost 30
years. He left Auckland's CBD in
1990, but was restored above
Whitcoulls' store on Queen
Street in 1998.
Kiwis' attitude to Christmas
In a 2006 survey, Reader's
Digest asked a representative
sample of 259 New Zealanders
‘Just what does Christmas mean
to New Zealanders in 2006 – and
December 2018 L.O.G.I.C 4
Editor’s Report
Yvonne Little
Nurse Practitioner
Welcome to the final edition of
changing how we communicate
LOGIC for 2018.
with our membership. After our
Another year has flown by and successful meeting in We hope you enjoy your
with it there have been many Christchurch we are in the December issue, where we
changes, the DHB Meca is planning stages to take these bring you some interesting
finalised and now we await the meetings throughout the articles for reading and some for
outcome of our PHC Meca. country, so keep an eye on our your ongoing education hours.
Alongside this, we have had webpage and also LOGIC for In 2019, our themed articles
changes in the Office of the further updates. include:
Chief Nurse, with Jane O’Malley We welcome aboard our new March – Respiratory and
stepping down to take on her committee members: Erica Healthy Homes
new role as Plunket first Chief Donovan to LOGIC; Kelly
June – Injuries (all manner of)
Nurse, this position was then Robertson to Professional
and Travel
ably filled in the interim by Jill Practice and Fiona Murray to
Clendon who has now moved the role of Secretary, taking September – Gastro and
onto her new role as ADON and over from our long serving Allergies
Ops Manager in Nelson- member in Wendy King. December – Travel (local) and
Marlborough and now we have Safety
LOGIC is about linking
a newly appointed Chief Nursing
opportunities and networking Added to this will be our regular
Officer Margareth Broodkoorn.
for Primary Health Care Nurses sections and what I like to term
We congratulate her and will be
and our aim as a committee is to our “freestyle” articles, which
in regular contact as we have
bring you a diverse and exciting includes anything any member
with her predecessors, we hope
journal and wish to be inclusive has a passion about which they
she will be amenable to
of all our members as we are no wish to share with colleagues,
continuing the tradition of
longer about Practice Nursing so if you have an article you
writing a report for us in 2019.
alone. To be able to do this, to want to have published then
Other changes, which we have borrow a phrase from the USA’s please contact any of our
discussed in previous issues, is Uncle Sam – WE NEED YOU. committee members.
the way in which we plan to
Finally, it has already been a
continue moving forward and
tragic year on and off our roads
to date, let’s hope this trend
does not continue over the
holiday period. As PHCN’s we
December 2018 L.O.G.I.C 5
are in a fortunate position to try to influence our patients, family/whanau and friends through education to keep safe and stay healthy. Please remember to look after yourselves as well as patients, family/whanau, friends and also those visiting our beautiful country. We need to bear in mind the hidden wounds, those with mental health issues, those less fortunate or simply being alone. Stay safe and healthy. If you are fortunate enough to have time off, please enjoy. If you are one of those who are needing to work, thank you and we hope you do get some time to rest and relax with your loved ones. Yvonne and the LOGIC committee (Celeste, Emma, Annie, Irene, Erica). December 2018 L.O.G.I.C 6
RURAL MUSTER #8
Kate Stark – Nurse Practitioner
As this goes to print, I am and it is reassuring to hear of Rural Nurses New Zealand has
pleased to report that lambing rural businesses including had a busy few months and
and tailing / docking is over for mental health support and currently has a number of
another year and we are looking suicide prevention programmes projects in progress including,
toward Summer. There is no in their strategic plans for health but not limited to the following:
doubt that sunshine makes us and safety going forward aiming
want to get out and about and • A letter was sent in early
for mental WEALTH, not just
be more active which in turn is October to NCNZ
health. We have come a long
good for our mental health. seeking a review of
way – it wasn’t long ago that
questions asked in the
As we know, being rural can be depression wasn’t talked about
APC to gain robust rural
isolating and again we are as openly as it is today and
nursing workforce
rounding off another year suicide was something that
data. We are currently
where suicide has featured wasn’t brought up in
awaiting a response
strongly as an area where health conversation. Creating
from the NCNZ CEO.
care is low on resource but high awareness helps us create a
in need. We all have mental plan to identify those at risk in • Work continues to
health and preservation is rural populations and hopefully develop a website link
essential to quality of life as well reduce suicide rates amongst from the RGPN website
as longevity. Unfortunately, rural people and enable those specifically for rural
isolation from rurality and stress who live in isolation to access nurses. This has steady
related to reduced access to care more easily and in doing so momentum and we
health care from living a live a longer happier life. hope to see this go live in
distance from available care is Technology will have a part to the next months.
highlighted in recent statistics play in this but we must still
• Mobile Health & RNNZ
which reveal there has been a place value on the power of face
webinar series continue
rise in suicide amongst farmers to face encounters and human
with the 4th webinar
in 2018. On a positive note, we touch.
being held on October
are now aware that this is a 30th. This was entitled
problem “Recognising Suicidal
December 2018 L.O.G.I.C 7
Behaviour” and has 4th of April. In of mental health and self-care,
been reported by collaboration, and with Craig Jones on debriefing and
attendees to have the support of Mobile changes to the PRIME
provided valuable Health we are hosting Curriculum, as well as
assessment tools for Michelle Boltz, an NP introducing Lisa Meadows who
practice. These are who has worked in rural is the national PRIME
available for viewing Arctic Alaska and Programme Coordinator. They
retrospectively. Current Montana. Michelle will in turn, enjoyed hearing the
ly the link to these are on have a session at the stories from the field and some
the RNNZ Facebook rural nurses’ workshop robust discussion was had
page newsfeed. Once as well as featuring as a regarding the things that go well
the website is up and key note speaker session and the things that go wrong.
