Post-disaster: finding the time to care

April 2016 Vol 16 (2)

Research into insights gained by a ‘rapid scan’ survey of Nurse Maude’s district nurses 18 months after the February 2011 Canterbury earthquake was also shared at the People in Disasters Conference.

 

Sheree East 2010 CMYK Chris Hendry 2015 CMYK
Sheree East Chris Hendry

 

District nurses and care workers negotiating potholes and roadworks were a lifeline for many isolated and elderly people in post-quake Christchurch.

In 2013 Christchurch’s Nurse Maude district nursing service staff were still reporting the quakes’ ongoing health and social impacts on their clients and delivering services remained a continuing challenge.

Director of nursing Sheree East and Chris Hendry, New Zealand Institute of Community Health Care, wanted to understand how their clients were faring 18 months down the track from the most devastating of the quakes on 22 February 2011. The pair told the People in Disasters Conference, held in Christchurch in late February to mark the quake’s fifth anniversary, that they faced a dilemma of how best to do that quickly in post-quake Christchurch with vulnerable clients, staff stressed with their own quake issues, and limited time and resources.

Hendry says they opted to send a ‘rapid scan’, short, six-question survey relating to the clients they care for in the community to all community health nurses and support workers with their paysheets. Just over a third responded, with 172 surveys returned from 34 nurses and 138 support workers and healthcare assistants. The majority had worked for Nurse Maude for more than five years and 60 per cent of them provided services in the hardest hit areas.

Two-thirds of the staff believed their clients’ health and/or other needs had worsened since the quakes. Nurses reported that the issues that were of most concern to clients were the loss of family and friends, increased severity of chronic illnesses, and nutritional and dietary needs. When it came to psychosocial issues, the nurses talked of social isolation, loss of confidence and many clients having anxiety and depression issues.

Hendry told the conference that nurses were concerned that the clients left behind in the hardest hit areas, who had lost services and supermarkets, were the least mobile and elderly; they were becoming increasingly isolated and unable to get about as they couldn’t navigate the cracked footpaths and roadworks by foot or mobility scooter.

In the free comments section of the survey, nurses and care workers talked about needing more time to care for clients in these challenging environments. For a start, finding clients could be difficult, not only because of damaged and blocked roads, but also because some moved house without warning. Also the staff wanted and needed more time to reassure and support clients, including listening to their stories and helping calm them down, because clients were more cautious and slower to move in the post-quake environment.

The service responded to the survey findings by giving feedback to the staff, and providing nurses and staff with more tools, resources and information to help them refer clients or families to other appropriate support services. East says this was particularly important to the nurses as they felt they could do something practical to make a difference to their clients.

Nurse Maude also offered a series of resilience workshops for staff as it recognised that some of the client issues reported in the survey reflected the staff’s own issues.

East says the survey also helped bring home to management that staff needed to have their daily caseload reduced to allow them more time with clients.

East told the conference the service tried to do its best at the time but “while you think you are doing enough but you can never do enough”. She says in hindsight Nurse Maude would have established earlier ways of seeking regular feedback on concerns and actions taken; it would have provided early training for staff on how to manage depression and anxiety and it would have given staff more information earlier on how to access support agencies and better coordinate care for their clients. “We needed to share the
load more.” ✚

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