Canterbury aged-care nursing

Canterbury District Health Board is strongly committed to building its aged-care nursing workforce. The following four stories showcase some of the support and training that are being developed for nurses working in all areas of aged care.

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New gerontology nurse specialists team

In 2010, Canterbury District Health Board (CDHB) developed a new role to lead and support the aged residential care (ARC) sector. The gerontology nurse specialists (GNSs) are part of increased collaboration between primary and secondary health services. They are seeking to improve assessment and care coordination of frail elderly patients. They promote a holistic focus of care and identify gaps in services.

A smiling nurse crouching down to talk with a frail-looking older woman.
Homestead Ilam resident Joy Denton with Nursing Entry to Practice nurse Natalia Batyaeva.

The GNSs were pivotal in the health sector responses to the 2010 and 2011 Canterbury earthquakes. They helped reduce the pressure on damaged hospitals by advising ARC facilities on how to care for residents who might otherwise have required hospital admission.

The GNSs have contributed to a marked reduction in presentations to Christchurch Hospital’s Emergency Department (ED) from ARC facilities. They also advise ARC staff and residents’ families on ways to prevent people with chronic conditions from deteriorating.

‘Principally, we’re there for nurses and managers as a backup if they have specific queries or are looking for nursing management strategies for a resident’s health care,’ says Sheryl Haywood, one of the three GNSs. ‘We also work with families, take referrals from other CDHB departments, such as psychiatric services, and work alongside GPs and consultants.’

Sheryl and colleagues Aileen Smith and Sue Holland have all worked in senior nursing roles. Sheryl has also been a rest home nurse manager. ‘We understand the pressures of working in aged-care facilities. Working as an aged-care nurse, you are often highly autonomous. It can be difficult, stressful and definitely challenging. We hope that our backgrounds will help nurses and managers feel that they can talk to us about any concerns.’

A major focus of the team’s work is empowering nurses to take the lead on issues and pass their learning on to others. ‘We can make a much bigger impact on local aged residential care if we help to upskill the sector,’ Sheryl says.

Since early 2011, the team has been running study days for nursing staff. In 2012, it provided peer support groups for managers. Workshop topics are selected from common issues identified in ARC audits. Care planning, continence management, infection control and pressure injuries are on the agenda for nurses and other health professionals in 2013. Human resources and general management issues will be discussed at the managers’ sessions.

Professional development strengthens the workforce

Title: Showcasing Aged Care Nursing: Canterbury – Strong Workforce, Better Care.

[The video starts with a shot of Homestead Ilam Home & Hospital, and then goes into an interview with Trish Palmer.]

Trish Palmer, Homestead Ilam manager and Registered Nurse: As manager of Homestead Ilam, it’s been great to get new staff through, new grads through. They bring a lot of knowledge with them. They question current staff's practices in a healthy manner.

[The interview is intercut with shots of Trish discussing some notes with a nurse.]

It’s good for the residents, from the point of view that they’re very thorough with their practices, so they get really good assessments done. And, yeah, they interact on a really good level with them.

Yeah, they need to have a good understanding of systems in the aged-care sector. And the NETP programme can further the requirements of the practice setting to meet those needs. And having the preceptor there as a dedicated person for support, where otherwise we would be using myself as a nurse manager, or the clinical coordinator, and they would lose time where it’s otherwise required.

Aged care is a really good career choice. And it’s great to be able to support people, younger registered nurses, into it.

There’s a lot of clinical skills required here. It’s not as– you’re a generalist specialist. So you need a really good, broad knowledge and really good assessment skills. Because we don’t have the backup of a doctor on site, necessarily, or even other colleagues at times. You do sometimes work solo in aged-care facilities.

[Inteview with Natalia Batyaeva, the nurse Trish was talking to. This is intercut with footage of Natalia and another nurse talking to a resident.]

Natalia Batyaeva, Nursing Entrance to Practice (NETP) Registered Nurse: Actually, I have time. In a hospital, probably, in an acute hospital, you won’t have that much time to talk to your patients. But here we do. It’s a big advantage. And if I have funny stories to share, or a life experience, or something else, who knows? This feels like a family-like environment.

[Interview with Eve Black, Natalia’s mentor, intercut with shots of Natalia and Eve looking at a resident’s notes.]

Eve Black, NETP preceptor (mentor): As Natalia’s preceptor, I see myself as a support person for her. This is her year out actually nursing. And she really needs somebody to talk to. If she has a problem, or a concern about something, or a way to do something, I see myself in that role, as being that support person. And I think it’s important that the NETP students have somebody that they can go to talk to that’s not in perhaps a tutorial role, but more as a nurse working in the facility.

They’re young. And the residents see these young people coming in who have got so much life and energy, and are so keen. And they give the residents one-on-one care.

