Mana Clinic: the way it could and should be?
For more than 13 years, Wesley Primary School’s Mana Clinic has been quietly modeling what many nurses would love to follow.
They whisk an undiagnosed asthmatic from the playground to the local GP in time to stop hospitalisation, conduct a health check on a child with learning problems, and fit in an opportunistic blood pressure check on a worried mum.
It is not unique work for a community nurse, maybe, but few are at a primary school day in day out and only a knock on the door away…
Back in 2000, following a community research project, and with the school’s enthusiasm and the support of Auckland District Health Board (ADHB), a public health nurse was appointed at the multi-cultural, decile 1 school. The purpose was to run a free health clinic for the school and its nearby Wesley Intermediate school pupils (about 300 pupils in all).
Although not a typical role for a public health nurse, it remains a unique community nursing position in ADHB. Much of the bread and butter work remains skin health. However, a daily presence also opens up the opportunity to do much more. This can range from acute care for playground accidents to providing health advice and support to otherwise hard-to-reach families.
When experienced PHN Sarah Williams stepped into the role more than a year ago, she became quickly convinced of the benefits of being a familiar face in the school playground and staff room. Having a permanent physical clinic at the school so children, teachers, parents, and grandparents know where to come for help facilitates better and timelier access to health services.
“I see this as potentially the way forward”, says Williams of the Mana Clinic model.
She says student nurses who visit tell her they love their Mana Clinic placement and the chance to be involved with family-centered care, as parents and children of the predominantly Pacifica school pop into the clinic.
Considered one of the staff and being able to mix closely with the teachers also assists in building relationships and working together supporting the health curriculum and health promotion activities. Teachers not only refer children to Williams with skin sores and other health complaints but also to check for health issues that could be affecting learning and behaviour in class. This is work Williams has a particular passion for as her recent master’s thesis on the role of the nurse in the B4 School check looks closely at the relationship between health and learning.
Embedded in the school community, Williams works hard to establish good relationships with local doctors and nurses to ensure children with acute skin and other conditions get access to antibiotics and appointments when needed, particularly when money and unpaid bills may be an issue. Another strength as a DHB employee is her established links with DHB referral services and professional support networks.
Williams is able under standing orders to prescribe amoxycillin for children with Group A positive throat swabs, as Wesley has been part of the Rheumatic Fever Prevention Programme for the past two years. Standing orders to be able to treat common skin conditions are due to follow shortly, which will be warmly welcomed by Williams.
An early evaluation study early on of the Mana clinic, led by Dr Jill Clendon and published in 2004, found the nurse-led clinic had led to a decreasing number of children requiring treatment by ENT specialists and general medical care.
“The provision of holistic, culturally-appropriate primary health care in an environment acceptable to children and their families that targets specific health needs is enhancing health outcomes for children in the area,” concludes Clendon.
Williams agrees. “I believe that this is a model worthy of further review. Although it is not always easy to quantify health outcomes, I do think having a nurse based in a primary school setting offers an accessible, efficient, and cost effective way of delivering health services to low decile, high-need communities.”