youth health – Nursing Review

Free nurse and GP visits for under-18s offered by Hawke’s Bay’s largest practice

Mon, 06 Nov 2017 00:18:17 +0000

Hawke’s Bay’s largest provider of primary health services is introducing free family doctor and nurse visits for under 18-year-olds enrolled with its health team.

Chief executive Andrew Lesperance said this would give more than 1700 teenagers living in Hastings and Havelock North free access to see their doctor, nurse practitioner or nurse.

“Offering free doctor visits for young teenagers is an important step towards youth establishing good long-term healthcare relationships which will help ensure they look after themselves now and in the future,” he said.

“As the region’s largest primary health provider, we recognise the leadership role we play in delivering services which help towards improving the lives and well-being for all those living in our local communities.”

The free visits for under 18s is in partnership with the Hawke’s Bay District Health Board, which became the first DHB in the country to provide extra funding beyond the Government’s policy which was extending to under 14s.

“Along with improving access to health services, we are also focused on establishing very good, relatable relationships between young teenagers and their healthcare team of doctors, nurses, nurse practitioners, pharmacists and others,” Mr Lesperance said.

“We want to do as much as possible to help encourage youth to be able to talk openly with their doctor and nurses about their health and we welcome the ability to enable this to happen by removing financial barriers.”

Keeping up with the digital age, all patients over the age of 16 could sign up to use The Hastings Health Centre’s web portal “Manage My Health” which improves communication and access to patient information, along with being able to book appointments online.

“Staying connected with youth through the digital world they live in today is another great way to engage with them to ensure they look after their health and stay well,” Mr Lesperance said.

“Making sure primary and community health services are far more accessible is a real focus for us here at The Hastings Health Centre, and technology is going to play an ever-increasing role in this going forward.”

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Nurse-led school clinics: life and death on the front lines of teen health

Mon, 23 Oct 2017 20:30:34 +0000

Her face was getting bigger and her airway getting smaller when Manaia King went to Catriona Lawler, the nurse and manager of her new school’s health clinic.

She’d just started at Otahuhu College after moving to Auckland from Rotorua and now she discovered, in the worst way possible, that she was “allergic to nature”.

It’s the kind of situation that after the fact can spark a giggle – discovering stuff that is all around us, that sustains us, can kill. At the time, it couldn’t have been more serious.

King didn’t know it, but her life was in danger. But she didn’t have to wait for an ambulance, or make a fast trip to hospital in a teacher’s car. Help was right there. Literally, right there.

Because Otahuhu College is one of 174 New Zealand high schools, teen parent units and alternative education facilities that offer free on-site health services.

Tucked deep inside the grounds, behind the South Auckland school’s imposing brick frontage and towering palms, sit a couple of humble yellow prefabs. Inside, students can see a doctor, nurse, social worker or physio for free – and they did 6028 times last year.

The students come for a variety of reasons, but there’s no doubt the Health and Wellness Centre, staffed by part and fulltime staff, has saved lives.

Now in her final year at the school, 17-year-old King still remembers the fear and relief she felt the day her life was saved.

“Catriona came in with some injections. I got the adrenaline, then I got a blanket, [and] they had given me an asthma pump because I couldn’t breathe on my own. And then I went in the ambulance.

“It was very scary, but I was glad that I knew someone was at our school who knew what to do because I didn’t know what was wrong with me, besides that I was allergic to something.”

She isn’t sure what she’d have done if not for the centre – maybe run home for help, which sounds like an entirely bad idea for someone experiencing a life-threatening allergic reaction.

Instead, by the time the centre’s part-time GP Fionna Bell arrived, Lawler had saved King’s life.

“The anaphylaxis was full blown. She was struggling to breathe. But Catriona did an amazing job,” Bell says.

When someone can’t breathe properly, and they’re given medicine to make it better, it is obvious their life has been saved. That’s the pointy end of frontline teen healthcare.
But there’s so much more.

School-based health services aren’t a new thing. Otahuhu College has been running them for more than 17 years, in one form or another.

But what’s available varies by school.

Ministry of Health funding is channelled through district health boards, and in some areas – such as the Auckland District Health Board, in which Otahuhu College falls – that has extended since 2014 to paying for a part-time doctor.

In others, funding pays only for a nurse.

Other services, such as social workers and the provision of psychologists, depends on a school’s location and funding streams available to it.

At Otahuhu College, Lawler until last month managed a team made up of Bell, two full-time social workers, a part-time physiotherapist, two part-time nurses and two receptionists, also trained in first aid.

A new nurse manager, Juliet David, replaced Lawler this month after she took on a new role in school-based health services for the Waitemata District Health Board.

So advanced is Otahuhu – they’ve had a GP since 2000 after forging a relationship with Otara medical centre South Seas – that Ministry of Health staff informally consider the centre to be the gold standard for school-based health services, an official told the Herald on Sunday.

Lawler is humbled, but unsurprised by the accolade. “We had always had a doctor through South Seas and they saw how well it worked and thought, ‘Okay, we’ll do this in other schools’.”

