The just launched Asthma and Respiratory Foundation NZ child and adolescent asthma guidelines are designed to help nurses, doctors and other health professionals – delivering asthma care in the community to emergency departments – to provide simple, practical and evidence-based guidance for the diagnosis and treatment of asthma in children and adolescents up to 15 years of age.
The new guidelines – developed by a team of health professionals under the guidance of Professor Innes Asher – include a shift from the ‘medical’ focus of the previous guidelines* to taking a holistic look at the ‘big picture’ factors that influence asthma outcomes.
Debbie Rickard, a child health nurse practitioner at Capital & Coast DHB who helped develop the guidelines, said the new guidelines were not just medical and encompassed many other factors for health professionals “such as how to support families to manage their child’s condition, and looking at the big picture of factors that contribute to child asthma, such as housing, environment and barriers to accessing services”.
A quick reference guide to the new Guidelines was published last week in the latest New Zealand Medical Journal (NZMJ), which said that the new guidelines were informed by recent New Zealand reports describing the growing impact of asthma – especially on children – and the inequities suffered by Māori, Pacific peoples and low-income families.
Lorraine Hetaraka-Stevens, the National Hauora Coalition nurse leader who was also part of the guidelines team, said underpinning the new guidelines was eliminating inequities. She said they included a focus on workforce, systems and broader determinants that impact on asthma, such as income and housing. The guidelines, she believed, also enabled consistent standards of care, which could the work of a wide range of health professionals working in a variety of settings; for example, school-based nurses and rural health professionals.
Dr Stuart Jones, Medical Director of the Asthma and Respiratory Foundation NZ, agreed that addressing issues of social inequities is of paramount importance “if we are going to address the disparities in childhood respiratory illnesses and set all New Zealanders up with good lungs for life”.
“I think every child in New Zealand should have the right to be raised in a warm, dry, well-ventilated house, free of cigarette smoke and have good access to medical care,” said Jones.
David McNamara, respiratory paediatrician at Starship Children’s Health, said the guidelines were an important step in reducing disparities and improving outcomes for children with asthma and their whānau.
“The guidelines address the biggest challenges in asthma management: patient education, follow-up, motivation and improving adherence,” said McNamara. “By focusing on these we hope to lift the health and quality of life of children with asthma and reduce the burden of acute sickness and hospitalisation.”
Click here to download the full 33-page Asthma and Respiratory Foundation NZ child and adolescent asthma guidelines.
*The new guidelines are a complete update of the Paediatric Society of New Zealand’s Management of Asthma in Children aged 1–15 years, published back in 2005.
]]>At least 200,000 people or 15 per cent of the New Zealand population are thought to have the often undiagnosed condition, mainly caused by smoking, with symptoms including coughing, increasing phlegm and breathlessness.
The Asthma and Respiratory Foundation NZ is marking COPD Day by encouraging those who have been diagnosed to take part in pulmonary rehabilitation, a programme of exercise, education and support to learn to breathe – and function – at the highest level possible.
The seven reasons why pulmonary rehabilitation is good for COPD are:
1. It improves your exercise capacity! Get more done in your day.
2. It helps you learn about COPD and how to manage it! Don’t let breathlessness get in the way of having a good time.
3. Classes are fun! Get out of your house, meet new people and make new friends.
4. It’s good for everyone! People benefit regardless of how severe their breathlessness is. Even people on home oxygen can improve their exercise capacity and manage their breathing better.
5. Exercise is good for your sex life! Breathlessness doesn’t just happen when you’re hanging out the washing or going for a walk.
6. It helps you feel in control of your health and wellbeing. Take charge of your life.
7. It improves your quality of life! All of the above.
At higher risk of COPD are people over the age of 40, who have at any stage been a smoker or worked in a job exposing them to dust, gas or fumes. Visit your doctor if you fit in this category and experience coughing, increased phlegm or breathlessness.
Today (November 15) is World COPD Day.
Facts about COPD in New Zealand
Chronic obstructive pulmonary disease (COPD) in New Zealand:
Source: Asthma and Respiratory Foundation of New Zealand
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Shocked award winner Jess Tiplady flew back to Auckland this morning clutching an enormous bouquet of flowers, a beautiful trophy and an enormous certificate.
The 29-year-old, who became a primary health NP in April, was awarded NZNO Young Nurse of the Year 2017 at the organisation’s annual conference dinner at Te Papa last night.
