Nursing and Midwifery at Taranaki District Health Board

I N T R O D U C T I O NWelcome to Nursing and Midwifery in the Taranaki region.We have taken this opportunity to showcase the many accomplishments of our nursing and midwifery staffacross the region.Significant work has been undertaken in the last few years to have a more regional approach to education,professional development, and work practices. This can be seen throughout the report, with a new role inthe aged care sector and more collaborative education. We hope over the next few years that this approachcontinues to go from strength to strength.Nursing and midwifery make up a significant proportion of the workforce. There are approximately 1,250registered and enrolled nurses, and midwives in the region.Our nurses and midwives are employed in many settings and roles including:General practicePrivate hospitalRural settingsLead maternity carersMedicalEmergencyNeonatalOncologyMental healthWell child providersOccupation healthMaori nursing servicesSurgicalPaediatricAssessment and rehabilitationMaternityDistrict and community services32007-2008 Nursing Midwifery Review

I N I T I A T I V E S A N DI N N O V A T I O N ST a r a n a k i D i s t r i c t H e a l t h B o a r d N u r s i n gR e - c o n n e c t P r o g r a m m eOur Nursing Re-connect programme provides a supportive environment to facilitate nurses who have beenout of nursing for more than five years to return to work in a healthcare setting.The programme is a 5-12 week course, depending on how long an applicant has been away from practice,and covers both theoretical and clinical days.This year we have run two courses and a total of eleven Registered Nurses, two Enrolled Nurses and oneObstetric Nurse have re-activated their practicing certificates. All have gone on to gain employment in bothhospital and community settings.Recently the course has been extended to include overseas nurses wishing to obtain their New ZealandregistrationN u r s e E n t r y t o P r a c t i c e P r o g r a m m e ( N E T P )The Taranaki District Health Board (TDHB) Nursing Entry to Practice (NETP) Programme employs RegisteredNurses with less than six months experience, who have recently graduated from a Nursing Council of NewZealand approved nursing programme, for a period of one year for 0.8-1.0 full time equivalent.This supported transition to the workforce provides a resource of competent Registered Nurses with a broadrange of basic skills.In 2007, eleven new graduates were supported to work in areas such as the Medical, Surgical, Mental Health,AT & R, Paediatrics, and Orthopaedics Wards; Neonatal Unit; and Hawera inpatients. Ten new graduateswent on to obtain permanent employment either within the TDHB or in Taranaki.As part of the programme, the new graduates also completed a 30 point post graduate paper with theUniversity of Auckland. New graduates from Southern Cross and Primary Health Organisations (PHOs) havejoined with our graduates to complete the paper.The 2008 programme has 14 graduates within TDHB and a further five new graduates from mental healthand maternity have been included this year due to the programme extending into these areas (a total of 19new graduates for 2008). In 2009 the plan is to extend the programme further, into Primary Health andAged Care.102007-2008 Nursing Midwifery Review

R e t u r n T o M i d w i f e r y P r o g r a m m eIn May 2008 the TDHB submitted its Return to Midwifery programme for approval to the Midwifery Councilof New Zealand. This programme is targeted at midwives who have been out of the midwifery workforce forthree years or more. The programme allows participants to re-enter practice with up-to-date knowledge andskills and the confidence necessary to meet the competencies for the midwifery scope of practice.Recruitment and retention of midwives is a current local, national and international issue and this is one ofthe recent strategies devised to assist with the immediate and future midwifery resource needs of the TaranakiDistrict Health Board (TDHB) and Taranaki region.“The midwives in the maternity ward were so patientand understanding. I was really nervous with our firstbaby and they did everything you could think of to supportand assist me – especially with breast feeding.I can’t thank them enough for being so good to us. ”2007-2008 Nursing Midwifery Review

B a b y F r i e n d l y H o s p i t a lI n i t i a t i v e ( B F H I )A Baby Friendly Hospital (BFH) is a health care facility wherethe practitioners who provide care for women and babiesadopt practices that aim to protect, promote and supportexclusive breastfeeding from birth. At the same time, BabyFriendly facilities ensure that women who choose not tobreastfeed are supported in their decision and provided withinformation and advice.The two goals of BFHI:1. To transform facilities providing maternity services and carefor newborn infants through implementation of the Ten Stepsto Successful Breastfeeding (The Ten Steps)2. To end the practice of distribution of free and low-costsupplies of breast milk substitutes to hospitals and health carefacilities.All our maternity, neonatal staff, theatre recovery staff andpaediatric staff receive initial and on going breastfeedingeducation, training and support to enable TDHB to beawarded Baby Friendly status. Base Hospital has just beenawarded another three years accreditation following theMay audit and Hawera Hospital and Elizabeth R Home andHospital (Stratford), have just been awarded Baby Friendlystatus for the first time.

MIDWIFERY COURSE LINKS IN WITH AUTTaranaki DHB, in conjunction withAuckland University of Technology (AUT),has began a Bachelor of Health Science,Midwifery, course based in Taranaki.This is an initiative to address the nationalshortage of trained midwives for theTaranaki region.Two Registered Nurses, Caroline Radichand Deb Parry, commenced second yearstudies in January, utilising a video link withAUT. They will complete the programme atthe end of 2009.Caroline says she was motivated to trainas a midwife after attending a birth as partof her nursing training. She has found thetransition in roles significant with a newfocus on looking after well women andbabies rather than unwell people. Her firstdelivery experience this year was especiallysignificant as she helped deliver her sister’sbaby. Caroline is grateful for the level ofsupport she has received from the midwiferysector.Deb Parry (centre) and Caroline Radich (right) with new mum AnnRodgers and baby Corbin.Deb has always wanted to do midwifery and this was the first time it waspossible to complete her training in Taranaki. She has found the contentof the course well organised and the support of a local tutor invaluable.A g e d & R e s i d e n t i a l C a r e S e c t o rA Nurse Consultant Aged and Residential Care position began in October 2007 and was developed to provide supportfor ongoing education, professional development in the aged and residential care sector in Taranaki. The two year pilot isfunded by the TDHB Workforce Development Fund.Key areas of work during the first year of this project have included developing an education plan tailored for nursesworking in the aged care sector. It was identified that nurses working in this sector were finding it difficult to accessappropriate education or training opportunities - as a result a flyer has been developed which contains information on avariety of education opportunities for these nurses to attend. These education opportunities are available for registeredand enrolled nurses, and care giving staff and include topics such as dysphagia, respiratory, urology, wound caremanagement and assessment of congestive heart failure. In 2007, 220 nurses from aged care attended TDHB education/training days, compared to 325 nurses in the first seven months of 2008.2007-2008 Nursing Midwifery Review13