running the link will at the conference. Otago Regional Rescue
enable access to these Helicopter Chief Paramedic
webinars Doug Flett presented an
retrospectively. At the end of October Dunedin excellent multi trauma case
hosted study days for PRIME study which was received
• Active exploration and nurses for the third time. Over exceptionally well, especially by
progression of research one and a half days they those in the audience who
in partnership with attracted around 30 PRIME attended the job! This case
Origin Research Trust is nurses mainly from the South study highlighted many of the
underway. The purpose Island who had a wonderful excellent things that PRIME
of this is to explore and time networking and learning. practitioners do in the field that
obtain a more detailed Feedback was extremely impacts on patient outcomes,
understanding of career positive and everyone is waiting including forward thinking
pathways undertaken by to hear when the next one will regarding
nurses, looking be. Despite being the initiative transportation/retrieval, early
specifically at the of PRIME nurses in the south, it identification of problems both
perceptions, motivators, was open to all nurses practising actual and potential and
and barriers that are PRIME across New Zealand and teamwork. PRIME makes a huge
associated with rural addressed topics including but difference to patient outcomes
nursing as a career not limited to trauma in the and it was great hearing stories
choice. elderly, pelvic trauma, hand to reflect this.
• We are starting to injuries, debriefing, headaches
A meal at a local Turkish
prepare for next year’s and associated reg flags. This
restaurant was also a highlight
NRHC in year highlighted the narrowing
on the Friday night where we
Marlborough. RNNZ of barriers between St John and
could relax and get to know
hope to have increased PRIME and we had a number of
some of our fellow PRIME
visibility at the 2019 St John attendees. We heard
nurses and associate members
conference. We will from St John Ambulance
Paramedic and Peer Support of the emergency services.
have a nurse’s workshop
again on Thursday the Scott Weatherall on the subject
December 2018 L.O.G.I.C 8
This event has gathered feel free to email me your momentum over the last few queries at years, running every other year, kate.stark@gorehealth.co.nz. and looks set to continue in the As this is the last Rural Muster future. We all have heavy for 2018, I wish you all a Merry workloads and so if there is Xmas and a safe holiday season anyone who would like to help with your friends and whanau. organise the next study days in See you in 2019. 2020, please contact me. Alternatively, if you live in another area of New Zealand and you think you would like to host a similar study day(s) in the future, we are very happy to share our event planning skills. If we run these in Dunedin again, look out for the next event on the PRIME Nurses and the Rural Nurses NZ Facebook pages. Your practices will also receive notification mid-year so be prepared and get your study leave booked! The National PRIME Committee has been working hard behind the scenes to raise the profile of PRIME and PRIME Coordinator Lisa Meadows has also recently travelled around parts of New Zealand distributing safety equipment whist meeting with PRIME practitioners. The Committee will meet face to face early December to plan for 2019 and we welcome your feedback regarding issues that affect nurses in the field. I regularly get queries from PRIME nurses from around the country and its great to hear what is happening, or not happening in the field. Please December 2018 L.O.G.I.C 9
A Christmas Story by Anne Elf December 2018 L.O.G.I.C 10
December 2018 L.O.G.I.C 11
My name is Erica Donovan and I am a Primary
Ring Blocks Healthcare Nurse, and I work at a GP
Practice/Urgent Care clinic in Christchurch.
In the past I've written for websites and
newspapers and I currently run a support and
education FaceBook page for nurses, midwives,
Erica Donovan students and other healthcare workers
called The Nurse Path. I am interested how
nurses can use technology in education,
through methods like podcasts and Twitter.
One of the first mantras I heard body could be conducted many situations with
as a student from a nurse in using a cocaine solution (Yentis, healthy patients, with no
primary health care was that 1999; Redman, 2011). complicating comorbidities and
adrenaline should never be have injuries without vascular
injected into ‘nose, fingers, Proponents of the
compromise that may benefit
penis, toes’. A year later when I adrenaline method suggest that
from adrenaline adjuvant.
started suturing myself, I saw addition of adrenaline into the
nurses using a blend of lidocaine wound aids in blood vessel In their research Reis
and adrenaline for injecting into constriction, leading to Júnior and Quinto (2013) state
fingers and toes. The one we see decreased bleeding and that due to the possibility of
most in my practice is prolonged anaesthesia (Ricci & complications, and little
subcutaneous digital blocks. Rizzolo, 2013, p. 29). perceived benefit of adrenaline,
This procedure involves Shridharani et al (2014, p.187) clinicians should consider
injection of local anaesthetic on also refute the claims that lidocaine only digital blocks.
