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December | 2019 EMERGENCY NURSE NEW ZEALAND The Journal of the College of Emergency Nurses New Zealand (NZNO) ISSN 1176-2691
EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019
In this issue
Features
Death in the Emergency Kotahitanga
07 Department: A Rapid Review 26 Compassion and Inclusion
CENNZ Conference 2019
Buckle Fractures in Kids
11
CENNZ Honorary Life Membership
30
Award – WENDY SINCLAIRCENNZ
Social Media Update
Triage Courses 202
24
Snippets Summer 2019
31
Regulars
A Word from Regional Reports
03 12
the Editor
Chairperson’s NEW FEATURES
05 23-30
Report College Activities
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019
A Word from the Editor
Matt Comeskey
Editor | Emergency Nurse NZ
mcomeskey@adhb.govt.nz
Letters to the Editor are welcome. Letters This is reflected in the regional reports Watch this space.
should be no more than 500 words, with in this edition. As a result, patient safety,
no more than 5 references and no tables equitable delivery and quality of care Moving on…
or figures. have been compromised.
This issue features a rapid review of
There is good evidence that our research into death in the Emergency
overburdened EDs, bed-blocked hospitals department, College Activities including
and inability to access GP services are the dates for the 2020 Triage Courses,
symptoms of a bigger problem in our Good Fellow Conference and a report
Any one of us who has ‘worked the floor’ health system, that being an ongoing on the 2019 CENNZ Conference. A big
in the past few months will know this has trend of underfunding and persistent thanks to everyone who have contributed
been a difficult and arduous winter. In my inequity in the delivery of health care (1). to the journal this year. I trust the coming
workplace, above seasonal average acuity summer will be rejuvenating.
Two things give me some small hope
and volume were dealt with by some
we have reached a tipping point. The
tired and stressed colleagues. None of
first being the NZNO’s attempt to lead
this is unprecedented, and none of it was
the media debate as to why this occurs
unforeseen. The year-on-year workload is
with a focus on the Auckland DHBs
increasing in our departments. We know Matt
as examples of what is happening
this to be true.
nationally. The second, - the Health and 1. Goodyear-Smith, Felicity. Ashton, Toni.
And you may agree, as the CEO of Disability System Review, undertaken Lancet (2019). New Zealand Health System:
Auckland DHB did, that winter planning by the Ministry of Health. This wide-
Universalism Struggles with Persisting
ensured the bulk of the winter workload reaching report will address issues like
Inequities. The Lancet. 3–9 August 2019,
was adequately catered for. But at times, the duplication of DHB services, the
Pages 432-442.
for prolonged periods, this wasn’t the health of the workforce and improved
case, both in Auckland and nationally. delivery of primary care.
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019
Editorial Info
Subscription: Journal Coordinator/Editor: Dr. Sandra Richardson: Dr Sandra
Richardson : PhD Senior Lecturer,
Matt Comeskey:
School of Health Sciences, University
Subscription to this journal is through a Nurse Practitioner, ADHB
of Canterbury.
membership levy of the College of Emergency Email: mcomeskey@adhb.govt.nz
Deborah Somerville: MN. Senior
Nurses New Zealand - NZNO (CENNZ).
The journal is published 3 times per year Peer Review Coordinator: Lecturer. Faculty of Medical and Health
Matt Comeskey: Sciences, University of Auckland.
and circulated to paid Full and Associated
Nurse Practitioner, ADHB
members of CENNZ and other interested
subscribers, libraries and institutions.
Email: mcomeskey@adhb.govt.nz Submission of articles for
publication in Emergency
Copyright: This publication is copyright in its Peer Review Committee: Nurse New Zealand.
entirety. Material may not be printed without
Margaret Colligan: MHsc. Nurse All articles submitted for publication should
the prior permission of CENNZ.
Practitioner. Auckland City Hospital be presented electronically in Microsoft
Website: www.cennz.co.nz Emergency Department, ADHB Word, and e-mailed to mcomeskey@adhb.
Lucien Cronin: MN. Nurse Practitioner. govt.nz. Guidelines for the submission
Auckland City Hospital Emergency of articles to Emergency Nurse New
Department, ADHB Zealand were published in the March
2007 issue of the journal, or are available
Editorial Committee Prof. Brian Dolan: FRSA, MSc(Oxon),
from the Journal Editor Matt Comeskey
MSc(Lond), RMN, RGN. Director
at: mcomeskey@adhb.govt.nz Articles
of Service Improvement.Canterbury
Emergency Nurse N.Z. is the official journal are peer reviewed, and we aim to advise
District Health Board.
of the College of Emergency Nurses of New authors of the outcome of the peer review
Zealand (CENNZ) / New Zealand Nurses Nikki Fair: MN. Clinical Nurse process within six weeks of our receipt of the
Organisation (NZNO). The views expressed Specialist. Middlemore Hospital article. CENNZ NZNO Membership:
in this publication are not necessarily those Paediatric Emergency Care, CMDHB Membership is $25.00 and due annually
of either organisation. All clinical practice Paula Grainger: RN, MN (Clin), in April. For membership enquiries
articles are reviewed by a peer review Nurse Coordinator Clinical Projects, please contact: Kathryn Wadsworth
committee. When necessary further expert Emergency Department, Christchurch Email: cennzmembership@gmail.com
advice may be sought external Hospital.
to this group. Design / Production / Distribution:
Libby Haskell: MN. Nurse Practitioner.
All articles published in this journal remain Children’s Emergency Department Sean McGarry
the property of Emergency Nurse NZ and Starship Children’s Health, ADHB. Phone: 029 381 8724
may be reprinted in other publications if Email: seanrmcgarry@gmail.com
Sharon Payne: MN. Nurse Practitioner.
prior permission is sought and is credited to
Hawkes Bay Emergency Department,
Emergency Nurse NZ. Emergency Nurse NZ
HBDHB.
has been published under a variety of names
since 1992.
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019
Chairperson’s Report
2019 Annual General
Meeting NZNO (CENNZ)
It is a privilege to present the Chairperson’s Report to the 2019
Annual General Meeting of the NZNO College of Emergency
Nurses New Zealand (CENNZ).