Another key area of work has been rolling out the TDHB Professional DevelopmentRecognition Programme (PDRP) to aged care facilities. This has involved developingan information resource folder for registered and enrolled nurses to assist them withcompleting their competent level portfolio. To date four organisations have signedmemorandums of understanding with TDHB to join the programme.142007-2008 Nursing Midwifery Review

N e w G r a d u a t e R e g i s t e r e d N u r s e s i n A g e d C a r eTraditionally the aged care sector has had difficulties recruiting registered nurses and is currently experiencinga significant shortage, with a number of organisations looking to overseas nurses to fill vacancies.To support the sector with this workforce issue, funding was sought earlier this year from TDHB Planning andFunding to fund two new graduate registered nurses in the aged care sector for 2009. Aged care facilitieswith hospital level of care facilities were invited to submit a proposal outlining their ability to support oneof these positions. Selection of the facilities has just been undertaken, with Chalmers Rest Home in NewPlymouth and Trinity Home and Hospital in Hawera chosen to support this initiative next year.The registered nurses who are employed to these positions will spend six months in the aged care facilityand the other six months in AT & R (Base Hospital) or Hawera Inpatients, and will also be part of the TDHBNursing Entry to Practice Programme (NETP).T D H B P r o f e s s i o n a l D e v e l o p m e n t a n d R e c o g n i t i o nP r o g r a m m e / Q u a l i t y L e a d e r s h i p p r o g r a m m e ( P D R P /Q L P )The TDHB Professional Development and Recognition Programme/Quality Leadership programme (PDRP/QLP)acknowledges a range of skills and sets out a career pathway for nurses and midwives. This is a voluntaryprogramme which provides additional financial incentives for nurses and midwives who achieve the higherlevels in the programme. This programme has been developed in conjunction with Wanganui and WairarapaDHBs and is managed in each DHB by the PDRP/QLP Co-ordinator.152007-2008 Nursing Midwifery Review

TDHB PDRP/QLP received a five year programme approval from Nursing Council New Zealand in February2007. The uptake from nurses and midwives within the provider arm continues to grow and as at 1 July2008 approximately 23% of staff have joined the programme.The PDRP component of the programme became available to nurses working in the community from July2007. Various community groups funded through TDHB have shown an interest in joining the programme.Currently ten groups have signed onto the programme this year through a memorandum of understandingbetween the organisation and TDHB. These groups represent PHO’s, aged care sector and mental healthNGO sector.162007-2008 Nursing Midwifery Review

T D H B C l i n i c a l S k i l l s a n d R e s e a r c h C e n t r eThe TDHB Clinical Skills and Research Centre, also known as the Skills Lab, continues to provide clinical skillstraining for the WITT Nursing students and TDHB staff.The beginning of the year saw the opening of our newest edition, a 50 seat lecture theatre and expansionof the skills room. The extra room has been a welcome edition as we are now able to accommodate largergroups very comfortably, such as the Nursing/Midwifery Refresher days.Most recently WITT students have been allocated what was previously Lecture room 1 as their Lounge. Thisarea has three computers, a small library and numerous health promotion resources.Utilisation continues to grow, with WITT and TDHB Nursing staff accounting for the majority of usage.However groups such as Medical staff, Midwives, PHO’s, Ambulance and most recently a DHB funded PainManagement Programme are also utilising the Skills Lab facilities.“The nursing staff are justwonderful. Nothing is toomuch trouble for them. ” 18Skills Lab Usage 2007160140120Hours1008060WITTTDHB40200Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov DecMonths2007-2008 Nursing Midwifery Review

W o u n d M a n a g e m e n t H i g h l i g h t sThe setting up of a nurse led leg ulcer clinic in the Outpatients Department at Taranaki Base Hospital in 2006has proved very successful. A small group of key clinician nurses provide comprehensive assessment andmanagement of patients with lower limb ulcers. Outcomes to date have demonstrated some patients havehealed their ulcers completely and are now managed on maintenance therapy of compression hosiery. Thisresults in a positive impact on both clients and our health care system by reducing admissions. This is alsoheartening in light of the wound chronicity some of these patients have endured.A specialty practice post graduate Wound Care paper is being delivered locally at the TDHB campus in2008 in conjunction with the University of Auckland. This paper has proved a popular choice for nursesworking in a wide range of roles throughout Taranaki in both the primary and secondary sector, with fifteenRegistered Nurses enrolled from a variety of clinical settings undertaking the paper. Presentation speakersfrom Australia, Auckland and Taranaki have broadened the horizons of the participants in regard to studyingthe wound bed at cellular level with such exciting topics as Wound Matrix, Inflammation and ReperfusionInjury, Wound Microbiology, and Determinants of Health. This paper is proving to be a valuable complementto Taranaki’s already versatile suite of post graduate academic papers.“Thank you for the photo and the delightful articlein the local newsletter. I am pleased all enjoyedthe presentation... I certainly had a great time inTaranaki! Happy to reappear any time in 2009 or 2010as numbers and University decide. Thank you for allyour support and for showing me the best end ofTaranaki”19Professor Donald MacLellan (Glasgow/Sydney) presenting an inspirational tutorial and workshop on CellularMatrix, Inflammation and Reperfusion to Registered Nurses in the Education Centre on 22 July 2008. TheProfessor is Director of Surgical Services in New South Wales, and has a keen and active interest in WoundManagement.2007-2008 Nursing Midwifery Review