Information provided to the Herald on Sunday by the ministry describes school-based health services as focusing on early intervention for teens, and allowing easy access to youth-friendly services students can trust are private and confidential, within the standard confidentiality limits related to harm.

The programme is targeted by decile, with funding for decile one to decile three secondary schools, teen parent units and alternative education facilities.

Most students’ first interaction with the service is a private and confidential psychosocial assessment done when they start secondary school.

The assessment is known by its acronym, HEEADSSS, derived from the series of questions asked of each student relating to home, education/employment, eating, activities, drugs, sexuality, suicide and depression, and safety.

From there health problems can be identified and treatment organised.

Schools are able to decline school-based health services, but based on ministry figures – estimated according to the Ministry of Education’s latest school roll numbers – most don’t.

In July, it was estimated almost 60,000 students were being reached by the services, out of the just over 64,000 who are eligible. More than half attend decile one or two schools.

About 25,000 students from decile three and above schools are also recipients, with some schools that have moved out of the lowest three deciles continuing to be funded.

Health responses to support students in mid-to-high decile schools are determined locally by district health boards, primary health care organisations and school boards of trustees, according to the ministry.

But is that enough?

The Labour Party announced in May its health policy would extend school-based health services to all public high schools, at an annual cost of $40 million.

The party’s then deputy leader, Jacinda Ardern, now Prime Minister-elect, said at the time all young Kiwis should “get the help and support for all their health needs, particularly mental health”.

New Zealand has the worst teen (15-19) suicide rate in the developed world, a shameful statistic highlighted by the Herald‘s Break the Silence suicide awareness campaign in July.

Depression and suicide risk were up to two-thirds lower in schools with comprehensive health services, Ardern said at the time.

“Early intervention works.”

Under Labour’s policy the average high school would have a full-time nurse and the support of a GP, she said.

For its part, National’s $100m social investment fund for mental health, announced in August, included a schools package that included initiatives such as a pilot scheme to provide frontline mental health staff in schools and teaching specific social and emotional skills, including those related to self-control and resilience.

So what does teen healthcare look like on the front line?

Embarrassing bodies, suicidal thoughts, period problems, skin conditions, breathing issues, sexual health, palpitations – often anxiety related – and sleep problems, often linked to an undiagnosed mood disorder, but sometimes due to gadgets over-riding shut-eye, are all things she sees, Bell says.

“I just see general practice stuff in this age group,” she says of the 10 hours a week she spends at the school.

That goes for the challenges of providing healthcare to those living in poverty – which she describes as every one of Otahuhu College’s 1005 pupils.

“It’s the whole school. That’s why we’re decile one. I also work at a decile three school and it’s incredible the parental resourcing … the fact that young people have money in their pockets and are like, ‘Yeah, I’ll go pick up a prescription’.

“Even the health literacy of the young people is different. Whereas here there’s no breakfast, there’s no lunch … and teens will protect the younger kids, they’ll let the money go for the little kids’ [food and healthcare].

“So even though they’ll have a health need they’ll be going: ‘Is it important enough for me to ask for $3 for the prescription’?”

And these are kids from working families. Their parents have jobs, but high rents are swallowing up much of the household income, Bell says.

Meetings between centre staff and school leaders help identify students showing signs of distress, such as acting out in class or wagging.

Intervention – usually through a HEEADSSS assessment – can be revealing.

“[With one boy we found out] there are 10 people living in a motel room, and there’s not enough food and he’s got a runny ear but no one can afford to take him to the doctor and he’s not getting enough sleep.

“So of course he’s not doing well in class.”

A number of school families were in emergency housing, but made sure their children got to school every day, she says.

“What people are doing to try to get their kids to a stable education – it’s really impressive.

“But the rental affordability [is an issue] … this service is our way of getting young people to be as healthy and well as possible and to get hold of this education, because then after that they can determine their economic security.”

A big part of her job is also to enable the centre’s nurses to do as much as possible without a doctor being around.

So, for example, if a throat swab shows a student has strep throat, the nurse can get them on antibiotics straight away.

Last year 209 sore throats were swabbed and 42 confirmed to be infected with Group A Strep, a bacteria that can lead to rheumatic fever, a serious illness that can scar heart valves and lead to early death in adulthood.

According to Ministry of Health figures, 137 people nationally were diagnosed with rheumatic fever in 2016, down from 177 in 2012.

None diagnosed last year were from Otahuhu College.

If Bell and the rest of the centre’s team are the circulatory system that helps deliver care to students, Lawler’s role is being the beating heart that keeps everything pumping in the right direction.

She has heard students say they know they need to see a doctor, but there’s no one to take them. Or revealing in the HEEADSSS assessment that they have been sexually abused.

“They tell you. [They say] that no one’s every asked them before.”

Speaking to the Herald on Sunday before moving to her new job, Lawler says she is disturbed when there are hints of any service reduction, such as the possibility social workers may be moved off-site. The service works best when everyone is in the same place, she says.

She knows what they have at Otahuhu is pretty special. “We carry everything here that you get at a GP practice, which is different from the non-health-funded schools. The schools that aren’t funded through that health contract, the nurses just do first aid.”