The committee is a cohesive and hardworking team who continue to work towards
CENNZ’s strategic aims of improving health outcomes, supporting the development
of skilled emergency nurses and building a strong workforce. It is recognised that there
are some key challenges facing our specialty. These are safe staffing in emergency
departments, strategies to respond appropriately to unpredicted acuity and demand,
and violence and aggression. These areas continue to be the focus of our work.
To be an influential organisation, we believe we must continue to work strategically
to position the College as a leading voice for emergency nursing. Activities to
achieve this have included; continuing to build and support national nursing
networks, contributing to submissions and consultations, seeking engagement with
key stakeholders, assisting nurses in education and advocating for safe staffing and
work on violence and aggression.
• Providing the NZ Triage • Support of the CENNZ National • A CENNZ position statement
Course continues to be a key Nurse Practitioners Network has been formalised on ‘Emergency
activity of the College and the National Charge Nurse Department Overcrowding’. A
Managers Network. Providing remit was approved at the 2019
• 8 National Triage Courses were held
a formalised structure for nurses CENNZ AGM to adopt this
• The CENNZ social media platforms across the country to collaborate
• Allocation of funds for education,
Facebook and Twitter have on shared issues is seen as key to
study and conference grants
experienced increased activity and strengthening emergency nursing.
provide clinically relevant resources Meetings were held in Wellington • Support of the 28th CENNZ National
and communication Conference in Hamilton 2019
• A remit was approved at the 2019
• The Emergency Nurse Journal has CENNZ AGM, to support the • CENNZ represented emergency
been published in electronic format establishment of a CENNZ nursing at the Australian College
Emergency Nurse Educators of Emergency Medicine (ACEM)
• Support of the Advanced Emergency
Network. This will allow national Mental Health Summit held in
Nurses Network who continue to
meetings and the collaboration Wellington in June. CENNZ
be very active holding 3 study days
of educators across the country. supported 10 nurses from around
per year
This will enable the sharing and the country to attend the symposium
strengthening of initiatives to to ensure emergency nursing
develop our workforce contributed to this discussion
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019
• A CENNZ Emergency Nurse • The CENNZ website is undergoing benchmark for triage education. The
Leadership grant was established review and upgrade revenue received from the national
following a remit at the 2018 triage course also enables CENNZ to
• We continue to seek opportunities
conference. High quality maintain its significant grant and
to engage with the Safe Staffing
applications were received from education programmes. I would like to
Healthy Workplace Unit (SSHW)
around NZ. Two nurses will attend also acknowledge the tremendous work,
/ CCDM. The CENNZ Charge
the highly regarded course in support, knowledge and skills of Sharyne
Nurse Managers Network continue
Australia in November this year Gordon at the NZNO Wellington
to investigate methods to calculate
office and Suzanne Rolls our NZNO
• A letter, on behalf of College base staffing, Variance Indicator
Professional Nurse Advisor.
members, was presented to the Scoring(VIS) and contributing to
2018 NZNO AGM to request the trial of Trend Care in emergency I will shortly step down from the CENNZ
NZNO prioritise work on departments committee as my 4-year term comes to a
violence and aggression. close. It has been a privilege to represent
• We have been very active in our
This resulted in NZNO the ‘Top of the South’ region and to
submission and consultation work
establishing a working party, contribute to the world of emergency
including -
action plan for future initiatives nursing in New Zealand. It has been a
and collaborating with Work Safe National Stroke Clot Retrieval Work professionally challenging but rewarding
NZ. Following this, Work Safe Safe Draft Guidelines on Violence role. I thank the CENNZ committee
NZ have presented the ‘Draft in Healthcare. Health and Disability for their support and look forward to
good practice guidelines: Violence Review ongoing involvement in the College.
in the healthcare industry’. CENNZ
• 5 complimentary conference
continues to advocate for mandatory
registrations were allocated to
and enforceable regulations to
Christchurch emergency department
ensure work place safety
to acknowledge their work in serving
• We have sought to optimise media the community on Friday 15th
opportunities to articulate our March, 2019.
Jo King
concerns regarding violence and
I would like to thank the CENNZ Chairperson
aggression in emergency departments
Triage Instructors for the success of the
College of Emergency Nurses New Zealand
• CENNZ position statements are Triage Course. Their work is vital to
being reviewed ensure this course remains the highest Contact: cennzchair@gmail.com
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019
Author: Natalie Elizabeth Anderson Affiliations: University of Auckland & Auckland
MSc(Hons), RN Emergency Department
Conflicts of interest: None to declare
Email for correspondence:
na.anderson@auckland.ac.nz
Death in the emergency department:
A rapid review
Abstract:
Those who work in emergency departments rarely consider them a ‘good’ place to die. Recent New Zealand
research suggests that palliative patients and their whānau/family – particularly those living in more deprived areas –
can benefit from hospital admission at the end of life, and this often occurs via emergency departments. Inclusive and
compassionate end-of-life care is associated with family involvement, relationship-building and detailed contextual
knowledge of the patient and family. Patient death in the emergency department can have unique and varied features
and challenges. Death may be sudden and unexpected, or there may be uncertainty about the cause of death. The
patient’s background, key relationships, cultural and spiritual priorities may not be known. This rapid review provides
an overview of the evidence base exploring care of the dying and bereaved in the emergency department. It asks:
What are the features of death in the emergency department setting? What are the barriers to quality care? Do
we know what bereaved whānau/family need and value when their loved one dies in the emergency department?
Research to-date suggests emergency department staff readily identify common challenges, and more research-
informed initiatives are needed to facilitate quality emergency care of the dying and bereaved.
Keywords: Death, Emergency Service, Hospital, Terminal Care, Bereavement, Emergency Department
Dying in hospital home, because they want to feel safe or they want to avoid being
a burden (Robinson, 2017).