P r e A d m i s s i o n N u r s e s ’ C l i n i cThe pre admission nurse led service was introduced early in 2007 within the specialties of gynaecology, ENTand dental. The pre admission nurse is responsible for providing expert clinical care and advice within thehospital pre admission process.These advanced practice nurses complete health history and physical examinations for patients undergoingelective surgery. Using nurses instead of House Surgeons in this role has had many benefits including HouseSurgeons having more time for clinical teaching and ward work. Nurses provide a holistic case managementrole and it has provided an advanced practice opportunity for senior nursing staff.In late 2008 this was successfully rolled out to general surgical patients. The clinic has provided much neededflexibility to the pre admission process and has received strong support from consultants and the public.E x e r c i s e T o l e r a n c e T e s t ( E T T ) C l i n i cThe nurse led ETT clinic is an ongoing initiative that was introduced in response to long wait times and erraticETT clinics caused by medical registrar workloads. An advanced practice nurse has been credentialed andpractices in place of a medical registrar conducting the treadmill test.The clinics have had a positive effect on wait times and the reliability of the clinics - they have enabled a chestpain protocol to be implemented in ED with the knowledge that urgent ETTs will be performed within a sevenday timeframe.“In spite of thembeing so busy, theyalways had time forme, and I never feltlike just anothercase file. They werereally skilled andprofessional all thetime. ”

N u r s e P r a c t i t i o n e r - H e a r t F a i l u r eThe Nurse Practitioner Heart Failure Pilot commenced in July 2007 with assistance from TDHB Planning andFunding. The goal was to improve the care of patients with cardiac failure both in primary and secondarycare; this followed a successful Heart Failure clinic running in Hawera for several years.This position has proven to be valuable both in contributing to keeping cardiology wait times manageable,and in the interaction with primary care. Recently the pilot concluded and the decision to make the positionpermanent has been made. This is TDHB’s first prescribing nurse practitioner and much has been learnt overthe past year in the implementation of such a role.I n t r a v e n o u s P u m p s - O u t w i t h t h e O l d , I n w i t h t h eN e wAndrew Fletcher, THDB Emergency Department and Kathryn Johnston, Cardinal Health.The long awaited upgrade for the intravenous pump has arrived. This is a result of close collaborationbetween staff, both clinical and non clinical, in the hospital. It has been a team effort to establish the drugand dosing information which has formed the basis of the Guardrail software. The Alaris GP pump withGuardrail software makes IV drug administration safer and more uniform. The user enters the drug data intothe pump and this allows the pump to determine the safe dose and rate of infusion. This is another way inwhich the organisation is striving to improve and maintain the safe delivery of medication in the hospitals.The Alaris GP pump is a lightweight single channel pump ideal for mobile and static usage and the batterylife is vastly improved when away from mains power. A new change for clinical staff will be entering detailsof the infusion into the pump. If the details do not correspond with accepted practise then the pump will notdeliver the infusion - this is the key for the safe delivery of medication.The ‘go live’ date was 28 July 2008 and Hawera will hand in the last IMED pumps in early August. We havethe chance to upgrade the drug data on a regular basis and this is critical as new treatments come on to themarket. These pumps also have storage capacity for the data entered and the drugs infused for later review.2007-2008 Nursing Midwifery Review21

M a t e r n a l M e n t a l H e a l t h N u r s e - R a c h e l G o o d i nThe Maternal Mental Health Service (MMHS) provides a specialist service to the Taranaki region; the service isfor women who develop serious mental health difficulties during their pregnancy and for one year after theirbaby is born.The team consists of the Psychiatrist, Dr Nosheen Sheikh; Psychologist, Debra Oliver; Social Worker, SallyPhillips; and Registered Midwife and Nurse, Rachel Goodin.The Maternal Mental Health Nurse role involves being a key worker for clients and advocating for them. TheMMHS provides consultation/liaison and may co-keywork if needed for pre-existing mental health clientsand/or clients with high needs.Rachel works in a community based specialised service visiting most women in their own homes throughoutthe Taranaki region. Written referrals are accepted via the Intake Coordinator from: Midwives, GPs, Wellchild providers (Plunket and Piki Te Ora), and Maternity services.This can be a challenging role but one aspect Rachel really enjoys is when the women feel they have reachedtheir goals and are managing their daily lives with the skills which they have acquired.K e e p i n g C o r e N u r s i n g P o l i c i e s , P r o c e d u r e s , a n dG u i d e l i n e s C u r r e n tThe core nursing policies, procedures, and guidelines are utilised across various clinical areas within TDHB.There are approximately 160 documents within core nursing that are reviewed two yearly and the content ofeach is researched using evidence based criteria. These documents are available from the TDHB intranet forstaff to access.Training in evidence based practice is provided by TDHB, and the procedure for writing evidence basedpolicies, procedures and guidelines outlines clear criteria for staff to follow.The process for ensuring core nursing policies, procedures, and guidelines are current is managed throughthe Nursing Directorate team by a nurse educator. This review process includes sending out the relevantdocuments to key people for review. The feedback provided is collated by the nurse educator and the editeddocumentation is presented to the Policy and Procedure Committee for approval. Once this approval hasbeen obtained then the updated document is implemented and all nursing and midwifery staff are informedvia email of new information and/or significant changes made.“I’ve been in and out of many hospitals over the years,and I have to say your staff here are just wonderful.They were friendly and pleasant and went out of theirway to inform me on all the things involved in mytreatment after my accident up here. Leaves our localhospital for dead.”222007-2008 Nursing Midwifery Review