both sides of the base of a finger adrenaline should not be used, This is also a view supported by
(Ahmad, 2017). As with many stating “very little clinical Nicks et al, (2010) who are
things in health, we need to evidence supports this dogma”. concerned with the risk of tissue
examine the evidence. Others suggest that the no ischemia and Kelly (2016) who is
adrenaline dogma may have concerned with the risk of
For or against? been created by confounding complications for those working
There has been much issues such as poor technique in in rural areas. There’s plenty
debate about the use of injection or tourniquet use, or more research where that
lidocaine with adrenaline for when anaesthetics other than comes from, from both sides of
extremity wounds. Lidocaine is lidocaine were used (Mohan, the fence – so have a look and
currently a popular product, 2007). However, Mohan does decide for yourself.
however in the past cocaine or acknowledge that patients with Risks
procaine may have been used. pre-existing vascular disorder
We often think about cocaine as may benefit from an adrenaline Regardless of if adrenaline
a drug of abuse, but in the 19th free product. In my facility we is used, any ring block has
and 20th century its use of were also taught to avoid use of potential for complications. The
widespread in medicine. The adrenaline in crush injuries as procedure must be done with
literature details at the time they can already have vascular extreme caution, as systemic
many nerve blocks around the compromise. This still leaves lidocaine can cause
December 2018 L.O.G.I.C 12cardiovascular toxicity (Donald • Lidocaine or lidocaine with finger to achieve anaesthesia of
& Derbyshire, 2004). As with adrenaline (Read the the entire finger.”
any procedure clean equipment evidence and decide for Now the patient’s key question
should be used and surrounding yourself!). – when will it kick in? The onset
skin cleaned prior to infiltration
• Cleansing wipes is thought to be about 2-5mins,
to decrease risk of infection. with the effect lasting around
Hematoma is another • Dressing pack
1.5-2 hours (Medsafe, n.d).
complication, which can be • Axillary materials –
prevented by using a needle dressings, sutures, other
gauge of 25mm or less, and materials depending on
minimising the amount of times reason for procedure.
the needle is inserted (New York
Just a tip – When positioning the
School of Regional Anaesthesia,
patient, make sure that you
2018, para 10).
make it easy on yourself.
What are we using digital Nursing has a high rate of back
blocks for? injuries; bending and craning
The most common need your neck and back is only going
for ring blocks is prior to to you cause you grief in the
suturing, however patients may long-run. Place the patient’s
also benefit from it in cases of hand pronated, resting on a flat
As a patient has described
fractures requiring reduction, surface.
the procedure as “the single
cleaning of deep wounds or For the next part, the New York most painful thing I’ve ever felt”
exploration of nailbed injuries. School of Regional Anaesthesia I’ve always been conscious of
Wounds of less than 2cm can has a good guideline: how I undertake the procedure.
generally be closed without use A couple of ways to lessen the
“ A 25-gauge 1½” needle is
of sutures, and achieve similar pain are to:
inserted at a point on the
closure and cosmetic outcomes
(Quinn et al, 2002). In these
dorsolateral aspect of the base • Warm the solution
of the finger and a small skin
cases steri-strips or wound glue • Use a small needle
wheel is raised. The needle is
may be more appropriate.
then directed anteriorly toward • Give it slowly
Patients are also usually pleased
the base of the phalanx. The • Sub-cut not
to avoid the need for needles
needle is advanced until the it intradermal
and sutures!
contacts the phalanx. One mL of
Procedure solution is injected as the • Manage
needle is withdrawn 1 to 2 mm expectations and
After gaining full informed
from the bone contact. An have the patient
consent, assemble the
additional 1 mL is injected lie down
equipment (brands may vary
between facilities). continuously as the needle is My favourite pearl of advice
withdrawn back to the skin. The from my boss is “Have
• Syringe
same procedure is repeated on empathy…but don’t let that
• Dental needle each side of the base of the sway your confidence, they’ll
December 2018 L.O.G.I.C 13thank you for it. As always, if ya Anesthesia website: infection, optimize healing,
not sure - ask”. https://www.nysora.com/digita minimize scarring: a thorough
l-nerve-block history and examination, use of
References
proper materials, and familiarity
Nicks, B. A., Ayello, E. A., Woo,
Ahmad, M. (2017). Efficacy of with the different wound
K., Nitzki-George, D., & Sibbald,
Digital Anesthesia: Comparison closure techniques make it
R. G. (2010). Acute wound
of Two Techniques. World easier to achieve these
management: revisiting the
Journal of Plastic Surgery, 6(3), objectives. JAAPA-Journal of the
approach to assessment,
351-355. Retrieved from American Academy of
irrigation, and closure
GoogleScholar. Physicians Assistants, 24(9), 28-
considerations. International
Donald M. J & Derbyshire S. 33. Retrieved from Gale
Journal of Emergency Medicine,
(2004). Lignocaine toxicity; a database.
3(4), 399–407.
complication of local doi.org/10.1007/s12245-010- Shridharani, S., Manson, P.,
anaesthesia administered in the 0217-5 Magarakis, M., Broyles, J.,
community. Emergency Whitaker, I. & Rodriguez, E.
Quinn, J., Cummings, S.,
Medicine Journal, 21, 249-250. (2014). The safety and efficacy
Callaham, M., & Sellers, K.
doi.org/10.1136/emj.2003.008 of epinephrine in hand surgery:
(2002). Suturing versus
730 a systematic review of the
conservative management of
Kelly, L. (2016). The occasional literature and international
lacerations of the hand:
digital nerve block. Canadian survey. European Journal of
randomised controlled trial.
Journal of Rural Medicine, 21(2), Plastic Surgery, 37(4), 183-188.