Between the years 2000-2010 more New Zealanders died in
public hospitals (34%) than any other single place (Palliative New Zealand researchers Gott et al. (2019) asked bereaved
Care Council of New Zealand, 2014). Researchers and clinicians relatives of patients who had been in hospital at the end of
have classified some hospital admissions at the end of life life for examples of good care. Participants described the
inappropriate or avoidable, but death trajectories are complex importance of family involvement, relationship-building
and unpredictable (Gott, 2014). Recent findings from New and contextual knowledge of what was important to, and
Zealand (Robinson, Gott, Frey, Gardiner, & Ingleton, 2018) and unique about, each patient and family. Concrete examples of
around the world (Procter, Ooi, Hopkins, & Moore, 2019) show compassionate actions included introductions, kind words,
many patients and families benefit from hospital care, as death taking time, ensuring quiet and providing refreshments.
approaches. New Zealanders affected by poverty, prognostic Emergency care workers are skilled at quickly identifying needs
uncertainty or social isolation may come to hospital at the end and building rapport with diverse people. However, providing
of life because they do not have the resources to be cared for at personalised care, taking time and ensuring privacy and quiet
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Death in the emergency department:
A rapid review cont.
in the fast-paced, noisy and dynamic emergency department known. Some patients die before their families arrive. When
setting can be difficult. Dying in the emergency department family are present, they can be highly distressed, may have
presents unique features and challenges, as discussed in the witnessed a traumatic event and may be asked to act as key
following section. sources of information or proxy decision-makers. An aggressive
resuscitation effort may precede patient death. Research
Dying in the emergency department: Unique features and supports giving family members the option of supported
challenges presence during resuscitation (Toronto & LaRocco, 2019).
Emergency nurses from all over the world cite business and A catastrophic event may mark the team’s inaugural contact with
lack of time as the most significant barriers to compassionate patient or family, with no prior chance to form rapport or build
care of the dying and bereaved (Decker, Lee, & Morphet, 2015; trust, making it difficult to establish a meaningful connection.
Ka-Ming Ho, 2016; Kongsuwan et al., 2016; Wolf et al., 2015). The health professional team may include a number of doctors
Patient numbers are increasing, and emergency staff must and nurses, with multiple hand-overs of care. Clinicians may
work to accommodate the rapid turnover of patients, competing not attempt to make an emotional connection with the patient
work demands and frequent interruptions (McCallum, Jackson, and family, due to fatigue, feeling overwhelmed, uncertain or
Walthall, & Aveyard, 2018). Even the emergency department a belief emotional distancing is the safest, most professional
environment itself has been described as ‘hostile’ and identified approach. It requires some vulnerability and emotional labour
as a key barrier to dignified care at the end of life (Diaz-Cortes to make a connection with a dying patient and their family, but
et al., 2018). Emergency departments are typically bright, this investment in the nurse-patient relationship is associated
sterile and impersonal, lacking in space, privacy, seating or with better care for dying patients and bereaved relatives, and
facilities for family members to gather in numbers. Ultimately, greater job satisfaction for emergency nurses (Bailey, Murphy,
emergency staff do not believe the emergency department & Porock, 2011a). Nurses’ first experiences with patient death
is a good place to die (Decker et al., 2015; Hogan, Fothergill- can occur after they have qualified and may have a lasting
Bourbonnais, Brajtman, Phillips, & Wilson, 2016). impact (Anderson, Kent, & Owens, 2015). Wherever possible,
Emergency care prioritises rapid assessment, life-saving experienced ED staff should try to mentor novice nursing
actions and rapid turnover of patients. Emergency triage is colleagues in post-mortem care and support them to care
a system which explicitly gives precedence to the prevention effectively for a dying patient and their family.
of deterioration and preservation of life. Saving lives is an Finally, there is a distinct lack of published, quality research
important part of the emergency care identity, with patient into the needs of patients and families when patients die in
death perceived as an unwelcome failure (McCallum et al., the emergency department (McCallum et al., 2018). Rather
2018). Emergency patient death trajectories are varied and than focusing exclusively on errors, barriers, complaints and
unpredictable (Chan, 2011). Most patients dying in EDs are failures, we need to identify and facilitate better care within
elderly, suffering from chronic diseases and could be classified the unique emergency department setting. Experience-based
by medical researchers as on a known death trajectory (Le Conte co-design involving patients, families and staff may have some
et al., 2010). However, some deaths are sudden and unexpected, utility (Blackwell, Lowton, Robert, Grudzen, & Grocott, 2017).
and the cause of death may even be unclear (Keirns & Carr, Research using an appreciative inquiry approach (Cooper-
2008). Ethnographic researchers Bailey, Murphy, and Porock Rider & Whitney, 2005) would help us to understand what good
(2011b) noted emergency departments are better equipped to care looks like, what actions bereaved families appreciate, and
provide care in the case of ‘spectacular’ deaths such as young what changes could make the most impact.
victims of trauma. In comparison, deaths from old age or at
the end of a long illness - so-called ‘subtacular’ deaths – may be Conclusion
neglected.
Although emergency care staff are experts at saving lives,
There are sometimes significant barriers to facilitating patient mortality ultimately has a 100% success rate. Patients will
and family-centred care in the emergency department. In some continue to die in emergency departments, and with an aging
cases, the patient’s background, key relationships, cultural and increasingly co-morbid population, the number of patient
and spiritual priorities – even their identify - may not be death is expected to increase. For disadvantaged patients with
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019
Death in the emergency department:
A rapid review cont.
limited personal, social or financial resources, hospital may be research in this area is needed, particularly to look at how
the best or only safe place for them to come at the end of life. best to meet the needs of Māori, Pasifika and disadvantaged
Recognising, naming and demystifying dying is important. New Zealanders.
Research suggests those emergency nurses who invest in
building a relationship with the patient and family as people Acknowledgements
and make a personal connection with them will deliver superior With thanks to members of Te Arai Palliative Care & End
care and feel the greatest reward in caring for the dying. of Life Research Group https://tearairesearchgroup.org/
What we know about the patient and family needs specific to No external financial support to declare.
death in the emergency department is mostly anecdotal – more
Compassionate care of the dying
and bereaved: What can we do?