I n t e n s i v e C a r e N u r s e S u p p o r t S e r v i c e ( I C U N S )Following the Capital and Coast Health and Disability Commission report the ICUNS service wasimplemented. The purpose is to provide support and education to bedside nurses and medical staff in theearly identification of ‘at-risk-patients’.The at-risk-patient is one who shows signs of a physiological deterioration and who would benefit from urgentclinical intervention. These patients may be experiencing medical emergencies such as respiratory distress,sepsis, cardiac arrhythmias, hypovolemia, or haemorrhage.Within the current FTE and workload ICU nursing staff respond, facilitating care/treatment as appropriate forthe at-risk-patient.This has allowed the formalisation of a service already being provided, enabling ward staff and medicalteams further access to support, clinical assessment, and education. This service highlights the importance ofward coordination involving: shift coordinator, request of medical/surgical staff review and notification of theDuty Manager prior to contacting ICUNS.ICUNS provides education on specific nursing cares including, but not limited to: BiPAP, Telemetry, UnderwaterSealed Drain, Central Venous Line, and Tracheostomy cares.This service will be integral with the anticipated implementation of an Early Warning Score System/Acute LifethreateningEvents Recognition and Treatment programme.“The nurses in Ward 1 were so lovely tous. They really explained things well tous (the family) and kept us informed onDad’s progress, and he had the best ofcare. Keep up your good work.”23P u b l i c H e a l t h N u r s i n g P r o j e c t - H a n d W a s h i n gI n i t i a t i v e f o r P r e - S c h o o l a n d P r i m a r y S c h o o lC h i l d r e nThe aim of this project was to raise awareness and improve the hand washing skills amongst pre-school andprimary school children. The key objective was to develop a hand washing resource kit for pre-school andprimary school children throughout Taranaki. The project had taken a strong intersectoral approach involvingstaff from TDHB Health Protection Unit, Health Promotion Unit and Public Health Nurses. The implementationof the hand-washing programme used a ‘Train the Trainer” approach, with Public Health Nurses presentingthe training kit to teachers, and these teachers using the kits with their students.Increased awareness and knowledge of the importance of hand washing is an important factor in the controlof disease. One of the key drivers for this project was the need to raise awareness of the importance of handwashing as a mechanism to control spread of disease, especially pandemic influenza.2007-2008 Nursing Midwifery Review

The evaluation results midway through the implementation of the programme are very positive and indicatethe resource has been well received by the teachers and children. Of particular note is that all respondentsfound the lesson plans contained in the workbook easy to follow. This finding demonstrates the valuable inputa teacher had in the development of this resource. Another key success factor has been the inclusion of theglow-gel activity which provides a fun activity to communicate the hand washing message to children.Suggestions for improvements mainly focus on how to improve the glow-gel activity and the need for moreage appropriate books for pre-school children. These suggestions are currently being addressed by theHealth Protection Unit and Public Health Nurses.E v i d e n c e B a s e d N u r s i n g G r o u pThe Evidence Based Nursing/Midwifery Group is a new initiative with the objective of encouraging andimplementing evidence based nursing.The group meets monthly and is comprised of nurses who have completed or are in the process of completingan Evidence Based Practice paper. The group’s focus is to enhance nursing practice and patient outcomes byincorporating Evidence Based Nursing into clinical decisionsB u i l d i n g O n S u c c e s s P r o j e c tA Nursing Services project was undertaken in 2007 that undertook a stock take of current nursing servicesacross the region so that this information could be used for future service planning.The nursing workforce is employed across the region in a variety of diverse settings for a range of providers.Workforce planning for the nursing sector is particularly complex and has developed in response to demandsfrom both the patient population and needs of the health care sector often in a reactive rather than plannedmanner. Additionally the nursing role has expanded in recent years to allow scope for advanced levels ofnursing practice without the necessary organisational readiness required to best utilise these advanced roles.The recommendations from this project supported a more planned approach to the utilisation of the nursingworkforce to ensure workforce configuration, scopes of practice, numbers, skills and competence are linkedwith the health sector and the needs of the population serviced by TDHB.Initiatives that have been implemented as a result of these recommendations include the expansion ofthe NETP programme into the community, work with TDHB planning and funding service around nursingcontracts and specialised nursing roles and the expansion Contact of Details education for Te opportunities Whare Whakaahuru for nurse working in thecommunity.Associate Clinical Nurse Manager: 06 754 4635Acute Services Manager (TDHB): 06 753 6139 ext. 7630phillip.galley@tdhb.org.nzTe Whare Puawai Manager: 06 759 4300admin@wharepuawai.org.nz242007-2008 Nursing Midwifery Review

S t i l l b i r t h a n d N e w b o r n D e a t hS u p p o r t G r o u p ( S A N D S )Pictured from left, Clinical Midwife Manager Dianne Herbert, SandsChairwoman Angela Kehely and Midwife Angie Walton, Sands Secretary.The Stillbirth and Newborn DeathSupport Group (Sands) NewPlymouth has supplied the DHB withspecial items for parents who havelost a baby.Among the items presented to theMaternity Department were books,painted boxes – decorated withteddy bears, albums, cameras,candles – support packs and Mosesbaskets.Sands New Plymouth is a voluntarynot-for-profit organisation made upof bereaved parents and midwives.The group supports people dealingwith the death of a baby inpregnancy, at or soon after birth ordue to medical termination or otherforms of reproductive loss. Sandsalso offers support to people whosebabies died many years ago.Sands Chairwoman Angela Kehelysays they have monthly meetings,which help bereaved families knowthey are not alone. “We meet andshare our own experiences andsupport each other through thisdifficult time.”Sands, which is in the process ofbecoming a registered charity, relieson fundraising and donations. Theorganisation thanks the followinggroups for making it possible tobuy the new items: New ZealandCommunity Trust, Scottswood Trust,TSB Trust, Resene Paint, Folk-ArtPaint Group and Busing Russell andCo Ltd.For more information about Sandscontact Angela Kehely on 06) 7534466 or Fleur Aslop on 06) 7538002.M e n t a l H e a l t h C o n s u l t L i a i s o n N u r s eThe Mental Health Consult Liaison Nurse role developed from a six month fulltime pilot position which began in March2006. During this time a business case was formulated and presented in October 2006 and funding was approved fora 0.5FTE. The nurse is also a Duly Authorised Officer under the provisions of the Mental Health Act.Contact Details for Te Whare WhakaahuruThis role provides expert mental health assessment Associate for clients Clinical presenting Nurse acutely Manager: to the 06 Emergency 754 4635 Department (BaseHospital) with mental health issues. Once the assessment is completed, a decision is made for further treatment. ThisAcute Services Manager (TDHB): 06 753 6139 ext. 7630can range from referral back to GPs, counselling within the community,phillip.galley@tdhb.org.nzurgent review by a Psychiatrist or admission toTe Puna Waiora either as a voluntary or compulsory client.Te Whare Puawai Manager: 06 759 4300admin@wharepuawai.org.nzThe other part of this role is to provide assessment and support to clients and nursing staff in the general wards.Education around the management of clients is provided along with general mental health information. Risk assessmentis provided for all self harm clients who have been admitted medically.Feedback from hospital staff has been very positive. It allows prompt assessment and support as required. Informaladvice also occurs regularly as nurses feel comfortable approaching another nurse for support.2007-2008 Nursing Midwifery Review25