BMJ : British Medical Journal,
51–52. Retrieved from General http://dx.doi.org/10.1007/s002
325, 1-3. Retrieved from:
OneFile. 38-013-0925-1
https://www.ncbi.nlm.nih.gov/
Medsafe. (n.d) XYLOCAINE Data pmc/articles/PMC117762/pdf/ Yentis, S. M., & Vlassakov, K. V.
Sheet. Retrieved from Medsafe 299.pdf (1999). Vassily von Anrep,
website: forgotten pioneer of regional
Redman, M. (2011). Cocaine:
http://www.medsafe.govt.nz/p anesthesia. Anesthesiology: The
What is the Crack? A Brief
rofs/datasheet/x/XylocaineAnd Journal of the American Society
History of the Use of Cocaine as
Adrenalineinj.pdf of Anesthesiologists, 90(3), 890-
an Anesthetic. Anesthesiology
895.
Mohan P.P. (2007). Towards and Pain Medicine.;1(2):95-7.
evidence based emergency Reis Júnior, A. D., & Quinto, D.
medicine: Best BETs from the (2016). Digital block with or
Manchester Royal Infirmary. without the addition of
Epinephrine in digital nerve epinephrine in the anesthetic
block. Emergency Medicine solution. Revista Brasileira De
Journal. 24:789–90 Anestesiologia, 66(1), 63-71.
New York School of Regional http://dx.doi.org/10.1016/j.bja
Anesthesia. (2018). Digital ne.2013.12.004
Nerve Block. Retrieved from Ricci, N. A., & Rizzolo, D. (2011).
New York School of Regional Laceration repair: avoid
December 2018 L.O.G.I.C 14Tall Poppy award
2018
Bronwyn Boele van
Hensbroek-Miller
Nurse Practitioner/Registered
Midwife
dedicated whānau of clinicians,
Te Aro Health Centre non-clinicians and volunteers variety of locations (including
Wellington who provide Primary Health the boot of a car), by dedicated
Care (PNC) to the city’s most workers, to the underserved in
vulnerable and marginalised our city where mainstream
In September 2018 I was the people. The homeless health care was not adequately
recipient of the NZNO New population and those with providing for this group. We
Zealand College of Primary mental health and or addictions know that the homeless
Health Care Nurses Tall Poppy classifications are our key focus, population have
award. with 60% of our enrolled unquestionably poor physical
There is a Whakatauki (Maori population having a mental and mental health with high
proverb) that says health and addiction susceptibilities to severe health
classification and 20% problems and untreated co
‘Ehara taku toa i te toa takitahi
homeless. morbidities. Often they have
Engari he toa takimano, nō aku
TAHC is a nurse led clinic suffered discrimination and
tūpuna’
situated in the heart of racism within their experiences
Success should not be bestowed Wellington City. It has a rich and of health and are therefore
onto an individual alone very colourful whakapapa wary of heath care workers.
As it is not individual success but stretching back to the 1980s of The key to what we do is to offer
it is success of the collective providing health care to the holistic health care within Sir
marginalised and disadvantaged Mason Durie’s – Te Whare Tapa
I am humbled to accept this
in our community. Since TAHC’s Wha Maori Model of Care. This
award but I do it in
inception in the early 1980s the is implemented through
acknowledgment of Te Aro
focus has been to offer timely, whānau ora processes by asking
Health Centre Whānau. I have
high quality health care in a whānau/patients the most
the great privilege to be a nurse
setting suitable to the needs of important question of ‘what is it
practitioner employed at Te Aro
the patient. TAHC has a history that you need to be well?’ At
Health Centre (TAHC). I am part
of over three decades of TAHC we do not separate
of a small but very
providing health care in a physical health and mental
health. We focus on what the
person identifies as a need- not
focusing on what we think is
December 2018 L.O.G.I.C 15important- definitely not tick seamless referral process to and population group and adapting
box primary health care! Care is from services which includes, where possible to meet their
therefore whānau centred and The Soup Kitchen, Kahungunu needs. My weekly morning soup
whānau driven whereby we gain Whanau Services, Downtown kitchen clinic is an example of
their trust to allow us to work Community Ministry, where I have changed the times
with them to achieve their Wellington Men’s Night Shelter, of the clinic to meet the needs
health goals. Wellington Homeless Women’s of the larger population group
Trust, Capital and Coast District having an evening meal at the
At TAHC the whānau strives to
Heath Board (CCDHB), Team for soup kitchen. The clinics are
address the issues of access to
Assertive Community now alternating between
health care understanding it is
Treatment and CCDHB’s Te evening and morning to reach a
complex and has many layers.
Roopu Aramuka Wharoaroa. greater group of people.