The young NP is one of only four NPs under 35 and Tiplady (whose mother is Ngāi Te Rangi) is currently the youngest Māori nurse to have achieved NP status in New Zealand.
To become an NP by age 29, Tiplady has studied every year but one since first enrolling in nursing school. “It’s been a massive journey to get to here,” acknowledges Tiplady. She said she was shocked by her win, was very grateful, and felt the award was a reflection of how much others have helped her on her journey.
Kerri Nuku, NZNO’s kaiwhakahaere, said when presenting the award to Tiplady that she was a great example of a nurse making a positive contribution to health outcomes for New Zealand children living in poverty. “The impact on families living in overcrowded houses, with the associated infection, itch and discomfort of eczema, loss of sleep and potential for hospitalisation, is significant,” said Nuku.
Tiplady has worked for Manurewa’s Greenstone Family Clinic since graduating in 2001 with a conjoint degree in nursing and health sciences from the University of Auckland.
Primary health has been her passion from the start and she says becoming an NP followed on from that passion as it seemed to be a “really useful tool”.
Early on at her time at Greenstone, she looked at how she could make a difference and saw a niche in helping prevent eczema crises for children and their families. “We were seeing a lot of children with nasty skin infections, and not sleeping and some very distressed children and parents.”
Around five years ago she started providing a nurse-led clinic in eczema for children to provide a whole package of care to support parents and reduce the risk of eczema flare-ups and distress.
A year later she set up an asthma clinic for children with the aim of using the clinical guidelines for good asthma care in primary health to see whether a focused clinic could make a difference to hospital admissions for asthma.
Invitations to the asthma clinic was tied in with the annual reminder letter sent to all children on preventative inhalers that it was time for their free flu vaccine. “We altered our annual letter to say come in and have a 30-minute appointment with a nurse to have your annual asthma check-up,” said Tiplady. “It was kind of a ‘warrant of fitness’ going into winter.”
She said in 2015 its practice admission rates for children with asthma halved compared with previous years, but it was very difficult to prove whether that was due to the asthma clinic or other factors. “But I think what we have managed to do is establish a really good model of care where our children are getting what is considered to be the best practice package of care for their asthma.”
Tiplady said about 80-110 children under 16 are eligible for the asthma clinic each year. She said she and other nurses chased up children where there might be barriers to coming into the clinic or grabbed an opportunistic clinic appointment if the child came into the practice for another reason.
While the young NP really likes working with children and young people – and has a special interest in mental health – her scope is primary care and her day-to-day work involves seeing a cross-section of patients across the practice’s population.
She also offers fortnightly clinics in James Cook High School and Alfriston College, predominantly in sexual health.
Tiplady was a member of the first cohort of the pilot Nurse Practitioner Training Programme (NPTP) and was mentored by two GPs at the Greenstone clinic. She said a particular aspect of NPTP that was particularly helpful was having two protected clinic days a week to focus on transitioning from being a nurse to being an NP.
After so many years of study, she says the focus for the next year was consolidating her knowledge and establishing herself in her role as an NP. “And then looking at where else I can utilise those skills as an NP. The clinical role is most important to me but the NP hat also offers the opportunity to do research, teaching and mentoring so I will look at where I can contribute in those areas.”
The Young Nurse of the Award was set up to recognise and celebrate the work of nurses in the younger age group and to encourage younger nurses to demonstrate their commitment to the nursing profession. The winner is chosen for showing compassion or courage beyond what is expected in their role as a nurse and who has improved care or health outcomes for their patients through their commitment to care, leadership, research or quality.
Kerri Nuku said she also warmly congratulated runner-up Dana Smith from Dunedin Hospital general surgery. Smith was nominated by her colleagues for her work in the community with children with Crohn’s disease including volunteering at their annual camps,” said.
The judging panel consisted of a representative from Otago University Centre for Postgraduate Nursing Studies, previous years’ award winners, the Ministry of Health’s Chief Nursing Officer (or representative), and the NZNO president and kaiwhakahaere.
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Lead researcher Dr Caroline Shorter from the Department of Medicine at the University of Otago, Wellington (UOW) said it had been known for a long time that damp and mould made existing asthma worse but this was one of the first studies to show that mould may actually cause asthma to develop. The research also found the more mould, the more cases of asthma.
The study investigated the homes of 150 children who had visited their GPs for their first prescribed asthma medication, and compared them with the homes of 300 matched children who had never wheezed. The research, published in international journal Indoor Air, was funded by the Health Research Council of New Zealand and carried out by researchers from Otago’s He Kainga Oranga, Housing and Health Research Programme.