Mostly she is just pleased they’re able to do something for young people that will continue helping them a lot longer than the few years they’re at high school.

“What we’re trying to do is teach these guys when they need to see a doctor, a physio, a nurse, a counsellor. That’s a lifelong skill.”

And it goes beyond the individual futures of those who come through the health centre’s doors. There is also a focus on encouraging those who want their lives to also be about helping others.

Students aren’t just learning valuable life skills about managing their own health in the little yellow prefabs. They’re also seeing that not only can you receive healthcare, you can also give it.

“We’re really big on trying to get people into health sciences and in year 9 and 10 they’re doing extra science classes, at this school, because we want to get people into it,” Lawler says.

“They can see what it’s like.”

Lawler has been trying to persuade King to become a doctor. Next year, the teen will study human anatomy and social science at Waikato University.

“How many other people have been to university, in your family?” Lawler asks King, for the Herald on Sunday‘s benefit.

“None,” King says.

It could all have been so different.

Good health keeps kids in school and gives them the oomph to work hard and turn their dreams into reality.

Because, on their own, dreams aren’t always enough.

They can’t make sure there’s someone at your school who can save your life in an emergency, and they can’t help you manage a health condition and all the other challenges in your life.

But an entirely sensible service, such as a health centre at a place frequented by vulnerable young people, that can make a difference.

The proof is sitting in front of Lawler, smiling shyly.

“It might have been in another school she’d have got sick, she’d have missed lots of school,” the veteran nurse says of the young woman she first helped all those years ago.

“She wouldn’t have done so well, you know?”

WHERE TO GET HELP:

If you are worried about your or someone else’s mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call 111.

If you need to talk to someone, the following free helplines operate 24/7:

DEPRESSION HELPLINE: 0800 111 757
LIFELINE: 0800 543 354
NEED TO TALK? Call or text 1737
SAMARITANS: 0800 726 666
YOUTHLINE: 0800 376 633 or text 234

There are lots of places to get support. For others, click here.

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NZNO backs reprimanded midwife’s concerns about “national shame” of families living in squalor

Wed, 27 Sep 2017 00:20:21 +0000

Children and youth living in squalor is a national shame, says the NZNO, and nurses share the concerns expressed by a reprimanded South Auckland midwife.

Former Counties Manukau midwife Danielle Hart-Murray’s Facebook post – describing the poor health of many children and the terrible living conditions of some of her clients, including some pregnant due to incest – went viral earlier this month (see post detail below). Her former employer, Counties Manukau DHB, last week asked Hart-Murray to remove the post out of concern that it breached patient privacy. A DHB spokesperson told the New Zealand Herald that staff members had recognised the cases referred to in the post and acted quickly to have the post removed.

Associate Professional Services Manager Hilary Graham-Smith said NZNO was very concerned about the issues expressed by the midwife, who had “bravely shared” her distress about housing, poverty and the resulting infant and child illness. She said the impact of poor housing and poverty and limited access to good health care was a national shame.

“The new government must get people out of living in cars and damp garages and ensure tamariki are physically and sexually safe. This is not a 100-day aim, this is now, immediately,” Graham-Smith said.

She said preventable diseases such as skin infections, rickets and respiratory diseases should not be a feature for any child growing up in Aotearoa.

“Incest resulting in mental and physical trauma and unwanted pregnancies for young women is an indictment on the conditions in which some people live because of poverty, leading to unwanted bed sharing, substance abuse and inadequate accommodation,” said Graham-Smith.

“We are speaking out in support of this midwife to let New Zealanders know the mental health and general health risks when people live in cars and garages and in squalor and call on the next government to urgently turn this shame around.

“We agree with and support Women’s Health Action maternal and child health manager Isis McKay that it is important for health professionals to speak out and highlight these terrible situations and the physical and mental health effect on children.”

The New Zealand Herald reported that in her Facebook post Hart-Murray wrote of the abuse of children from the time they were infants; middle-aged women born in New Zealand who needed interpreters because their parents were immigrants and they didn’t get an education; and a family of six who felt lucky their cousin was allowing them to stay in the single-car garage of the rundown state home he had just been given.

“Its old, cold, there’s no running water, there are rats and it’s mouldy,” Hart-Murray wrote of the garage. “The baby to come will sleep in the bed with the parents and three toddlers, unless I can find an alternative in time. At least the baby will be warm, but that’s not going to improve [the] atrocious rates of SUDI New Zealand has. It’s better than the relatives’ van in a dodgy carpark, where the parents take turns staying awake to protect [the children].”

Hart-Murray also said she would pay for important prescriptions herself from time to time because many families could not afford them once they had paid for food.

One pregnant teenager she saw was forced to live with a relative in a house where she had to share a bed with two teenage boys. Used needles and condoms were on the floor and there was a pile of used adult nappies and human excrement in the house, which didn’t have a toilet.

“I don’t think a lot of New Zealand is aware of what really goes on for so many people here in Aotearoa. It’s a largely hidden shame we’d rather not see.”