As identified by the
International Council of Nurses, Clinics are held at the main clinic Another initiative has been
it involves responding to issues in Willis Street and throughout responding to our hepatitis C
such as; availability of services, the city where the homeless patients. Of our enrolled
meeting diverse needs, congregate to access social population approximately 5%
identifying unmet needs, quality services. Outreach clinics are are positive for hepatitis C. I
and affordability of care, provided in an environment have a close collaborative
timeliness of care, and that the that is familiar and where relationship with the
care is people centred. whānau feel more comfortable community hepatitis nurse
and safe to access health care. Lynnaire Matthews. We have
At TAHC we work to address the
Street outreach, where we meet worked creatively to provide
issues of access in several ways.
people sleeping rough is alternative fibroscan clinics for
It begins by the way whānau are
undertaken when concerns are our patients as they were
greeted in reception through to
raised about a particular experiencing a variety of
the way we structure our clinics,
person. Throughout April this barriers getting to their
the continuing innovation in
year clinics have been extended appointments. Attending an
how services are delivered and
to include evening free flu appointment to have their scan
working closely with
clinics at the men’s night shelter at a venue that was unfamiliar,
collaborative partners. TAHC is
and evening clinics at the soup difficult to access and with
not a one stop shop, for the
kitchen. These clinics have been people they didn’t know was
needs of our patient population
undertaken to provide flu difficult for many. So in
are too wide ranging, complex
vaccinations to this at risk group collaboration with Lynnaire, we
and diverse to address every
of individuals. The extra bonus have set up clinics in our
issue they are presenting with.
of these clinics is being available outreach rooms and recently at
Collaboration is one of the keys to discuss general health our main base in Willis Street,
to the success of what we do, questions and to enrol new locations that feel safe and
with collaborative patients who have not engaged familiar for our patients. The
partners/services such as ‘Te with any PHC service. non-attendance rates have
Kakano o Te Aroha’ with which dropped significantly and more
We are constantly responding
TAHC shares a memorandum of patients have been successfully
to the unmet needs of this
understanding. We have a
December 2018 L.O.G.I.C 16‘worked up’ for their hepatitis
treatment.
The nurse practitioner role has
helped address issues of access
and equity and timely care as
acute presentations can be
assessed and treated, repeat
prescriptions provided and
medical certificates reviewed,
this being especially relevant in
the outreach clinics. Being a
registered midwife has many
positive advantages in
addressing the needs of
pregnant women who are
finding themselves in difficult Te Aro Health Centre
331 Willis Street
circumstances often late in
Wellington
pregnancy with no antenatal
care.
I am proud to be part of the
TAHC whānau and what we
achieve. More can always be
done but we have to work
within the constraints of our
very tight budget. For us it is
about creativity, thinking
outside the square, utilising
staff and a strengths based
approach. A whānau once
recently told me TAHC is a place
where the judgment glasses are
removed, you can be yourself
and express what you need to
without criticism. Comments
like this are what motivates me
to keep striving for excellence in
what I do and the service we
provide.
December 2018 L.O.G.I.C 17Reflection:
Student Health
Mauri Ora
Michelle Benson
clinical challenges. One of the
Clinical Lead Nursing My colleague refers to the
biggest challenges we face is
Victoria University of managing students with students’ experience in their
Wellington complex medical conditions first year of study as “a year of
over this short time, before they firsts”. Students may be living
When I came to Student Health
return home for the summer. away from home for the first
I thought that the environment
New patient management is an time, have their first sexual
would be very similar to that of
area we constantly review to experience, first
general practice, an area of
manage this workload and experimentation with alcohol,
nursing I felt very comfortable
resolve the issues. first time socialising outside of
working in. In a matter of weeks
their childhood peer group, first
I realised that youth health was The primary health care nurse in their family to come to
definitely a nursing speciality of role at Student Health is not university and, most
its own and one in which that I only that of the health importantly, managing their
had a lot to learn. professional, but also life coach, own health for the first time.
At Victoria University of counsellor and surrogate
parent. Many students have a Nurses play a huge role in
Wellington, approximately
low level of health literacy and supporting these students and
22,000 students enrol in study
need support to learn the skills assisting them to navigate their
every year, about 3,000 of them
to care for themselves whilst way through their university
in first year study. At the start of
they are at University. experience.
every academic year, Student
Health transfers in The majority of the students we Nurses are able to give basic
approximately 3,000 new see are in the 18-25 year age health education and advice but
patients and then transfers a group, many of them school also provide the support and
similar amount out again at the leavers. reassurance that a student may
end of year. have received from their family
This younger cohort of students had they been living at home.
Delivering health services to a is where I feel the role of the For some students, taking time
transient student population is primary health care nurse in to listen and reassure them that
challenging. The constant flux of Student health has the most to the pressure and anxiety they
students in and out of our offer and personally it is an age are feeling is ‘normal’, with
health service over the group I most enjoy working some suggestions on how to
relatively short academic year with. manage this is all that is
poses both administrative and
required to de-escalate their
December 2018 L.O.G.I.C 18symptoms. The provision of
more nursing clinic time has
enabled students to access this New member of the New Zealand College of
support more easily.
PHC Nurses, NZNO
The increasing demand for
health services and support Professional Practice Committee
from students has encouraged Kelly Robertson
the diversification of our
I live in Christchurch and have been nursing
workforce and changes to how
for 40+ years, working in both the secondary
we approach the delivery of
and primary health care sectors.
health care services. The
I am passionate about nursing in primary care
introduction of Student Health’s
and my 26+ years in this sector has
first nurse prescriber, nurses
included working as a practice nurse and then for Pegasus Health
working to the top of their
providing leadership and oversight of nursing workforce development
scope of practice using their
programmes for the general practice nursing workforce. I am now
specialised skills to manage
working for Healthcare NZ Ltd as the Nursing Workforce Facilitator,
contraception, sexual health,
supporting the advancement of nursing practice within the
diabetes and mental health
community, including NETP, PDRP and policy development.
conditions using standing
In my spare time I enjoy gardening and of course am a devoted “one-
orders, has provided extra
eyed” Crusader supporter!
capacity in our service and
increased patient access to
healthcare. LOGIC Committee
When I reflect on my work at Erica Donovan
Student Health, I am not sure if
being a mother of three young
adults makes me more
empathetic to this age group.