Working as a Nurse inthe Child and AdolescentMental Health ServiceJulia McLeanChild and adolescent mental health nursingcan be challenging - but rewarding.Julia McLean, a Child and AdolescentMental Health Nurse at Taranaki DHB,works with young people with mentalillnesses including, but not limited to,depression, anxiety and eating disorders.Julia enjoys working with teenagers. “Theyare in a stage of development when theyare in search of their identity, which canbe a challenge in itself, but you can usuallyfind something they are passionate about,”she says.Julia is part of the Child and AdolescentMental Health Team (CAMHS), whichincludes psychiatrists, psychologists,nurses, social workers and mental healththerapists. She works closely with otherdepartments such as Ward 2 (children’sward) to provide support to staff workingwith young people experiencing mentalillness.Referrals to CAMHS come from GPs,schools, counsellors, public health nursesand other primary care agencies.Julia carries a case load of clientswho benefit from not only her support,knowledge and skills but also the expertiseof the multi-disciplinary team. She may see part about being a mental health nurse.some young people for only a few visits, You have to be open and honest, butwhile others with more complex illnesses at the same time be very aware of yourwill be seen for a much longer period of professional boundaries, you are not thetime.young person’s friend.”A big part of Julia’s job is working with The relationship boundaries betweenclients’ families. “When teenagers have child and adolescent mental health nursesthe support of their families treatment and their clients is an area of particularoutcomes may be more beneficial,” she interest to Julia. Last year, she completedsays. Part of her role includes meeting with a Masters Degree in Nursing fromschools and other agencies in order to Victoria University. Her studies focusedmeet the needs of the young people and on adolescent mental health nursing andtheir families.her thesis was on nurses’ experiences ofprofessional boundaries with their clients.Julia co-facilitates a weekly dayprogramme for clients who are not well In order to work in a specialised area suchenough to attendContactschoolDetailsfull-time.forTheTe WhareasWhakaahuruCAMHS, mental health nurses shouldprogramme is Associate attended by Clinical up to eight Nurse Manager: be prepared 06 754 4635 to undertake post graduateyoungsters, who are supported by two staff study specific to the area.Acute Services Manager (TDHB): 06 753 6139 ext. 7630members. The programme phillip.galley@tdhb.org.nzis a structuredday which includes therapeutic groups Julia has worked in child and adolescentand outings outsideTeofWharethe hospital.PuawaiItManager:runs06mental759health4300settings for the last 10 years.admin@wharepuawai.org.nzunder the philosophy of a therapeutic She shares her skills and experience withmilieu. “The programme works because new graduate mental health nurses andit helps the young people to see that other student nurses. This year CAMHS haspeople share similar experiences,” Julia obtained a new graduate nursing positionsays. “They learn a lot from each other.” and Julia is the preceptor for MichelleHenderson who is currently in this position.In mental health nursing building trustingrelationships with clients is vital, she says.“That’s what I see as the most important

P R O F E S S I O N A LD E V E L O P M E N TThere are many opportunities for professional development for our nursing and midwifery staff - this gives anoverview of what we’ve been doing.P o s t G r a d u a t e S t u d i e s b e i n g u n d e r t a k e n b yT a r a n a k i R e g i s t e r e d N u r s e sOver 90 Registered Nurses (including 27 from the primary sector) are studying at post graduate level inTaranaki in 2008. A wide variety of post graduate papers are being studied, including five well supportedHealth Science Nursing papers which are being locally delivered at the Taranaki District Health Board (TDHB)campus. This joint initiative, between with The University of Auckland and TDHB, is proving to be verysuccessful as nurses advance their academic knowledge and scholarship and then bring this new knowledgeback to integrate into their clinical nursing practice.The number of Nurses undertaking post graduate study has increased markedly over the last five years, whichhas been supported by the Ministry of Health’s Clinical Training Agency funding assistance and also the TDHBDirector of Nursing.This exciting initiative is set to continue in the coming years.Comparison of 2007 Post Graduate Nursing Paper ResultsNo. students enrolled inTaranakiNo. of pass completionsNumber of withdrawals prior tocompletionNo. of people2520151050704 Applied Science (S1 & 2)705 Advanced Assesment & Clinical Reasoning (S1 & 2)718 Advanced Nursing Practice (S2)720 Evidence Based Nursing (S1)Paper title282007-2008 Nursing Midwifery Review