Hart-Murray is not working as a midwife after having had successful treatment for a benign tumour. She is now suffering cardiac trouble.

She said on her Facebook page that she had been overwhelmed by the response to the post from midwives who had the same stories to tell.

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Vote 2017: Party promises for tackling New Zealand’s shocking youth suicide rate

Tue, 12 Sep 2017 07:12:04 +0000

Warning: This article is about suicide and may be distressing for some readers.

New Zealand has the highest teen suicide rate in the developed world. When it comes to youth suicide – those 25 and under – we have the second highest rate.

Across all age groups, provisional suicide figures for 2016-17 show 606 people died by suicide in New Zealand, up from a then all-time high of 579 the year before.

In July and August the New Zealand Herald’s ‘Break The Silence’ series about youth suicide revealed how not talking about suicide has become the orthodox approach to dealing with a problem that will not go away. The overall death rate has shown no sign of sustained decrease for two decades.

It also showed the fear government wrestles with when it comes to dealing with this national tragedy.

An expert group set up to advise the Ministry of Health proposed a target of reducing the total suicide rate by 20 per cent over 10 years.

It was rejected over fears the Government would be held accountable if the rate didn’t drop. Health Minister Jonathan Coleman has since said he would be open to a 20 per cent reduction.

The problems revealed by Break The Silence signalled a crisis in almost every part of our mental health system and its ability to deal with youth suicide.

We revealed how almost 2000 young people seeking specialist mental health care were turned away or passed on, with some kids waiting up to six months for an appointment.

Research also showed that only the most serious 5 per cent of cases were being seen, with little ability to manage those with low or moderate mental health issues.

The Herald has been contacted by hundreds of affected families wanting a way back to wellness for young people.

We asked parties standing for election to give those families answers, setting out their policies for bringing down the suicide rate, outlining their particular approach to youth suicide issues should they have one. Here are the responses, in alphabetical order.

Act

No response.

Greens

The Greens are promising free counselling for all New Zealanders aged 25 and under as part of a $260 million youth mental health package.

They will increase spending on youth mental health services by $100 million a year to reduce waiting times, provide specialist treatment and retain and value staff.

They say accessing a school counsellor is currently too difficult for many. There needs to be tagged funding and a ratio of 1 trained school guidance counsellor to 400 students.

They would integrate wellness into the school curriculum – involving developing skills among parents and other whanau – to provide young people with what they need to cope with life’s challenges.

The Greens want government to commit to zero suicides as an aspirational target so resources are focused on “ensuring that we don’t lose another person”.

Labour

A mental health review in the first 100 days will identify service gaps and needs in schools, secondary specialist services and availability of “talking therapies”.

Labour will introduce a two-year pilot “onsite talking therapies” programme of primary mental health teams at eight places across the country, working with GPs, district health boards and mental health bodies. It is expected to help nearly 40,000 people each year of the pilot at a cost of $43 million over two years.

There will be 80 full-time roles in Canterbury and Kaikōura for primary and intermediate schools to deal with post-earthquake issues and mental health needs.

There will be school-based health services in every state secondary school to assist with mental health.

Labour will re-establish an independent mental health commissioner and is considering a suicide reduction target.

It says its wider health policy will also help, with cheaper GP visits, increased funding for GP training and a review of primary care funding to reduce barriers to accessing care.

Mana

No response.

Māori Party

The Māori Party seeks more funding and an expansion of Oranga Rangatahi, which gained $8 million in this year’s budget to develop projects to equip young Māori with the weapons to fight “the scourge of suicide”.

Oranga Rangatahi builds on the work of the Rangatahi Suicide Prevention Fund, set up in 2015, which saw 38 community and youth-led initiatives funded. It is producing “real and tangible results”.

Young Māori are two-and-a-half times more likely to take their lives than non-Māori. The Māori Party seeks to resource whānau to develop solutions to suicide in “prevention, post-vention and health promotion approaches”.

That includes the aim to lower the threshold to access appropriate support for individuals experiencing distress. The party also commits to reducing health disparities for Māori by increasing the number of youth and whānau services targeting addiction and mental health.

The Māori Party also seeks to resource and carry out the Turamarama Declaration, which was developed by Sir Mason Durie and tabled at last year’s World Indigenous Suicide Prevention Conference. It aims to place suicide prevention at the centre of government and society priorities and to develop tools to tackle it.

National

The drivers behind suicide are complex and it is a “whole of society issue”.

National says evidence shows mental health services need to change to “build resilience in young people to help them better deal with mental health issues and to learn how to overcome known risk factors”.

This is being done through a recently announced $100 million social investment fund for mental health, which aims to provide better access to effective and responsive mental health services. This new approach is being supported by the Government’s chief science advisers.

National is “open” to setting an aspirational suicide reduction target.

It has announced Lifekeepers, a new suicide prevention training programme to help communities “build the capability and capacity to support people at risk of suicide”.

Submissions received during consultation on a draft suicide prevention strategy will be incorporated into the final advice provided to the Government and help inform the wider mental health work currently under way.

New Zealand First

Current funding is insufficient and poorly allocated and funds will be allocated in line with a national mental health inquiry.