When I see young people able to
My name is Erica Donovan and I am a Primary Healthcare Nurse, and
manage their health and
negotiate health services to I work at a GP Practice/Urgent Care clinic in Christchurch.
promote their own sense of In the past I've written for websites and newspapers and I currently
wellness and achieve academic run a support and education FaceBook page for nurses, midwives,
success, it gives me a great students and other healthcare workers called The Nurse Path. I am
sense of reward. Youth health interested how nurses can use technology in education, through
as a specialty in nursing that I methods like podcasts and Twitter.
recommend all nurses
experience.
December 2018 L.O.G.I.C 19A regional approach
to nurse prescribing
practice – the South
Island story
Heather Gray
Christine Andrews
The South Island is home to over
a million people or 23.3 percent working together in a ‘best for The early discussions regarding
of New Zealand’s total system, best for people’, upcoming prescribing
population. Our communities alliance approach in 2011 and legislation changes began
are geographically diverse, our are successfully working locally, with groups of nurses
population is ageing and towards a fully integrated South from across education and
demand for services is steadily Island health system, with clinical sectors meeting to
increasing. Our workforce too is integrated information systems provide joint feedback on the
facing pressures – an aging and regionally consistent draft legislation to the Nursing
population means an ageing models of care. We do this so Council of New Zealand.
workforce and we face our communities can access the Through these discussions, core
challenges in attracting and same level of high quality care focus groups continued to
retaining staff in specific no matter who they are and meet. We quickly realised we
locations and areas of practice. where they live. were having similar discussions
locally and that there was
Registered nurse (RN) This alliance way of working has
opportunity to network and
prescribing presents an supported the development of a
develop our thinking on a wider
opportunity for us to better South Island nurse prescribing
scale.
meet the needs of our policy and framework, for local
population, by making the best implementation. Our regional On this basis and in the light of
use of our health care approach was driven by a need the 2015 legislation, the five
resources, supporting to ensure that RNs on the South Island Directors of
collaboration in our health care prescribing pathway are well Nursing established a RN
teams and making it easier for supported, both as they are Prescribing Group tasked with
people to access the medicines training and while they are developing a regional
and health care they need. practising, and that the RN framework for moving RN
prescribing service is available prescribing from legislation to
where it is needed most. practice across the South Island.
The five DHBs in the South This framework will guide local
Island have a strong history of areas to ensure registered nurse
collaboration. We committed to prescribing is well supported
during education and in daily
December 2018 L.O.G.I.C 20practice to better meet the level policy and framework, and certified RN prescribers
health needs of the South Island detailed local process options. with specific roles and
community. responsibilities for each
The South Island Alliance’s
of the following:
Workforce Development Hub
trainees and certified RN
facilitated the work of creating
A joined-up approach prescribers, employers,
the draft documents, which we
Heather Gray nurse leaders and
completed largely by email and
mentors.
Chair of the South Island RN teleconference.
Prescribing Group The South Island policy and
The education providers in the
Director of Nursing for framework has been developed
group linked the work back to
Christchurch Hospital to assist services to plan and
education frameworks for
implement RN prescribing in
As elected chair of the South prescribing and helped to
their local areas. The
Island RN Prescribing Group, it is ensure that practice
documents provide guidance
my privilege to work alongside development was consistent
for employers, health
this highly skilled and highly from entry, to undergraduate
professionals and collaborative
engaged group of professionals education, through to
teams to support RNs to
from across the sector – all with postgraduate preparation.
become prescribers and achieve
a shared purpose and common So far we have achieved the potential health gains for
goal. agreement on the following our population. They also detail
We knew that for registered principles: the agreed pathway for RNs to
nurse prescribing legislation to • South Island health achieve certification, which
translate into practice we services support RN begins with a conversation with
needed a common vision and prescribing as an their employer.
support from the sector as a addition to the For instance, the support
whole. Our group includes collaborative team, to network for a nurse prescriber
representatives from secondary meet identified in Fiordland is likely to look
care, primary care, education population health different to that of a nurse in
providers and the New Zealand needs. central Christchurch. Likewise, a
Nurses Organisation, facilitated
• All registered nurses nurse in the New Zealand
through the South Island
who wish to practice as Defence Force will have a
Alliance’s Workforce
RN prescribers must different process for education
Development Hub.
discuss their intentions support than a nurse working
The starting point was a with their employer and with a Māori health provider.
stocktake of work to date and their professional
The principles of collaboration
the direction of travel in each of nursing leader before
and support are the same, but
our local areas. All parties were commencing study on
where you apply, and who
generous in sharing work and this pathway.
supports, your practice may be
we found that together we held • Supervision, support
quite different. In recognising
many of the pieces for a high and mentorship is
these differences, we are
provided to trainees and
celebrating the variety and
December 2018 L.O.G.I.C 21depth of our health service in primary care settings as the need over 200 RN prescribers to
action. basis for supporting RN help our teams meet the needs
prescribing processes alongside of our population over the next
A primary care focus
consultation with employer decade.
Christine Andrews stakeholders.