Emergency nurses can provide compassionate care of When patients die in the emergency department, there
the dying and bereaved. It is important to recognise and can be an operational drive to move the body/tūpāpaku
name dying – if you are unsure, ask the doctor if they out of the department. It may be important that key
think your patient is actively dying or might die today, spiritual leaders or family members attend the patient
and if the family are aware. Ensure patient wishes around immediately after death. Involving family in post-mortem
resuscitation have been discussed and documented. If care can be very rewarding if they are keen.
curative interventions are limited or discontinued, do
It is often difficult to meet all the needs of the bereaved
not see or describe this as a ‘withdrawal’ of care, but an
family, so specialised support services are a helpful
opportunity to redirect your focus to patient comfort
resource for larger emergency departments. These
and family support. Facilitating family presence and
supports may include specialist bereavement care
comfortable patient positioning in a dry bed, under
teams, cultural, social and spiritual support workers,
a warm blanket may be your most important actions.
bereavement care packs of written information and
De-mystify dying by helping to answer family questions
follow-up bereavement care pathways.
and explaining the common features of dying including
sleepiness and noisy, irregular breathing. Ask the patient Finally, don’t forget to check-in with your colleagues after
or family members: What is important, to you? What are they have cared for a dying patient and their family. Let
you worried about, right now? them know what a great job they’ve done and give them a
chance to talk about it, if they want to.
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019 Death in the emergency department: A rapid review cont. References Anderson, N. E., Kent, B., & Owens, R. G. (2015). Experiencing patient death in clinical practice: Nurses’ Ka-Ming Ho, J. (2016). Resuscitation versus end-of-life care: Exploring the obstacles and supportive recollections of their earliest memorable patient death. International journal of nursing studies, 52(3), 695- behaviors to providing end-of-life care as perceived by emergency nurses after implementing the end- 704. doi:https://doi.org/10.1016/j.ijnurstu.2014.12.005 of-life care pathway. Applied Nursing Research, 29, e7-13. doi:https://doi.org/10.1016/j.apnr.2015.05.014 Bailey, C., Murphy, R., & Porock, D. (2011a). Professional tears: developing emotional intelligence around Keirns, C. C., & Carr, B. G. (2008). From the emergency department to vital statistics: cause of death and dying in emergency work. Journal of Clinical Nursing, 20(23-24), 3364-3372. doi:https://doi. death uncertain. Academic Emergency Medicine, 15(8), 768-775. doi:https://doi.org/10.1111/j.1553- org/10.1111/j.1365-2702.2011.03860.x 2712.2008.00193.x Bailey, C., Murphy, R., & Porock, D. (2011b). Trajectories of end-of-life care in the emergency Kongsuwan, W., Matchim, Y., Nilmanat, K., Locsin, R. C., Tanioka, T., & Yasuhara, Y. (2016). Lived expe- department. Annals of Emergency Medicine, 57(4), 362-369. doi:https://doi.org/10.1016/j.anne- rience of caring for dying patients in emergency room. International Nursing Review, 63(1), 132-138. mergmed.2010.10.010 doi:https://doi.org/10.1111/inr.12234 Blackwell, R. W. n., Lowton, K., Robert, G., Grudzen, C., & Grocott, P. (2017). Using Experience-based Le Conte, P., Riochet, D., Batard, E., Volteau, C., Giraudeau, B., Arnaudet, I., . . . Potel, G. (2010). Death Co-design with older patients, their families and staff to improve palliative care experiences in the Emer- in emergency departments: a multicenter cross-sectional survey with analysis of withholding and gency Department: A reflective critique on the process and outcomes. International journal of nursing withdrawing life support. Intensive Care Med, 36(5), 765-772. doi:https://doi.org/10.1007/s00134-010- studies, 68, 83-94. doi:https://doi.org/10.1016/j.ijnurstu.2017.01.002 1800-1 Chan, G. K. (2011). Trajectories of approaching death in the emergency department: clinician narratives McCallum, K. J., Jackson, D., Walthall, H., & Aveyard, H. (2018). Exploring the quality of the dying and death of patient transitions to the end of life. Journal of Pain & Symptom Management, 42(6), 864-881. experience in the Emergency Department: An integrative literature review. International journal of nursing doi:https://doi.org/10.1016/j.jpainsymman.2011.02.023 studies, 85, 106-117. doi:https://doi.org/10.1016/j.ijnurstu.2018.05.011 Cooper-Rider, D. L., & Whitney, D. L. (2005). Appreciative inquiry a positive revolution in change (1st ed.). Palliative Care Council of New Zealand. (2014). Deaths in New Zealand: Place of death 2000-2010 San Francisco, CA: Berrett-Koehler. Retrieved from https://palliativecare.hirc.org.nz Decker, K., Lee, S., & Morphet, J. (2015). The experiences of emergency nurses in providing end-of-life Procter, S., Ooi, M., Hopkins, C., & Moore, G. (2019). A review of the literature on family decision-making at care to patients in the emergency department. Australasian Emergency Nursing Journal, 18(2), 68-74. end of life precipitating hospital admission. British Journal of Nursing, 28(13), 878-884. doi:https://doi.org/ doi:https://doi.org/10.1016/j.aenj.2014.11.001 10.12968/bjon.2019.28.13.878 Diaz-Cortes, M. D. M., Granero-Molina, J., Hernandez-Padilla, J. M., Perez Rodriguez, R., Correa Casado, Robinson, J. (2017). Benefit or Burden? Exploring Experiences of the Acute Hospital as a Place of Care M., & Fernandez-Sola, C. (2018). Promoting dignified end-of-life care in the emergency depart- Amongst People with Palliative Care Needs. (Doctor of Philosophy), University of Auckland, Auckland. ment: A qualitative study. International Emergency Nursing, 37, 23-28. doi:https://doi.org/10.1016/j. Robinson, J., Gott, M., Frey, R., Gardiner, C., & Ingleton, C. (2018). Predictors of patient-related benefit, ienj.2017.05.004 burden and feeling safe in relation to hospital admissions in palliative care: A cross-sectional survey. Gott, M. (2014). Avoidable for whom? Hospital use at the end of life. Palliative Medicine, 28(7), 917-918. Palliative Medicine, 32(1), 167-171. doi:https://doi.org/10.1177/0269216317731991 doi:https://doi.org/10.1177/0269216314534807 Toronto, C. E., & LaRocco, S. A. (2019). Family perception of and experience with family presence Gott, M., Robinson, J., Moeke-Maxwell, T., Black, S., Williams, L., Wharemate, R., & Wiles, J. (2019). 