NZ First says there will be an independent inquiry into the funding of the public health system.

It pledges to increase the number of mental health and addiction nurses at all DHBs and to increase options for treatment with a community, rather than medical, view of services.

Along with increasing staff numbers, there will be an increase in the number of acute and non-acute beds and accommodation units for the mentally ill.

NZ First will also “modify the process of judicial review of decisions to release mentally ill patients into the community”.

Work is continuing to finalise the policy which “won’t be available before the 2017 general election”.

United Future

United Future says there needs to be increased funding for youth-focused mental health services including better workforce development.

The increased funding includes youth-focused counselling services as a first response rather than “over-prescribing pharmaceuticals for mental health problems”.

DHBs also need to develop secure facilities for the treatment of young people with mental health problems.

United Future wants increased funding for more research into child and youth suicide. There also needs to be more research for youth-related health problems such as suicide, alcoholism, and bulimia, it says.

And it wants additional community health providers and more resources for mental health professionals.

The Opportunities Party

Social and economic isolation and disadvantage is a major cause of our suicide epidemic, says TOP.

Its fair tax reform and asset tax will soften house price growth and ease financial stress on working people. Tenancy reform will give low-income earners the stability of a “home” whether as owners or renters.

The Unconditional Basic Income of $200 a week gives young people “in the midst of the most difficult life transition” the ability to pursue dreams and manage their lives.

Cannabis reform takes $150 million off dealers and puts it into drug and alcohol education and rehabilitation. It will allow people to ask for help without the threat of criminal sanction.

“Of course more needs to be spent on treating those with mental illness in the here-and-now and TOP will support such spending.”

But “the real big picture answer is to create a society and economy which doesn’t leave so many people alienated and desperate”.

WHERE TO GET HELP:

If you need to talk to someone, the following free helplines operate 24/7:

DEPRESSION HELPLINE: 0800 111 757
LIFELINE: 0800 543 354
NEED TO TALK? Call or text 1737
SAMARITANS: 0800 726 666
YOUTHLINE: 0800 376 633 or text 234

There are lots of places to get support. For others, click here.

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Nurses urged to help vaccinate ‘lost generation’ against mumps

Thu, 07 Sep 2017 22:14:55 +0000

Nurses are being encouraged to vaccinate against mumps at every opportunity –particularly olders teens and young people in their 20s – as the Auckland mumps outbreak continues.

Only 20 cases of mumps were reported across the whole of the country last year and Auckland alone has at least 300 cases to date. The disease can be mild for young children but adults who get mumps can experience severe disease.

“Unfortunately we are bearing the brunt of a mumps outbreak in Auckland,” said Dr Josephine Herman, Auckland Regional Public Health’s medical officer of health. The outbreak had now spread to the Waikato and mumps cases were also being reported in smaller numbers across the country.

She said it was looking to the primary health sector and nurses in particular – who are the backbone of primary care – to help promote the MMR (measles, mumps and rubella) vaccine amongst the younger, adolescent population.

Public Health are particularly concerned about a “lost generation” now in their 20s who either did not receive the MMR vaccine in the first place or may have missed out on their second MMR dose when the timing of the second dose was shifted in 2001 from being done at age 11 to age four. They are also at risk of measles and rubella.

Henman said the difficulty was that this age group was generally healthy and independent so didn’t often visit health services. Also the national immunisation register was only 12 years old so it was difficult to identify those who had or hadn’t been vaccinated.

Practice nurses had an important role as families were being urged to check with their family’s general practice to see whether family members had been fully immunised – and also to check their child’s blue Well Child (Plunket) book.

The Immunisation Advisory Centre (IMAC) says the last major mumps epidemic in New Zealand was in 1994 which lead to 188 hospitalistions. Mumps is a viral illness spread by coughing, sneezing and direct contact with infected saliva.

The incubation period (time from infection to onset of symptoms) is on average 16-18 days, and can range from 2-4 weeks. A person with mumps may be infectious from seven days before the salivary glands swell until nine days after.

Henman said for the majority of people who catch mumps it is a mild illness with some painful swelling in the jaw. Some don’t get any swelling with 30 per cent of mumps cases being asymptomatic (though still contagious). But in some cases – with adolescents and adults at higher risk of severe disease from mumps – there can be serious consequences including meningitis, hearing loss and in the case of young and older men it is orchitis (painful swelling and inflammation of the testicles) which in rare circumstances lead to infertility. Henman said women can also have pain through swelling of the ovaries.

According to national immunisation data, the coverage rates in young children up to the age of 12 years are around 80 percent. Today’s mid twenty year olds have even lower rates, with a national coverage survey reporting that only 60 percent of Pakeha children were fully immunised in 1991, with lower rates for Maori (42 percent) and Pacific children (45 percent).

ARPHS has been notified of 300 cases from January 1 to 4 September 2017, with this total greater than all the cases of mumps in the last 16 years. But Henman says there are probably a significant number of cases that have been brought to the services’ attention.

“Mumps is now at large in the community and the only way we can stop this spreading further is to achieve high levels of MMR vaccination in the population,” said Herman.