C l i n i c a l T r a i n i n g A g e n c y ( C T A ) P o s t G r a d u a t eF u n d i n gCTA funding provides assistance for fees, travel, accommodation, and backfill for registered nurses studyingtowards Nursing Council of New Zealand approved post graduate qualifications. The current CTA postgraduate funding structure began in 2007 and was well supported by both TDHB and primary healthcareemployees in its first year. The number of applications received for 2008 study was three times those receivedin 2007, with significant growth in support from both the primary and secondary sectors.Funding requested in 2008 well exceeded the allocated budget from CTA, however upon receiving additionalfunding from CTA all eligible applicants (90+) were able to receive funding. There is a good mix of firsttime post graduate students and those continuing their studies in 2008 and the increase in 2008 numbershas enabled TDHB to run several more University of Auckland papers locally, with study days being heldonsite at Base hospital. These local papers include a well supported Long Term Care complete post graduatequalification in 2008, comprising of two papers around long term management and chronic care in primaryhealth.CTA funding for 2008 has been distributed as follows:Distribution of 2008 CTA fundingAged Care, 2%Primary, 22%Secondary, 76%Papers undertaken this year include:••••••••••••Applied science for registered nursesAdvanced assessment and clinical reasoningPharmacologyEvidence based nursingLeadership PracticumScholarship of PracticeLong Term Management in Primary CareEthics, Culture and Societal ApproachSexual HealthLegal Issues in Mental HealthClinical Practice DevelopmentSpecialty papers in Wound Care; Cardiac Nursing;Emergency, ICU Care; Renal, Nursing Assessment& Management Across the Lifespan••••••••••••Interventions for Chronic Care in Primary HealthClinical Assessment and Diagnostic Decision MakingNursing ResearchNursing KnowledgeAdvanced Nursing Practice - Long Term Conditions ManagementComplex Assessment and Diagnostic Reasoning in Palliative CareResearch Paper in NursingUndertaking Qualitative Health ResearchHealth EconomicsQuality in HealthcarePsychosocial Issues in Palliative CareNursing Praxis in the Community Setting292007-2008 Nursing Midwifery Review

O r t h o p a e d i c S c h o l a r s h i p sOver the past four years the Ministry of Health has provided funding for orthopaedic nursing scholarshipsand TDHB has been successful in obtaining this funding that has allowed approximately 40 nurses to developskills and expertise in the area of orthopaedic nursing.This funding has been used in a variety of ways including:••••Two nurses being given the opportunity to attend a one week orthopaedic training course in Melbournein 2006Four nurses attending the Australian and New Zealand Orthopaedic Nurses Association (ANZONA)conference in Rotorua in 2007Six nurses funded to complete a Post Graduate CertificateOne nurse funded to complete a Post Graduate DiplomaThe funding also provided an opportunity for staff from Ward 4 to provide a series of orthopaedic studysessions, both in Hawera and New Plymouth. These sessions ranged from 2 hour to full day sessions andwere designed to allow rostered nursing staff to attend. The sessions targeted nursing staff working withorthopaedic patients throughout the hospital including outpatients department, ICU/HDU, the surgicalinpatient wards and our rehab ward.These education sessions provided up to date orthopaedic knowledge for nursing staff, and covered a rangeof topics including basic orthopaedic anatomy and physiology, joint replacements and patient education.The feedback received indicated staff generally found the sessions very informative.“I can’t praise the nurses inWard 4 enough. They werejust wonderful.”302007-2008 Nursing Midwifery Review

D i s t r i b u t i o n o f P r o f e s s i o n a l D e v e l o p m e n t F u n d i n g2 0 0 7/ 2 0 0 8In the financial year ended 30 June 2008 the Nursing Midwifery Professional Development Fund provided$73,190 of funding which was distributed as follows:162007-2008 Nursing Midwifery Review

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P o s t G r a d u a t e Q u a l i f i c a t i o n s C o m p l e t e d i n 2 0 0 7We are aware of the following Taranaki nurses who have completed a post graduate qualification in 2007and we congratulate them on their results:332007-2008 Nursing Midwifery Review

Jane Bococki n v i e t n a mSUPPORTING CHANGE IN NEONATAL PRACTICE IN VIETNAMLeft: Jane and Nurse Loan at Bong Son Hospital.Right: Paediatric Team at City Hospital, Quy Nhon.My first visit to Vietnam was in 2001,when I accompanied Dr Alan Parsons fora paediatric visit to hospitals in Binh DinhProvince. Our visit supported the NewZealand Vietnam Health Trust’s objectivesof providing much needed equipmentand training to hospitals and medicalpersonnel. This first visit provided me withmany challenges.It was my first visit to Asia. I found ithard work just existing – the language,the noise, the food, the heat – let alonetrying to work. At this time, I found thatnursing was medically directed and taskorientated. Nurses’ knowledge and skill inneonatal nursing appeared to be minimal.They did not understand individualised,holistic care. They did not know abouttemperature regulation in babies orhow to do tube feeds, or understand theconcept of continuous positive airwaypressure (CPAP) in supporting a babywith respiratory distress – the very basicsof good neonatal care. They were doingtheir very best in difficult circumstances– lack of equipment, overcrowding andpoor environment.Six years later and my fifth visit - what achange! A paediatric/neonatal team hasbeen making regular visits to this sameprovince and the same three hospitalsand what progress has been made.Each of the three hospitals now haverelatively new neonatal units. Each unithas an identified doctor in charge whois working alongside the nursing team.There is now evidence of strong nursingleadership that is driving the nurses’enthusiasm for learning and to do better.Just looking at the babies in their cots andincubators indicates that they are beingwell looked after. Babies are tube fedearly, rather than have intravenous fluidsgiven through a standard giving set at3-5 drops per minute! Syringe pumps arebecoming more evident for those babieswho do need intravenous fluids. CPAP isregularly used in each unit and is savingbabies’ lives. They do have, and use,pulse oximeters. I have made friends ineach of the hospitals. I get asked specificquestions now – how do you look after ababy on the ventilator? How do you nursea baby on CPAP prone? How do yousafely insert a nasogastric tube? What isdevelopmentally supportive care?They tell me they have team meetings,have inservice sessions, discuss complexcases with their medical colleagues. Thereis still much more to do.This year Alan and I were invited by theDirector of the Maternal and Child HealthProject of the Binh Dinh Department ofHealth, to visit six of the District HealthCentres – much smaller hospitals in ruralareas of the province. We had beenasked to teach the obstetric and paediatricstaff the basics in the care of the newborn.We found the midwives to be expertsat neonatal resuscitation and this is dueto the concentrated training done byTricia Thompson, former New Plymouthmidwife, during her four years as a VSAvolunteer. The focus of my talks were themanagement of the premature and sickneonate before and during transfer to thebigger hospital.We are already planning next year’svisit. We have requested that we give atwo day workshop for doctors and nursesand then visit the different centres to giveadditional, and individualised training asrequired. I also have a goal to write, andhave translated, a basic training manualfor my neonatal colleagues. We visitedthe National Paediatric Hospital in Hanoiand met the Director of the NeonatalUnit. What an amazing lady and what aninspiration. On the day we visited therewere about 90 babies in the NeonatalUnit, two or three to an incubator, andabout 10 nurses to look after them. Yetthe babies looked well cared for andwere surviving, although infection is a realproblem.Each year that I visit Vietnam I enjoythe countryside and the friendliness ofthe people. I feel it is a privilege to bewelcomed and to work in their hospitals. Icome home enthused and satisfied by eventhe smallest change. Change takes timeanywhere and in someone else’s countryand differing culture, change is slow andhas to be managed carefully. We aremaking a difference in Binh Dinh Province.Jane Bocock,Clinical Nurse Manager