Shorter says the team found that mould and leaks were more likely to be found in the bedrooms and homes of children who had just started wheezing compared to the children who had never wheezed.
“The amount of mould present in the bedroom made a difference; the more mould, the greater the risk that children would start wheezing,” said the research fellow.
She said this was particularly concerning as surveys carried out by the Building Research Association of New Zealand and others indicated that around half of all New Zealanders have mould in their homes.
“We also have very high rates of asthma in New Zealand with 1 in 6 adults and 1 in 4 children reported to suffer from the condition,” said Shorter. “Worldwide prevalence of indoor mould is estimated at 10-30 per cent of homes, depending on climate and asthma rates are 1 in 20.”
“We urgently need to improve the quality of our children’s home environments”.
Dr Shorter’s research shows that it is important for dry homes to have ‘the basics’ sorted, for example:
She said moisture needed to be reduced in homes by using extractor fans, not drying clothes inside, and improving ventilation by opening windows often, even for just 10 minutes a day.
“Even with these measures mould can still grow, so we also need to frequently check for mould and remove it when we see it, particularly around windows, where condensation can increase mould growth,” she said
The next stage of the team’s research is to look in more detail at what types of mould might be important and what additional prevention measures could be used to keep mould at a minimum.
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His comments follow a Herald investigation that found that preventable, housing-related illnesses such as pneumonia and bronchiolitis killed more kids than car crashes or drownings.
On top of the deaths, 30,000 hospitalisations a year are associated with unhealthy homes.
The majority of those were from respiratory diseases including the third-world condition bronchiectasis, where babies’ lungs are scarred for life.
Coleman said the National government had set a target to reduce avoidable hospitalisations, which included earlier interventions and best treatment of respiratory illness.
He said: “No doubt that this is an unacceptable statistic and there is a lot more work to be done.”
Coleman said the government had already made child health a priority with free GP visits and prescriptions for under 13s, insulating 300,000 homes, setting the first rheumatic fever reduction target, and dramatically increasing immunisation rates.
The diseases included in the Herald’s investigation did not include vaccine-preventable conditions.
It detailed how the rheumatic fever target wasn’t met, including how a Healthy Housing Initiative was unable to rehome 75 per cent of families at risk of rheumatic fever due to a lack of housing supply.
Labour leader Jacinda Ardern called the situation “deeply saddening”.
“This is what this election should be about. This is what we should be debating – do we have a tolerance for kids dying because our houses are in such a bad state? Do we tolerate this?” said Ardern.
“The idea a kid dies because they’re cold is just appalling in a place like New Zealand.”
If elected the party would address unhealthy homes in its first 100 days, by introducing the party’s Healthy Housing Bill, mandating high insulation standards and requiring rentals to be warm, dry and healthy.
It would also fund universal $2,000 insulation grants, offer a $700 winter energy payment and build more state houses.
The Green Party’s social housing spokeswoman Marama Davidson said the deaths were an “absolute farce and an absolute scandal”.
Davidson said the Greens would bring in a comprehensive Warrant of Fitness for houses to make sure all properties, not just rentals, were warm, dry and safe.
“We want people to be able to heat their houses sufficiently. We know lots of people can’t afford adequate heating at the moment.”
She said the Greens would also boost a government insulation programme back to former levels.
A range of organisations condemned the high hospitalisation rates yesterday, including the Asthma and Respiratory Foundation and health bodies.
Plunket’s Chief Executive Amanda Malu said Plunket nurses regularly see babies living in “bone cold”, damp, overcrowded houses – some with no curtains or with holes in the floor.
“This is a systemic issue and policies are needed to increase access to quality houses for families.”
]]>The Foundation was responding to today’s New Zealand Herald report linking cold, damp and overcrowded homes with 30,000 children being hospitalised each year with housing-related diseases, including asthma, bronchiolitis and the third-world disease bronchiectasis that should be confined to people in their 80s.
Letitia O’Dwyer, Chief Executive of the Foundation, said currently reducing respiratory disease was not a Ministry of Health, district health board or “even a primary health organisation” target but the Foundation advocated that the next government should ensure a cross-portfolio target was set to help break down silos between health, housing, education and other related portfolios.
The cross-portfolio target it wanted acted on was: “Reduce emergency visits for acute respiratory illnesses by 20 per cent within the next five years”.