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Long-term conditions research projects get $2.3m boost

Fri, 01 Sep 2017 10:14:15 +0000

Helping Pacific youth avoid diabetes is one of two projects receiving $2.3 million funding in the latest grants from a long-term conditions joint research partnership.

The Healthier Lives National Science Challenge, the Ministry of Health and the Health Research Council of New Zealand (HRC) joined forces to establish the $7.9 million research funding pool to tackle long-term chronic health conditions.

Yesterday’s $2.3 million announcement follows the $5.7 million announced for diabetes research in February.

Massey University research fellow Dr Riz Firestone, who is of Samoan descent, received almost $1 million in health research funding to develop and put into practice a Pacifika community-based intervention programme to reduce prediabetes, the precursor to full-blown diabetes.

Dr Michael Epton, Director of the Canterbury Respiratory Research Group at Christchurch Hospital, has received just over $1 million for a 24-month study that will address New Zealand’s low referral and attendance rates for rehabilitation programmes for people with multiple long-term conditions (LTCs), such as diabetes, heart failure, arthritis, and chronic obstructive pulmonary disease.

Dr Firestone’s study will establish a Pasifika prediabetes youth empowerment programme involving Pacific youth (15–24 years old) from community groups in South Waikato and Auckland. It will build on Firestone’s recent HRC-funded pilot study in which a group of Pacific youth was taught how to plan and champion community-based interventions to counteract the key public health issues of obesity.

Epson says current approaches to rehabilitation for people with multiple LTCs focus too much on the biological aspects of their diseases and don’t include all the aspects of wellbeing that are important for improving health.

“Rather than developing new disease-specific interventions, we’ll work together with communities to develop and try initiatives that help people with multiple LTCs access community support, increase their sense of connectedness within their community, improve physical activity, and thus live lives they feel are fulfilling and worthwhile,” he said.

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Nurse innovators among $20,000 Clinicians’ Challenge finalists

Wed, 23 Aug 2017 19:00:33 +0000

Supporting youth in crisis and helping immigrant children catch up with immunisations are two digital innovations co-led by nurses to make this year’s Clinicians’ Challenge finals.

The two projects are among the four finalists from 41 entries received this year for the $20,000 annual digital health challenge, with the winners decided at the 2017 HiNZ conference in Rotorua in early November.

An app designed to help support young people in crisis has been created by Wellington mental health nurse Dion Howard, working with development team Jaymesh Master, Michael Smith and Rosie Parry, and is one of two finalists in the Active Project category.

The Ask Ruru app creates a log of all crisis-based texts and calls between community health workers and young adults and teenagers (who generally rely on mobile calls and texts to communicate). The aim of the app’s log is for mental health professionals to be able to deliver safe and more effective crisis coaching for young people by being able to access and analyse their communications with health workers. The information could be used to help promote earlier intervention, decide on therapeutic models and manage ongoing crisis support.

Southern District Health Board nurse Jillian Boniface and public health analyst Leanne Liggett are finalists in the New Idea category, with a proposal to develop an online immunisation ‘catch-up’ calculator for immigrant or refugee children.

Boniface is the DHB’s programme leader for vaccine preventable diseases. The pair says that planning immunisation catch-ups is a “complex, time-consuming and manual process for busy practice nurses”. The aim of the calculator is to simplify data collection, improve workflow efficiencies, support timely clinical delivery and ensure the National Immunisation Register is updated.

The other finalist in the New Idea category is from Dunedin family physician Dr Adrian Laurence, who is proposing to develop a web and mobile application called GreenHub to help simplify the Green Prescription (GPX) system for consumers, providers and clinicians.

The aim of this secure application is to streamline consumer enrolment, management and communication to save time and improve health outcomes for consumers who are given green prescriptions to support them in making healthy lifestyle changes, such as increasing exercise levels and improving dietary habits. The proposal is for GreenHub to combine multiple communication methods, including smartphones, secure video chat, messaging and notifications, enabling patients to communicate in the ways they choose. GPX clinicians, such as nurses and doctors, could also use GreenHub to monitor their patient’s progress and set triggers to know when patients need extra support.

The other finalist in the Active Project category is dermatologist Associate Professor Amanda Oakley, the founder of the online skin resource website DermNetNZ.org, and her daughter Emily Oakley, who is the website’s development manager.

The mother and daughter team aim to add a skin disease image recognition tool to the website, which would use artificial intelligence software to identify images of skin diseases through pattern recognition, leading to quicker, easier and more accurate diagnosing. Their intent is for the tool to be either free or low cost to healthcare providers worldwide as long as they have a mobile or desktop device that can connect to the internet. The pair say that an estimated one in six visits to a doctor are for skin complaints and many communities worldwide have very limited access to dermatologists.

The Clinicians’ Challenge is a joint initiative by the Ministry of Health and Health Informatics New Zealand (HiNZ) and the finalists receive free registration to the three-day HiNZ conference. The four finalists present their cases at the HiNZ conference and the winners will be announced at the awards lunch on 3 November. The winner of each category receives a grant of $8,000 and the runner-up $2,000.