'It during cardiopulmonary resuscitation: An integrative review. Journal of Clinical Nursing, 28(1-2), 32-46. was peaceful, it was beautiful': A qualitative study of family understandings of good end-of-life care doi:https://doi.org/10.1111/jocn.14649 in hospital for people dying in advanced age. Palliative Medicine, 33(7), 793-801. doi:https://doi. Wolf, L. A., Delao, A. M., Perhats, C., Clark, P. R., Moon, M. D., Baker, K. M., . . . Lenehan, G. (2015). Exploring org/10.1177/0269216319843026 the Management of Death: Emergency Nurses' Perceptions of Challenges and Facilitators in the Pro- Hogan, K. A., Fothergill-Bourbonnais, F., Brajtman, S., Phillips, S., & Wilson, K. G. (2016). When Someone vision of End-of-Life Care in the Emergency Department. Journal of Emergency Nursing, 41(5), e23-33. Dies in the Emergency Department: Perspectives of Emergency Nurses. Journal of Emergency Nursing, doi:https://doi.org/10.1016/j.jen.2015.05.018 42(3), 207-212. doi:https://doi.org/10.1016/j.jen.2015.09.003 If you would like to submit an advertisement or article for the next issue of the journal please contact the editor matt comeskey for more information! email Matt at: mcomeskey@adhb.govt.nz P 10
EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019
Buckle Fractures In Kids
Buckle fractures of the distal radius are common in children between 2 and 12 years of age
This type of fracture occurs in about 1 in 25 children and represents 50% of pediatric fractures of the wrist.
The fracture occurs when there is axial loading of a long bone. This most commonly occurs at the distal radius
but can also occur in other long bones i.e tibia, humerus
Assessment
The wrist may be sore, swollen and painful to move but there
is no clinical deformity.
Why do they occur?
Buckle (torus) fractures occur when the bony cortex is compressed
and bulges. There is no extension of the fracture into the cortex.
Plain Radiographs:
- Distinct fracture lines are not seen
- Subtle deformity or buckle of the cortex may be evident
- In some cases, angulation is the only diagnostic clue
How are they treated? Follow up
This injury is treated in either of the following ways: This injury is treated in either of the following ways:
1. A below elbow back-slab No repeat x-rays required
2. A removable orthotic wrist splint (this can GP review in 2-3 weeks from the time of injury to have
be removed for bathing). the back-slab/splint removed and wrist reviewed.
Simple analgesia i.e. paracetamol can be used for It is common for the wrist to be a bit stiff and sore at
24-48hrs if required. first but this should resolve quickly.
Contact sport and rough play should be avoided
for6 weeks.
Kathryn Johnson NP
Starship Children’s Emergency Department
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Regional
Reports
Northland/Te Taitokerau | Auckland
Midland | Hawkes Bay/Tarawhiti
Mid Central | Wellington | Top of the South
Canterbury/Westland | Southern
Vacancy
The Hawkes Bay/
Tarawhiti delegate
position is currently
vacant. Please contact
CENNZ for further
information or
to apply
P 12EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019
Northland/Te Taitokerau Region
New census population updates capacity overstretched and a high
have confirmed the increase in priority has been on supporting
Whangarei and regional population staff well-being.
- one of the reasons for increasing
On a brighter note we welcomed
ED presentations. The winter
Lyndsay Kidd-Edis, another NP to
workplace stressors have been
the team this week.
increased with the measles and
meningococcal presentations. We Spring is here with the promise of
appreciate the completion and longer days (& daylight saving) and
commissioning of the new isolation return of warmer temperatures.
cubicle. A recent quality initiative was 10
Since June there has been a change for 10 - the principle being that if
to 5 code colours for ED status - can reduce EDLOS by 10 minutes
Sue Stebbeings for each patient this will allow more
GREEN – YELLOW – AMBER –
Nurse Practitioner RED – BLACK. The code calculation time to provide care. There were 10
is based on: initiatives - 1 each week for 10 weeks
Emergency Department
– using a plan, do, study, act process.
Whangarei Hospital 1. Resus occupancy
These initiatives either focused
Contact: sstebbeings007@yahoo. 2. ED capacity on using existing processes better
co.nz – such as early bed requests - or
3. CaseMix – acuity of presentations
introduced new ideas – a brief team
4. ED wait - number of patients huddle / update at the start of each
waiting for ED to see for more nursing shift. This also involves
than an hour cross service collaboration – this last
5. IP wait – number of patients week of the initiative was a request
waiting for inpatient team to see for ambulance staff to do vital signs
for more than an hour on arrival when ED is code red and
status 3 arrival.
6. Bed Availability – number
of patients waiting for bed Thanks to Waikato for an
allocation > 30 minutes inspirational conference and the
reminder that Nurses need to be
7. Transfer to ward – number of leaders in providing compassionate
patients that have beds allocated inclusive care – care for ourselves
but haven’t left ED and colleagues as well as those
Unfortunately, there have been coming through the front and back
whole shifts in Code Black territory doors.
even with ongoing development of
hospital wide responses to acute Sue
care demand. As staff efforts and
P 13EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019
Auckland Region
Starship Children’s ED One of our nurses Graeme Bennett
won the Local Hero Award - this is
Winter hit us early like most other
a monthly award given out by the
regions across NZ; May and June our
CEO to an ADHB employee who
busiest on record. This winter’s poor
makes a difference.