“It’s obvious that one organisation or agency cannot act alone to address poverty, unhealthy housing and inadequate basic health care,” said O’Dwyer. “There is a strong need for a government approach that ‘sees the bigger picture’ and works across all areas focusing on prevention.”
At present the Foundation was working with a healthcare provider in South Auckland to deliver respiratory health ‘action plans’ to schools in the area, with the aim of reducing the “disproportionate hospitalisation rates” of the people most at risk, said O’Dwyer.
The Foundation said its proposed national target should go across all of the following portfolios:
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The Sailor the Puffer Fish show has been taken to schools from Auckland to Wellington between May and July educating about 14,000 school children about asthma, tips on managing asthma and what to do in an emergency. The show was initiated by Asthma Waikato but has now been taken up by the Asthma and Respiratory Foundation. Schools that have hosted the show are being invited to become Asthma Friendly Schools. To qualify schools need an asthma policy and a first aid kit containing an up-to-date reliever inhaler. Schools interested in becoming a certified Asthma Friendly School can contact the Asthma and Respiratory Foundation NZ.
]]>The experienced aged care nurse is the general manager of the Selwyn Institute for Ageing and Spirituality, which initiated a pilot into using tablet-based telehealth technology to help older people living at home to manage their long-term conditions.
The case study Johnson-Bogaerts shared was of George, a man with heart failure (leading to multiple hospital admissions, COPD (chronic obstructive pulmonary disease) and hypertension.
As part of the pilot, George had access to a blood pressure monitor, pulse oximeter, thermometer and scales, which were connected by Bluetooth to a touchscreen tablet. He used the devices to take his ‘vitals’ daily, with the information digitally delivered to his telehealth nurse Sandi Milner.
During follow-up teleconferences on the tablet – to discuss missed out or out-of-range readings – Sandi found out that George had a problem with constipation, had little energy and had stopped gardening. She also found out that George – who had been advised to go on a low-salt diet – wasn’t sharing meals with his family and was trying to resolve his constipation by eating cornflakes.
Johnson-Bogaerts said the telehealth nurse guided George on how to check the salt content on the packaging of food, like his cornflakes, and shared advice on how to better manage his fluid and salt intakes. Sandi also suggested he try kiwifruit and he slowly started to introduce fruit and vegetables back into his diet and to eat with his family again.
Over six weeks he improved and over the four months he learnt to better control his symptoms. At the post-discharge check, George reported he was out in the garden planting vegetables, feeling better than he had felt in years and had had no hospital admissions.
Following the pilot, the telehealth-based chronic disease management programme is now being delivered by a joint venture between the Selwyn Foundation and Australian provider Feros Care, called Inviga. A second telehealth care pilot also got underway late last year, which involved retirement village residents having home-based video consultations with the on-site doctor.
]]>More information at https://cpd.whitireia.ac.nz.
]]>Amongst the work carried out by the public health nurses is monitoring patient adherence to medication treatments for notified diseases like tuberculosis. In some cases this monitoring involves ‘directly observed therapy’ (DOT) to ensure, for example, a full course of antibiotics is taken to prevent the risk of relapse or an increase in drug-resistant tuberculosis.
So rather than sending public health nurses by car to battle Auckland’s traffic – serving a region spread from Waiuku in the south to Wellsford in the north – the service looked to technology for an alternative way of delivering ‘face-to-face’ monitoring.
Westbrooke says the first platform for remote monitoring was video telephones, but technology was moving rapidly so after an early evaluation it quickly moved on to using a video app for electronic face-to-face DOTs or teleDOTs as they are now known.
At first the app was used purely on computers and laptops but then it downsized so mobile devices as smartphones and tablets could produce the good quality images needed to ensure a patient was taking their medication.
They addressed the digital divide – clients without their own computer and broadband connection or a mobile device with plenty of data – by supplying them with iPads and 3G cards.
Finding the right app was not as straightforward as downloading Skype or FaceTime to a device because of the need to ensure a secure private connection for clients and patient data was not stored off-shore. So they are using a New Zealand-hosted video conference provider rather than one using cloud storage.
Westbrooke says the DHB is now talking to the community long-term conditions directorate about using similar telehealth technology to support other services including hospice and community palliative care and linking its mental health sites.
She says video calls also have great potential for supporting people doing home dialysis as you can help someone having problems by saying ‘just look to your right and you will see the button you need to push’.”
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