Clinicians’ Challenge Categories 2017

New idea: a disruptive innovation for a digital system or application to deliver health services in new ways to enhance patient outcomes, improve workflows, deliver efficiencies and/or support more integrated care.

Active project/development: an innovation for a system or application being developed, or already developed, that improves the way people work, supports better patient care, delivers efficiencies and results in more integrated health services.

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Nurse telephone triage assessment criticised in HDC report

Tue, 22 Aug 2017 00:39:39 +0000

Red-flag meningitis symptoms reported by a 20-year-old student should have led to better questioning by telephone triage nurses, says a Health and Disability Commissioner’s report.

Health and Disability Commissioner Anthony Hill has found that a student health service doctor (‘Dr D’), and a nurse did not treat red-flag meningitis symptoms reported by a student (‘Ms A’), who phoned and visited the service over several days in May 2014, with reasonable care and skill.

The student later collapsed in her student flat and was taken by an ambulance to ED, where she was diagnosed with meningitis and admitted to ICU. As a result of the meningitis she has been left with an ongoing neurological disability and adverse consequences, including hearing loss, daily headaches and extreme fatigue.

Hill found that Dr D failed to take an adequate history from Ms A, did not undertake an adequate physical assessment, and did not consider broader diagnoses including meningitis.

He found that ‘RN C’, the fourth nurse to assess the student, had failed to ask focused questions relating to the student’s red-flag symptoms during a telephone call with the student’s friend; she did not consider meningitis and did not advise them to call an ambulance immediately. Hill also made adverse comments about the documentation of two other nurses, ‘RN F’ and ‘RN E’, who took earlier triage calls from the student (see summary details of case below).

The commissioner recommended that the university student health service updated the Office of the Health and Disability Commissioner (HCD) on its use of generic protocols to provide consistency of telephone triage and clinical record-taking.

The health service said at the time of the event that its nurses, including RN C, had been provided ongoing training in triage skills and the triage room had had a copy of the Telephone Guidelines in General Practice Setting (January 2005), which sets out prompt questions to ask someone with cold symptoms or a headache to check whether meningitis-related symptoms were also present.

Since the incident the service had made improvements to its nursing assessment of acute and unscheduled presentations and had developed protocols to provide consistency of telephone triage and clinical record-taking. These included standardised scripts, a telephone triage documentation tool, and a process to exclude life-threatening emergencies on all calls.

Dr D had undergone a programme to enhance his clinical record practice, including attending a workshop and undertaking regular case reviews as part of one-on-one supervision. RN C had had one-on-one telephone supervision for approximately two months and after online training had returned to telephone duties.

CASE SUMMARY

The 20-year-old university student (Ms A) first presented to the student health service with a sore throat and tiredness over two days. She was seen by a nurse who took a throat swab and advised her on sore throat management.

Two days later (day three) she phoned the service and talked to RN E, who noted she was feeling much worse – including headaches and fever – and arranged a follow-up appointment with Dr D that afternoon.

Ms A tried to cancel the appointment as she felt too unwell to attend, but her boyfriend phoned at 4pm and spoke to RN F, who recorded that Ms A was getting worse and was unable to swallow or get out of bed. RN F made a new appointment for Ms A with Dr D.

Ms A and her boyfriend arrived at the service around 4.30pm to see Dr D. He noted worsening symptoms and that she was sweaty, tearful, had a runny nose, a temperature of 39.5, her throat was red, her ears mildly red and that the throat swab had come back normal. He diagnosed flu-like illness and prescribed pain relief and anti-nausea medications.

The next day Ms A deteriorated further and her flatmate rang the service around 3.10pm and spoke to RN C.

She noted: “Has been unwell now for quite a few days and seen here x3 already. Bad headache — pale and not keeping food down — vomiting. Not particularly responsive to her friends apparently. Sounds miserable in the background and crying. Friends will bring her down as soon as they can and if they cannot get her up I suggested they call an ambulance but aware will cost.” RN C made the first available appointment for Ms A but soon after Ms A collapsed and an ambulance was called, leading to the diagnosis and by 6.15pm she was in intensive care.

After receiving expert advice, the commissioner was critical that Dr D in his consultation did not take an adequate history, including questioning about headache, vomiting, rash, confusion, photophobia, and recent travel, also that he did not take her blood pressure or examine her for signs of meningeal irritation. “I am highly concerned that, given Ms A’s symptoms, Dr D did not consider a broader differential diagnosis (including meningitis).”

HDC’s RN clinical advisor Dawn Carey said that the documentation from Ms A’s previous visits and calls to the service had raised red-flag symptoms, such as bad headache, vomiting and not being particularly responsive, which should have prompted focused questioning from RN C. She said she would have expected RN C to have considered meningococcal disease as a possibility. She found the assessment by RN C “moderately departed from accepted nursing standards” and her advice in response to Ms A’s symptoms was “insufficient” and she should have advised Ms A’s friends to call an ambulance immediately.