Member of the South Island General practitioner shortages More information about RN
RN Prescribing Group in the provinces are also likely to prescribing in the South Island:
Director of Primary be a strong driver of the new RN https://www.sialliance.health.n
Healthcare Nursing, prescriber health care z/rnprescribing/
Nelson/Marlborough innovation. The good news is
Quality Improvement that the increasing number of
Manager, Marlborough RN prescribers in New
Primary Health Zealand suggests that there is a
perceived value to the health
care system as a whole.
One of our country’s biggest
health priorities is the Concordance has been
treatment and management of identified as an issue in the
long-term conditions, and effective use of medicines in
primary care is a key area where primary care. Therefore, part of
RN prescribing has the potential the ongoing role of the South
to improve the efficiency of Island RN Prescribing Group will
care, especially for elderly and be to develop a range of
vulnerable people. Timely regional measures, including
access to safe and appropriate investigation around which type
medicines can improve health of prescriber is more effective
outcomes and reduce acute for which particular patient
demand on hospitals. group.
From a quality perspective, the We are now proud to report
great advantage of a regional that we have 21 qualified nurse
approach to RN prescribing is to prescribers practising in the
reduce variations in the way it is South Island and another 21 on
implemented. However, local the pathway. Each of these is
flavour will always play a part based in a collaborative
and this is mostly about multidisciplinary health care
developing strong relationships team across 15 speciality areas
with individual employers in including: rural, primary care,
order to build capacity and diabetes, oncology, hospice and
capability in nursing staff. Whānau Ora.
The South Island RN Prescribing But our work is just beginning,
Framework will be used in local we expect the South Island will
December 2018 L.O.G.I.C 22Sun safety advice be over-exposed to UV rays. Slop on sunscreen - plenty of
Check the UVR level before broad-spectrum, water-
from the Cancer going outdoors so you know if resistant sunscreen of at least
the UV level is 3 or more and SPF 30. Apply 20 minutes before
Society
you need to use sun protection. going outside and reapply every
UV levels can be found: on the two hours and especially after
Sun Protection Alert, by loading being in water or sweating.
the uv2Day app onto your Slap on a hat - wear a hat with a
phone, or go to NIWA’s UV- wide brim or a cap with flaps.
Over-exposure to UV radiation forecast page2. More people are sunburnt on
(UVR) from the sun can cause Follow the slip, slop, slap and the face and neck than any
permanent skin damage. Levels wrap rule for sun safety other part of the body.
of UVR in New Zealand are high
The Cancer Society say New
and a key reason why we have a
Zealanders practicing the slip,
much higher rate of skin cancers
slop, slap and wrap procedure
than other countries. It is
for sun safety will be better
estimated that over 90,000 New
protected this summer. Cancer
Zealanders will be diagnosed
Society sun smart health
with a skin cancer this year, say
promotion measures centre on
the Cancer Society.
these messages:
New research1 has shown an
Slip on a shirt - with long
alarming proportion of New
sleeves. Fabrics with a tighter
Zealanders are neither wearing
weave and darker colours will
hats nor seeking shade to
give you better protection from
protect themselves from the
the sun.
sun. The Cancer Society provide
some advice on ways to be sun Slip into the shade - of an
safe and on checking skin. umbrella or a leafy tree. If you
can, plan your outdoor activities
Check the UV level
for early or later in the day when
UVR, unlike heat and light, the sun’s UV levels are lower.
cannot be felt or seen. Even on Usually before 10am and after
a cloudy or cool day you can still 4pm.
1
The study, led by public health only 4.3 percent of people wore Sun protection alert -
researchers Ryan Gage and sun protective hats and just over https://www.sunsmart.org.nz/sun-
Professor Louise Signal, 10 percent sought out shade
protection-alert
observed 2635 children and during times when sun protection
adults in outdoor recreation was warranted.
2 The UV Index can also be found
spaces in the Wellington region Android - https://goo.gl/XnXn9m
between 2014 and 2015, at www.niwa.co.nz/UV-forecasts
iPhone - https://goo.gl/eQHgJ5
including beaches, playgrounds,
and outdoor pools. It found that
December 2018 L.O.G.I.C 23Wrap on sunglasses - choose D - diameter over 6 millimetres good light using a
close fitting, wrap-around style - a spot that is growing and dermatoscope. If they do not
sunglasses. Not all sunglasses changing in diameter or size. use a dermatoscope another GP
protect against UV radiation, so who does use one should be
“New Zealanders should be
always check the label for the recommended.
encouraged to get to know their
sun protection rating.
skin and regularly check for Melanoma New Zealand has a
It only takes a minute to check changes. list of accredited skin check
providers:
Skin cancers can be successfully “Skin cancers can be in places
www.melanoma.org.nz/melano
treated if detected early says you can't see yourself and a
ma/skin-check-provider.
Cancer Society Medical hand mirror can be helpful to
Director, Dr Chris Jackson. Skin check hard to reach areas like: More information can be found
cancers have many variations armpits, behind ears, scalp, the on the Cancer Society website
and changes to look for include: bottom of feet, fingernails and www.cancernz.org.nz.
toenails.”