P U B L I C A T I O N S &P R E S E N T A T I O N SS o m e o f t h e m a n y p r e s e n t a t i o n s a n d p u b l i c a t i o n sb y o u r n u r s e s a n d m i d w i v e s . . .John Billings (Associate CNM, Theatre) presented “Urachal Adenocarcinoma A Case Study” at the UrologyNurses Conference 2007 in NelsonHelen Bingham (Nurse Educator - Acute Mental Health Services) presented “Te Puna Waiora Nurses Use ofOutcomes Tool, HONOS, in Daily Nursing Practice” at the Australasian Mental Health Outcomes Conference”in October 2007. Helen also presented “Nurses Taking Management of Adverse Events in the IntensivePsychiatric Care Environment” at the Mental Health Nurses Conference in 2006.Marilyn Chittenden and Chris Bowden (Public Health Nurses) presented “Physical and Psycho-SocialAssessment of Sixteen Year Olds in Taranaki” on 26 September 2007, at the Collaborative for Researchand Training in Youth Development 6th Annual Australia and New Zealand Adolescent Conference inChristchurch. The abstract from their presentation below:“Some of the nurses wear trainers and I can see why. They were so verybusy, but always found time to smile and have a little chat when I wasreally worried about what was going to happen.”35“An exciting initiative which fills an obvious gap” words used by the Principal of a Taranaki secondaryschool in 2006 when accepting the offer for public health nurses to provide physical and psycho-socialassessments for sixteen year old adolescents. The Principal also commented on the potential of this initiativeto further develop positive relations between the school and the Taranaki District Health Board. This youthfocused initiative employed an internationally recognised HEEADSSS assessment tool and was offered to allsixteen year olds in the school, a total of 100 students received the assessment. Opportunity for adolescentsto express their needs confidentially to interested health personnel offered adolescents improved access toprimary healthcare. The major findings of 57% of students identified an unmet health need for which they hadnot sought help, and 21% of students who signalled they were either sad, depressed, suffered from insomnia,stress or had experienced suicidal thoughts. Students were assisted by nurses to identify health deficits, andhealth care needs, to prioritise those concerns and to select an appropriate health care provider. Adolescentswere supported in linking to health providers and followed up within a three month period to assess ifneeds were being met. The response rate, and satisfaction level was very high in feedback from students.Recommendations following this improvement to youth services project for District Health Boards includeda need for implementation of physical and psycho-social screening for all adolescents at some point duringmiddle adolescence (15-17 years), as well as routine use of the HEEADSSS tool by nurses for other adolescentswith identified risk factors, in secondary and alternative education settings.Karen Georgeson (Registered Nurse, Ward 2) presented “Isolating Children with Bronchiolitis in an AcuteChildren’s Ward - Does testing for Respiratory Syncytial Virus need to be routine practice?” In February 2008.The report looked at whether testing for RSV needed to be routine practice within an acute paediatric ward.The practice within Ward 2 has always been to test children with bronchiolitis symptoms for RSV and toisolate depending on whether they are RSV positive or negative.2007-2008 Nursing Midwifery Review

The report highlighted that this was not necessarily the best practice for isolation purposes as we heavily reliedon the accuracy of the NPA for yielding correct positive or negative results. Karen presented her findings tothe Paediatric team at their Thursday Grand Round meeting and practice has now been changed in that weno longer routinely test for RSV.Children with signs and symptoms of bronchiolitis are now isolated and treated with the assumption that theyare RSV positive. Obviously this change in practice has had lots of benefits for the ward in that we are savingmoney by not testing, saving nursing and laboratory time during a busy season and best of all no horribleprocedure for the child!!Marjory Ross (Registered Nurse, Neonatal Unit), Helen Lander (Registered Nurse, Neonatal Unit) and JaneBocock (Clinical Nurse Manager, Neonatal Unit), prepared a poster presentation “The Strip” in September2006 which demonstrated the change management process undertaken in the Neonatal Unit to facilitatethe implementation of pH indicator strips - a more reliable predictor of gastric pH and a tool to assist in thecorrect placement of gastric feeding tubes.Linette Davidson (District Nurse/District Nursing Coordinator) presented “Maintaining Professional BoundariesIn A Rural Setting” at the 14th Annual District Nurses Conference at Palmerston North 20-21 of June 2008 atPalmerston North.Nurses working in small rural communities face the often daily challenges of having to maintainprofessional boundaries with people with whom they must also maintain a variety of other relationships.Their patients may be relatives, friends and social associates, or people with whom they share otherprofessional relationships (tradespeople or other professional relationships). There is much discussion aboutmaintaining patient privacy, but little information about how nurses can deal with this rather sensitive aspectof their practice. What can nurses do to protect their practice, and their own personal space?Her presentation discussed a rural nurse perspective and coping strategies to deal with this aspect ofpractice, with reference to relevant literature whilst maintaining professionalism and remaining true to ourscope of practice.Brigitte Lindsay’s (Cardiac Nurse Practitioner) poster regarding the success of the Rural Nurse Led HearthFailure Clinic’s evaluated outcomes was accepted at the Asia Pacific Heart Failure Congress, in Melbourne, 31January-3 February 2008.Kerry-Ann Adlam (Director of Nursing) published an editorial in Nursing Praxis (Adlam, K.K. (2007).Editorial. Nursing Praxis in New Zealand. 23,(1). 2-3)Kerry-Ann also published a co-written article in the Journal of Nursing Management (Adlam, K.K., Dotchin,M., and Hayward, S. (2008). Nursing First Year of Practice, past present and future. Journal of NursingManagement).Chris Gruys (Wound Clinical Nurse Specialist) presented a poster in 2006 at Te Papa called Silver isas Topical as it is Topical evidencing the efficacy of topical silver hydrofibre in partial thickness burnmanagement.This was followed by Building Bridges - Spanning the Boundaries - a 2007 presentation at CaseManagement Conference in New Plymouth explaining the inception to implementation of the Wound362007-2008 Nursing Midwifery Review