RN E told HDC that she was adamant that she would have questioned Ms A about whether the student was suffering any red-flag symptoms and the fact that her notes don’t mention this indicated to her that the answers to her red-flag symptom inquiries were all negative.

Carey advised HDC that even if RN E did ask focused questions about the red flags, she was critical that she did not document the questions and responses from Ms A.

RN F said she advised Ms A’s boyfriend when he called that if there was any breathing restrictions he should call an ambulance, but if she was happy to come to the service she would be triaged straight away and see Dr D.

Carey acknowledged that RN F did raise calling an ambulance, but was also critical of RN F’s lack of focused further questions on the red-flag symptoms and documenting of what questions were asked and answered.

The full HDC report can be viewed here

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Schools and primary health a major focus of MH social investment proposals

Tue, 15 Aug 2017 02:14:33 +0000

The social investment mental health funding announced in the Budget is to be split between 17 initiatives and pilots.

Details of the proposed initiatives was announced yesterday by the government. The largest share of the $100 million funding over four years is to go to supporting primary and community mental health care ($25 million over four years) with the bulk of that ($5 million a year) going to workforce training initatives including CBT training for nurses and other health professionals.

The next biggest investment announced would be in piloting frontline mental health provision in schools and other school initiatives ($11 million over four years), followed by three e-therapy and telehealth/distance therapy initiatives which will get $10m over four years.

Health Minister Jonathan Coleman in announcing details of the package acknowledged the increased in demand for mental health and addiction services and said the initiatives being invested in were designed to “improve access to effective and responsive mental health services, while at the same time starting to shift our focus towards prevention, early intervention and resilience-building.”

The Public Service Association, whose membership includes mental health nurses and other mental health workers said the social investment approach failed to address the key issue of underfunding of the health sector or to address growing demand and cost pressures in the mental health system.

The initiatives proposed include:

Expanding primary & community mental health and addiction care ($25 million over four years)

Offering Cognitive Behavoural Therapy (CBT) to about 250 nurses, social workers and other health professionals.
Training about 250 youth peer support workers, 125 community care workers and 13 more clinical psychology intern positions
Expanding access to youth one-stop shop (YOSS) and Child and Adolescent Mental Health Services

Schools package ($19 million over four years)

Piloting frontline mental health services in selected schools using screening by social nurses, social workers or counsellors with back-up support by a mental health practitioner ($11 million over four years)
School-based programmes to improve young people’s self-control and resilience ($8 million over four years)
A pilot of using the electronic HEEADSSS (home, education/employment, eating, activities, drugs, sexuality, suicide and depression, and safety from injury and violence) assessment tool with approximately 4000 young people a year focusing on School Based Health Service secondary schools and Youth One-Stop Shop settings.

Distance and e-therapy initiatives ($10 million over four years)

Enhanced e-therapy options for pre-teens to young adults (like SPARX)
Access to e-therapy for young prisoners
Designing and piloting telehealth distance therapy initiatives for adolescents to adults

Other Initiatives

Piloting initiatives for follow-up support for people who attempt suicide ($5 million over four years)
Designing and implementing a multi-agency ‘co-response’ service in two large cities and one provincial town for people who ring 111 requiring a mental health response ($8 million over four years)

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Obese children more likely to have issues with their emotional health

Wed, 09 Aug 2017 21:11:00 +0000

The study, published today, assessed the health of 233 clinically obese children aged four to 16, who were enrolled in Taranaki intervention programme Whanau Pakari.

The study required both parents and children to fill out two questionnaires measuring “health-related quality of life” and signs of behavioural or emotional difficulties like anxiety, sleep issues and aggression.

Researchers found 44 per cent of the children in the study had scores indicating a high likelihood of emotional and behavioural problems – six times the rate typically found in young people.

Nearly a third (28 per cent) had scores indicating a high likelihood of psychological difficulties serious enough to warrant intervention.

The study found that the greater the child’s Body Mass index, the lower they and their parents scored their quality of life.

The children’s quality of life, as reported by their parents, was comparable to young people diagnosed with cancer and worse than a group of Taranaki children living with a chronic condition which required daily treatment.

Reported quality of life was worst in those who experienced breathing pauses while sleeping, headaches, difficulty getting to sleep or developmental problems.

Study co-author, Liggins Institute researcher and Taranaki paediatrician Dr Yvonne Anderson said the findings highlighted how important it was that obesity programmes involved psychologists.

“This study highlights that a large proportion of children and teens struggling with weight issues are also highly likely to be affected by psychological problems, and in turn, lower quality of life.”

But because the findings came from a group who were seeking help with their weight, they could not be generalised to all of society, she said.

“We hope these findings serve as a reminder that we all need to work to reduce the stigma associated with obesity.

“It is really important that we do not see obesity as a single condition. It has many contributing factors, can affect individuals in many ways, and undertaking respectful, non-judgemental, and individualised assessments is critical for any type of meaningful engagement.”

The study is the first in New Zealand to assess the rate of health risks associated with obesity in young people.

The study was a collaboration between the Liggins Institute based at the University of Auckland, Taranaki District Health Board and Sport Taranaki.

Read the full study here.

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