6-hour flow compliance has had a
huge impact on additional hours for Graeme is a Level 4 RN who is our
children and their families in CED. local immunisation legend, making
The extra workload from this was sure CED staff are 99.5% vaccinated
a challenge to manage.Then along and promoting vaccination with
came Measles! This challenged us families.
even further with how to manage the
We have started work on converting
department with only two negative
a consultation room into a low
Anna-Marie Grace pressure rooms.
stimulus room- a room that we
Nurse Unit Manager We all learnt a new lingo “clean, can care for young people with
clean”, “clean dirty”, “dirty, clean” challenging behaviours more safety
Children’s Emergency and made a plan to try and keep one and children ASD who may need a
Department side of the department clean and the quieter room.
other buggy (dirty).
Starship Children’s Health Anna Marie Grace
Our focus quickly turned to ensuring
Auckland City Hospital the vulnerable (the very young and Auckland Adult ED
the immunocompromised) were
Contact: annamarieg@adhb.govt.nz
kept safe.
Graeme Bennett, ADHB Local Hero Award, with
Children’s ED team & ADHB CEO, Ailsa Claire
P 14EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019
Auckland Region cont.
Auckland ED continues to see record hoardings, room numbering systems
numbers of patients while working and navigational routes keeping
within a hospital operating at or everyone on their toes. Builders
over capacity throughout the Winter have worked carefully to ‘refresh’
months, and now into Spring. In spite each emergency department patient
of the constant pressure, we continue bed-space individually, helping to
to work hard to provide the best minimise disruption to clinical care.
care we can. Along the way we have
Our specialised team of health
farewelled existing staff, welcomed
security staff are growing and proving
new staff and continued to provide
their value to ensure the safety of
clinical mentorship to medical,
patients, families and staff across the
nursing and paramedic students.
emergency department and clinical
Natalie Anderson While the measles outbreak has decision unit.
created challenges, it also seems
Registered Nurse On a happy note, a large contingent
to have raised awareness of the
from the Auckland Emergency
Doctoral Candidate importance of immunisations
Department recently enjoyed some
& Professional Teaching Fellow amongst patients and families.
‘team-building’ at the Emergency
We have had to adapt existing Services Ball. It looks like everyone
Adult Emergency Department,
resources to protect and isolate enjoyed the opportunity to relax and
Auckland City Hospital patients at risk. A new rapid influenza celebrate the end of the busy winter
Contact: na.anderson@auckland. testing system is also now embedded season.
ac.nz into practice.
Natalie Anderson
Renovation of our built environment
continues across Level 2, with new
Contributions for Publication
We are always open to receiving submissions for
publication. Submissions in the form of case studies,
research posters and practice guidelines are welcome.
There is a modest contribution for featured articles.
You can find guidelines for publication here: https://www.nzno.org.nz/groups/colleges_sections/colleges/
college_of_emergency_nurses/journal
Alternatively, email and enquire: mcomeskey@adhb.govt.nz
P 15EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019
Midland Region
The Midland region has seen its fair of time when their emergency care
share of trauma this year, particularly has finished and their ward-based
road trauma. Most recently, we had care commences (this includes HDU
a mass casualty incident in the level patients which feature a lot in
Rotorua area in which 18 patients bed delays).
were transported to Rotorua ED and
Staff safety incidents continue to
3 patients flown to Waikato ED. This
occur to frequently and they have
incident was similar to our recent
created a working group consisting
EMERGO training incident and the
of mental health staff, integrated
teams were able to put into real life
operations center nurse manager,
what had recently been practiced.
St Johns, DHB security, Te Puna
In Rotorua ED we are trialing a new Oranga, ED champions, health and
“treatment corridor model” with our safety and quality and patient safety
Kaidee Hesford
CNS’s and select group of SMO’s representatives to review all staff
Nurse Manager driving this. So far this has been safety incidents and decide on an
Lakes District Health Board very positive for the department outcome eg: alert on iPM or a letter to
particularly given the trial has been the patient or their family / whanau
Emergency Department,
during the busy winter period. Over re poor behavior and expectations
Rotorua Hospital 40% of patients who have presented if they present again with support
to ED are seen in this model which services they can attend if needed
Contact: kaidee.hesford@lakesdhb.
govt.nz largely frees up the main ED for those eg: HAPE. This information is also
who need more intensive treatment fed back to staff eg: this month four
and beds. This has also shown the patients had letters sent regarding
need for additional CNS’s and we behavior in ED in a confidential
are now looking at developing and manner to ensure we close the loop
expanding this role. and keep the staff aware of outcomes
to incidents they are involved in.
Hamilton held the 2019 CENNZ
conference which was well received Waikato ED continues to see record
with approx. 100 attendees. The mix numbers with their busiest days
of various speakers kept the audience being Sunday, peaking on a Monday
captivated and the feedback from and then starting to level out on a
the conference has been all positive. Tuesday - Wednesday.
Waikato ED continue to await Tauranga ED are soon to trail
feedback from their service pressure Trendcare in ED with this going live
document submitted earlier this in November 2019. There was a lot
year requesting an increased nursing of interest nationally from ED’s and
and medical FTE to keep up with many attended the training held in
demand in ED and ensure safe staff Tauranga in August.
to patient ratios (although there is
With winter coming to an end and
no current way to calculate what this
the long summer days not too far
ratio should be at this point).
away we are all looking planning for
Their pressure points continue to the summer influx in the midland
be a full hospital with delays for region.
inpatient beds leading to patients
remaining in ED for long periods Kaidee
P 16EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019
Mid Central Region
Palmerston North Emergency • CENNZ conference – Nicola
Department Morgan received the Kirsty
Morton Triage award for 2019.
• High number of traumas that
2 nurses nominated for senior
staff are managing well. Trauma
nurse of the year. Conference
network being managed by Sonya
attended by 7 staff nurses.
Rider. Have developed new
trauma documentation sheets • Celebrated Te Wiki o te Reo Maori
as a result of auditing required with hints and encouragement
reporting information. Have also for staff to use Te Reo in the
cemented the roles of trauma workplace more confidently.
attendees with identifying roles
• Ongoing high presentation
on stickers.
numbers with elevated VRM
Katie Smith • Increased numbers of staff has levels.