Support Team within Taranaki District Health Board - a highly specialised team advising on complex wounds.Chris’ third presentation was ABC with Aquacel Ag at Queenstown in November 2007 showcasing TaranakiDistrict Health Board’s embracement of a silver hydrofibre treatment for certain burns and how advancednursing practice can influence colleagues to gain therapeutic outcomes.C a s e M a n a g e r s C o n f e r e n c e 2 0 0 7“Spanning the Boundaries” - CaseManagement and Care Co-ordination”The Case Managers’ Conference was held on 15-16 March 2007 at the Devon Hotel, New Plymouth, withapproximately 80 attendees. Committee members were Lyn Muller, Valerie Steel, Kathy Curd, Trevor Lockley,and Anna McDermott.The key theme of the conference was new initiatives and strategies for case management and care coordinationtowards enhanced patient health and well being. An exciting prospect is the move towardbridging the gaps between providers, both in primary and secondary care together with health and socialservices.TDHB Nurses made the following presentations:• Kathy Curd (Health Co-ordinator PATHS) - “Fact, Phenomena or Reality”• Chris Gruys (CNS Wound/CTA Post Graduate Co-ordinator) - “Building Bridges - Spanning theBoundaries”• Anne Ridgway (Manager Community Mental Health) - “The Past, Present and Future of Mental HealthCase Management”• Phillip Galley (Unit Manager, Acute Services Mental Health) - “Oranga Ngatai: A Case ManagementApproach to ‘Making Connections’ Across the Continuum of the Mental and Physical Health Service”From Left: Ministry of Health Chief Nursing Advisor Mark Jones, Medical Case Manager Jenny Quinn, Medical Case Manager ValerieSteele, Orthopedic and Gynaecology Case Manager Lyn Muller, Surgical Case Manager Trevor Lockley, Ministry of Health Team Leader,Richard McLachlan, Case Manager Health Co-ordinator Kathy Curd.

n e p a lBANDAID BOX MEDICAL CLINICJenny CoulsonKharikhol aWhen you accept an invitation to be part of asmall medical group travelling to a remote area inNepal your life begins to change. There’s a sense ofexcitement, mixed with a little anxiety and when youhave hauled yourself up Mt Egmont’s translator trackfor the sixth time, a wish you were 20 years youngerand somewhat fitter.The Band-Aid Box trust, founded by Robin Drakeof Inglewood, has undertaken to provide ongoingaid in the form of healthcare delivery for a periodof 15 years to the small village of Kharikhola andthe surrounding villages in the Khumbu area of eastNepal. The majority of villagers are subsistencefarmers, others work as porters during the shorttrekking season and a few own tea/guest houses withsmall shops attached. Kharikhola is not on the touristtrail so little extra income is generated during thetrekking season.The 2007 Nepali team, employed by the Band AidBox trust, consisted of two doctors, two nurses, adentist, two ophthalmologists and their own theatresister and an optician, all from Katmandu. The NewZealand team of voluntary workers was made up ofa gynaecologist, dental assistant, three registerednurses and a jack of all trades, Robin. We wereaccompanied to Kharikhola by a trekking group of14 led by John Jordan of Inglewood. They continuedonwards and upwards to the Goyko lakes, 5,500metres above sea level in the Sagaramatha (Everest)National Park.As we began to set the clinic up, patients arrived.Clinic dates had been broadcast over radio(transistors) or word of mouth. Over the next 14days 2,500 villagers presented with a multitudeof health issues including ENT, eye and dentalproblems, COAD, tuberculosis, gastritis, skin diseases,abscesses, fractures, burns, lacerations, urinaryretention, gynaecological disorders as well as seekingcontraceptive advice.Congenital conditions assessed in infants includedhair lip/cleft palate, spinal meningocele and one caseof blindness. A young girl with horrendous woundssecondary to a snake bite had been transported bystretcher for two days to reach the clinic. Without theTrust’s intervention in financing a rescue helicopterto transport her to KTM she may not have survived.It also provided continuing financial support formedications, food and clothing for the girl and hermother during the six week recovery period in KTM.It was back to basic nursing for me and I was ableto draw on my experience of 30 plus years oforthopaedic, surgical and district nursing. We hadelectricity this year and running water sometimes.The hospital village committee members assistedwith translation when triaging patients, but it wasnot uncommon for ten people in succession to havethe same complaint because they had listened to theprevious person. For some it was simply a chance tohave a check over by a doctor for the first time in theirlives. There was heaps of laughter and some very veryemotional times as well.All in all, the people of the Kharikhola region presentas a happy, hardworking and predominantly healthygroup. They are hugely grateful for the continuedefforts to keep Kharikhola healthy. Their simple wayof life grows on you and it’s amazing what you learnto live without, eg daily showers and clean clothes.However a daily dose of local Kukari rum made thatbit easier to bear.I have already booked to return with the team in 2009.Jenny Coulson,Stoma nurse

“For some it was simply a chance tohave a check over by a doctorfor the first time in their lives.”2007-2008 Nursing Midwifery Review39