A – asymmetry - if the spot or
lesion is divided in half, the two The Cancer
halves are not a mirror image Society advise
the immediate
B - border irregularity - a spot
checking of any
with a spreading or irregular
change on skin
edge
by a GP or
C - colour variation - a spot with specialist who
a number of different colours will examine the
through it entire skin
surface under a
December 2018 L.O.G.I.C 24Investing in a well
child nursing
workforce;
Anne Hodren Plunket Trust
National Educator, RN
(Comprehensive), BA, MA
(Nursing).
development. Neuroscience
terming them ACEs, or adverse
“When we strengthen families, research confirms the
childhood experiences (Stevens,
we ultimately strengthen the importance of the early years
2014). ACEs include abuse,
community. Our goal is that and the protective influence of
neglect, household alcohol or
parents everywhere work with nurturing relationships (Irwin,
drug abuse, household member
supportive providers, feel Siddiqi et al. as cited in Kvalsvig,
in prison, mother treated
confident in their parenting D’Souza, Duncanson, &
violently, one or no parent,
role, and form strong, resilient Simpson, 2016). The Plunket
parent experiencing mental
attachments with their children. Trust’s strategy (2016-2021)
illness, and economic hardship.
To help achieve this, providers focuses their intent on the first
Research shows these
must be responsive to parents, 1000 days of a child’s life
experiences can create toxic
knowledgeable about child (Plunket, 2016).
stress and negatively affect
development, and eager to see Most parents living in poor child brain development leading
every parent succeed” circumstances provide a loving to the presence of many adult
(Brazelton, 2018, p.1). The and nurturing environment, physical and psychological
challenge for the Royal New despite many difficulties. diseases. As the number of
Zealand Plunket Trust is how However, children living within ACEs increases, so does the risk
best to achieve the best health a multi stressed family are more for poor outcomes (American
outcomes using the latest likely to be exposed to factors of Academy of Paediatrics, 2016).
research to inform practice adversity (Farrington et al;
Recent research has shown that
within increasing complex Shonkoff and Phillips as cited in
even factors previously thought
community practice. NHS, 2012). When a child
to be unmodifiable, such as
Early childhood is a key period experiences chronic,
genes, can be influenced even
where social and environmental unmitigated adversity without
modified by the child’s
factors exert their effect on the access to stable, supportive
environment. This
equity of health and life relationships with caring adults,
understanding has rapidly
outcomes providing an toxic stress can occur. Research
evolved into a new field,
important window of in the 1980s categorised
epigenetics, which seeks to
opportunity to build a strong negative experiences of
understand how genes and
foundation for future childhood
environments interact. There is
December 2018 L.O.G.I.C 25now a greater understanding of would inform nurses care for and reduce risks (Minnesota
the profound importance of children and their whānau, and Department of Health, 2016).
environments early influences guide decision making on It is acknowledged that gaining
on children’s physical health, assessment and effective the skills required to work as
emotional health and interventions. Plunket nurses, in particular
development. (Korosi, Naninck with whānau experiencing
et al., Wang, Walker et al. as adversity, is complex. Currently
cited in Kvalsvig, D’Souza, Plunket nurses actively enhance
there is a mixed method
Duncanson, & Simpson, 2016). early childhood health and
approach in orientation with
wellbeing as a core component
mentoring, preceptorship and
of the primary health care
online learning. This learning is
New Zealand children in poverty workforce. The New Zealand
then further developed through
and vulnerable situations, and Government offers whānau a
the nursing postgraduate
the high prevalence of abuse free Well Child/Tamariki Ora
programme, an academic-
and neglect were identified as (WCTO) universal programme
clinical partnership between
concerning when compared with additional services
Whitireia Community
with international data (UN available according to
Polytechnic and Plunket. Face
Committee on the Rights of the need/vulnerability
to face and online learning is
Child as cited in Kvalsvig, (‘proportionate universalism’),
being developed to keep pace
D’Souza, Duncanson, & including assessment, health
with education innovation and
Simpson, 2016). New Zealand promotion, family/whānau
to reduce barriers for distance
research has also highlighted support and advice, and referral
learners. Nurses need to find
concerns regarding the where appropriate and
important conduits to bridge
increasing pressures facing available. Plunket Trust, the
the gap between theory and
many whānau in particular for largest provider of the WCTO
clinical practice, supported
Māori and Pacific children with programme is committed to
through mentoring and
resulting higher incidence of giving every New Zealand child
supervision (Crick, White, Shaw
physical, emotional and the best possible start to ensure
& Ross as cited in Cameron,
behavioural problems (Ministry better life outcomes (Plunket,
2017).
of Health, 2012). 2016). Gaining the skills for this
role can be complex as nurses Emphasis needs to be placed on
“The long-term goal of public
enter Well Child practice with a nurses developing critical
health is to achieve lasting
variety of knowledge and thinking to engage with
change in the factors and
experiences, some being new complex practice issues. With
conditions that place people at
graduate nurses. (Fraser, Grant, the rapidly evolving research
risk by making changes at the
& Mannix, 2016). Essential is related to ACEs, child mental
individual, family, community,
the capacity to work in health and neurodevelopment,
and societal levels.” (National
partnership with clients and Plunket staff have expressed a
Center for Injury Prevention and
communities, to engage need to have access to up to
Control, n.d., p.2). It would
families in a relationship that date knowledge and skills in this
seem timely from the evidence
encourages protective factors area. Being able to evaluate
that the health impacts of
which assessments and
adversity in early years of life
December 2018 L.O.G.I.C 26You can also read