Nurse Practitioner, ED seen the educators working their
• Staff have worked very hard
magic at super high speeds. Now
(Knowledge & Skills Framework over the winter months and we
have minimum of 2 triage nurses
& Website/Social Media) are all looking forward to some
22 hours per day.
sunshine soon!
NZDF • Using MCH pastoral care provider
Palmerston North Hospital as a pilot initiative in ED – she NZDF
Midcentral DHB comes daily to the department • Conducting ongoing clinical
and sees staff as individuals placements within EDs and
Contact: katie.smith@nzdf.mil.nz and groups depending on need. DHBs around New Zealand.
Has lead several debriefs after These continue to be well supported
traumatic events. Uptake by staff by DHB staff.
has been fabulous. A focus on
staff wellness has been forefront • RNs able to attend CENNZ
in the department. conference which was well
received.
• Associate team has new members
to ensure ACNM cover 24/7 Taranaki DHB
and protected time for quality
improvement work. NIL report available.
• 2 security guards in the dept – one
Whanganui DHB
available for MH client reviews.
NIL report available.
• CEO & Executive DON have
spent a day on the floor –
Katie
shadowing staff to get better
understanding of the daily
stressors and demands on staff.
Focused on safe patient care
and staffing.
P 17EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019
Wellington Region
Good morning from the Wellington quality advancement initiatives on
region. Thick frost on the ground hold. Staff sickness again is a huge
this morning with a promise of a issue with the need for multiple
beautiful day ahead and although days from staff following the general
the Wellington region is spread illnesses and injuries of this season.
across a huge area I think this is
essentially what my colleagues over The addition of a 1200–1800 hour
the Remutaka hill are experiencing shift in Wellington ED and the 1600–
also. The Tararuas are loaded with 0030 hour shift in Wairarapa ED
snow and the air is clean and fresh. has helped manage the afternoon
influx of patients. Hutt ED have
I wish I could capture something employed a new CNS and another
entirely different in this month’s CNS in training from November.
Kathryn Wadsworth report but the same theme continues. They also welcome a new position of
Clinical Nurse Manager All three Emergency Departments Security Coordinator based in their
have and are experiencing either ED with a focus on staff support and
Acute Services high numbers, high acuity or both. education and a driver for a safer
Wairarapa District Health Board Flow out of our departments is hospital.
particularly challenging with the
Contact: Kathryn.wadsworth@ shorter stays in ED measure as low The Wairarapa is working on triage
wairarapa.dhb.org.nz as it has been in five years of capture nurse initiated xray requests and are
for many of us now sitting in the about to undertake the education
80’s rather than the 90% region. required to achieve this. It is hoped
The issue of vulnerable patients that this will improve wait times and
particularly mental health associated interruptions to the Clinical decision
issues waiting for long hours before makers on the floor and potentially
a management plan and appropriate improve patient flow through the
transfer is established is an ongoing department.
problem. Wellington ED takes the
record on this` with a patient in the It has been another round of
department from Friday afternoon challenging months but all three
until Monday afternoon. It is very departments have coped admirably
frustrating having little control over with a constant focus on safety
this especially when we are all very and patient care. The busier we get
aware of the researched evidence of the more examples of the unique
patient harm when they stay in our skills we see amongst our teams.
departments for extended periods. The organised chaos, the constant
reprioritising of care and the overall
Mike in the Hutt referenced survival empathy shown by our team when
mode and this rings true with all pushed beyond limits still amazes
hands on deck on many occasions. me and makes me feel proud to be
The acute nursing skills are called on part of it.
regardless of existing positions held
and the impact of this is starting Kathryn
to be felt with staff fatigue and any
P 18EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019
Top of the South Region
Greetings from the Top of the South card and at times they can be seen
where we are welcoming the arrival immediately. This is a fantastic
of spring. initiative that really looks to
improve access and equity for unmet
Nelson Emergency Department community need.
It is business as usual in our The concept of frailty has been
emergency departments and we gaining global momentum. Many
are enjoying relatively stable and frailty studies have identified the
predictable presentation numbers need for collaborative and multi-
and demand. We will shortly be disciplinary approaches, including
looking to plan for our summer surge emergency departments, to recognise
as our populations swell over the frailty as a risk stratification tool
summer period and we host large
Jo King events such as ‘Bay Dreams’ and
and work to prioritise and optimise
care. We have begun to think
Nurse Practitioner Intern ‘Marlborough Food and Wine’. about our models of care for older
(CENNZ Chairperson) Considerable work has taken place patients with complex needs. This
across the organisation to improve work is in the very early stages. It
Emergency Department,
the emergency department care for is interesting to consider if we can
Nelson Hospital improve the journey and interface
people who present with mental
with the emergency department for
Contact: jo.king@nmhs.govt.nz health and addiction need. This
project has involved collaboration frail older persons. And if we do this
and input across many sectors. We can we improve health outcomes for
will shortly roll-out a Triage Initiated this population?
Mental Health Pathway that will I will shortly be finishing my four-
formalise the standards required year term as the ‘Top of The South’
for assessment, observation and representative on the CENNZ
documentation. It will also include national committee. It has been
systems to improve the ED/Police a great privilege to have had this
interface and the exchange of opportunity to contribute to
information and the understanding emergency nursing in Aotearoa /
of responsibilities between us. NZ. Louise Holland from Nelson
Our hospital dental department has ED has been the successful nominee
recently launched a new service. to take over this role. She will
This is a twice weekly ‘Relief of bring significant expertise to the
Dental Pain’ clinic. The emergency committee and I wish her well.
department can refer any patient
Jo
who has a community services
P 19EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019
Canterbury/Westland Region
The passion for emergency nursing If you want to see what the new build
and the amazing innovation and will be like, take a look at the following:
development of skills and knowledge https://vimeo.com/332904772
was highlighted at the CENNZ
The development of a ‘front of
conference in Hamilton, with good
house’ model, with care provided by
attendance from Canterbury and
CNS and NPs together with a senior
the West Coast, and the additional
doctor acts as a form of effective risk
support from CENNZ to provide
reduction and a means of improving
assistance to members from
patient flow and service delivery.
Christchurch was much appreciated.
These initiatives, together with the
The CDHB continuing programme
embedding of the overnight social
of Sankalpa mindful meditation,
work ‘on-site’ service and the ‘front
together with consideration of the
Dr Sandra Richardson broader issues of compassion in
door’ ED physio hours are creating a
sense of innovation and an exciting
Nurse Researcher healthcare, was presented at the
professional work environment.
conference by Christchurch ED
Emergency Department, nurse Sandy Richardson. An educational seminar was
Christchurch Hospital hosted by the Trauma Network in
Attendance at these events allows us
Christchurch, bringing Professor
Canterbury District to share our stories, and re-connect
Karim Brohi, the Clinical Director for
Health Board with colleagues as well as forge new
the London Major Trauma System to
alliances which will strengthen areas
talk about mass casualty events and
Contact: sandra.richardson@cdhb. into the future. Our region is pleased
responses. He was directly involved
govt.nz to be able to advise we will be hosting
in the management of a number of
the 2021 conference in Christchurch
significant mass casualty incidents.
– this will give us time to have settled
He was the surgical commander
into our new department, and to
at the Royal London Hospital for
have many new and exciting aspects
the London Bridge attacks, and
Christchurch ED of the Christchurch rebuild to share.
responsible for leading the medical
The ongoing issues with high acuity Currently, the Christchurch Hospital response to the Westminster
and patient numbers remain, and staff ED continues to plan for the move to Bridge and Grenfell incidents. The
continue to meet these challenges a new building, and while there is a session was well attended with a
across the region. The ability of staff delay in the staff and public open significant representation from the
to step up and manage in times of days, there was a brief opportunity Christchurch ED and prehospital
capacity loading, overcrowding and for ED staff to visit the new area community as well as others
challenging circumstances is one under controlled conditions. The interested in the topic. In addition
we should be proud of, and where need to look at changes to our models to Professor Brohi’s presentation,
we should recognise the resilience of care, to integrate effectively with a panel session was held with
and commitment of our colleagues adjacent services, and to consider representatives from Christchurch
to provide quality patient care. the best way of managing the move able to talk to the impact of our own
This means recognising the need continues to take up much of the mass casualty events, most notably
to support each other, and to offer planning and organisation time, and the earthquakes and mass shooting
encouragement and recognition of we will be looking to orientation
the good moments, as well as the programmes for staff in the near Sandy
difficult ones. future.
P 20EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019
Southern Region
being cared for in inappropriate bed Projects
spaces such as corridors and triage
Ongoing projects in Dunedin
which is not ideal but assists with
include the OPAL (Older Persons
the capacity to see waiting patients.
Assessment Liaison) – this is a four
There has also been a significant bedded unit in the older persons
increase in the patients who did not care ward that admits directly from
wait and left before treatment. ED. which does run well when it has
available capacity.
Acuity and complexity of the
patients has increased although The “Fit to Sit” (ambulatory care in
unable to measure it is reflective in ED) project has gained significant
the increased use of ICU and HDU traction and we are waiting for
demand. The variance response tool planning consent to expand this
Anne O’Gorman utilised also showing an increase area. Recruitment for staffing has
ACNM in the number of hours spent in already begun.
overload.
Southland District Health Board We have also introduced a new Oral
Dunedin has seen an increase in hydration pathway for paediatric
Dunedin Hospital Emergency influenza like illness with many patients.
Department confirmed cases of both A and B
Electronic handovers to all wards is
putting pressure on the department
in the process of being rolled out. We
Contact: anniegoygoy@gmal.com to accommodate patients whom need
had been trailing this initiative for
appropriate isolation. Fortunately
some time to one of the wards and it
we have need seen any measles cases
proved to be both safer and efficient
unlike Queentstown who have had
medium of handover.
confirmed cases.
Skill mix has been an issue at times Education
Dunedin with minimal skill evident on We had a successful trauma
Hopefully that is the winter done some shifts. This is mainly due to conference here in Dunedin in
and dusted. We are in great need recruitment of junior staff and the September with many RN’s in
of some reprieve from the high movement of some RN’s into some attendance from all over the South
volumes and acuity we have been senior roles within the department island. We are also sending RN’s
experiencing over the last 3 months. and hospital. However a robust to both TNCC and Triage later
It’s been exceptionally busy and all education plan has commenced for in the year. We have an in house
departments in the Southern region all skill levels and 3 RN’s where Mental Health study day planned
have experienced a record high successful on the last Triage course for October.
number of presentations of patients.
Nursing Staff are certainly feeling the Simulation teaching continues on
We continues to have high acuity and impact of this overload and demand. a monthly basis and we have been
an increasing number of days spent Care rationing is certainly evident able to facilitate insitu Sim training
in access block. With the hospital at and staff sickness has increased. within the busy department
capacity patients are spending up to Many nurses are working overtime
24 hours in ED waiting for inpatient and the loss of non clinical time has We have also introduced a weekly
beds. Inpatient teams continue to had an impact on the development skills session which has been in
utilise over 25% of the ED beds this of new projects and initiatives within place since July.
sometimes running for 24 hours at the departments.
Anne
a time. Patients are increasingly
P 21EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019 College Activities P 22
EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO DECEMBER 2019 Triage Courses 2020 Please see CENNZ Web page for details: https://www.nzno.org.nz/groups/colleges_sections/colleges/college_of_emergency_nurses/courses Region / City Dates Taranaki 22/23 February 2020 (Sat/Sun) Christchurch 13/14 March 2020 (Fri/Sat) Waikato 18/19 April 2020 (Sat/Sun) Tauranga 9/10 May 2020 (Sat/Sun) Rotorua 30/31 May 2020 (Sat/Sun) Wellington 19/20 June 2020 (Fri/Sat) Christchurch 25/26 September 2020 (Fri/Sat) Hutt Valley 16/17 October 2020 (Fri/Sat) Waikato 14/15 November 2020 (Sat/Sun) P 23
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