[Interview with Becky Hickmott, intercut with shots of Becky working in her office, and of one of the residents talking to Natalia.]

Becky Hickmott, Nurse manager – Workforce Development, CDHB: So the benefits of providing the NETP programme in the aged residential care, they’re twofold, really.

One is that for the staff, it ensures really good, supported staff members coming through that first year of practice. It helps with retention, ongoing recruitment and retention issues. So we’re trying to put people who really have a keen interest in aged care, and so it’s a career pathway for them as well.

And for the patient, which I think is the most fundamental thing, is that they’re coming to that facility with fresh eyes, with really good, solid training. And they’re putting into place very good skills and attributes around caring, using evidence-based practice and critical analysis, and ensuring the best outcomes of patients are managed.

An ageing population along with recruitment and retention issues among aged-care nurses has prompted Canterbury District Health Board (CDHB) to focus on developing aged-care nursing as a career choice for nurses at all levels.

Kate Gibb is CDHB’s Older Persons Health nursing director. Kate says that it is vital to strengthen the existing workforce and encourage new graduates into the field. This will help to ensure that there are enough nurses to care for Canterbury’s older people now and in the future.

The Gerontology Acceleration Programme (GAP) offers training for mid- to senior-level Canterbury nurses. It aims to provide nurses with a core set of clinical skills for working in the aged residential care (ARC) sector.

To be eligible to take part in the GAP, nurses need to have been registered for at least one year. They also need to be working in the health system but not specifically in aged care. ‘Gerontology is generally a big part of any nurse’s working day, whether they are in general practice, on a surgical ward or in an aged-care facility,’ Kate says.

Along with postgraduate study, participants take part in 12-week work experience rotations through a variety of CDHB and ARC facilities. The rotations last for five months. After that, the nurses return to their usual workplace to finish the study component of the programme which is provided through the University of Otago.

Participants are assigned a mentor for the length of the programme. They are also linked to a gerontology expert who will guide them in each rotation. Health Workforce New Zealand covers the cost of the study and release time from participants’ usual workplaces.

Nurses will qualify from the programme with a post-graduate Certificate in Health Sciences endorsed in gerontology nursing. From there, they can progress to a post-graduate diploma or master’s degree.

Cashmere View Rest Home and Hospital in Christchurch has been involved in the GAP since the start of 2013. Nurse manager Robyn Hulme explains, ‘I think it provides nurses with marvellous opportunities to experience the breadth of acute, rehab and psycho-geriatric nursing care. Having nurses on this programme will bring more leadership into the sector and encourage facilities to look at things in new ways.’

CDHB has also extended its Nursing Entry to Practice (NETP) programme to new graduates working in ARC facilities and community nursing.

As with the GAP, new graduates on the NETP are linked with a preceptor (mentor) who guides them through the programme. During this time, they complete some formal study with support from the programme’s tutors.

Kate Gibb says that the new graduates value the support offered in the programme. It helps them build clinical confidence. Also, they appreciate having someone to turn to for advice.

‘Aside from growing and strengthening the workforce, our increased attention to the training and support of aged-care nurses is having a wonderful impact on relationships across the aged-care sector, including the DHB, community nursing and ARC facilities,’ Kate says.

Walking in Another’s Shoes

Title: Showcasing Aged Care Nursing. Canterbury – Strong Workforce, Better Care.

Pablo Manning, Resident of Rosewood Rest Home: [Singing Pokarekare Ana, with a family member and nurse beside him.]

Dorothy Chilwalo (voiceover): This is somebody. This is a person who had something. He’s a person with a family. He’s somebody’s uncle, he’s somebody's husband. These are somebody’s mother, father. They had a career before. They were doing something.

[Interview with Dorothy, intercut with shots of her and another staff member at work.]

Dorothy Chilwalo, Registered Nurse: I move to New Zealand here and applied for a job in the dementia unit and I was picked. And I’ve loved it since I came here. It’s one of the areas where, when you are at work, you really know who you’re working with, what you’re doing. You go home, you find that job satisfaction knowing you’ve done something for someone.

We’ve got a patient who likes just working in the garden, and when he’s working in the garden, you come in, you wouldn’t know this patient has got dementia. So, you’ve got to know who this patient is, take a holistic approach.

[Interview with Lucie Kaal, intercut with shots of her walking down the hall with another staff member.]

Lucie Kaal, Rosewood Rest Home manager and Registered nurse: When we employ people and we think it’s really important that we get staff that are right for the residents that we have, not necessarily focusing on their experience, or their training, although obviously that is important and we do a lot of training here. But we tend to train in a slightly different way along with the Walking in the Shoes program at the CDHB. And it can be such great fun working with the residents and the families.

I love to see the staff learn and flourish.

[Interview with Alan Beasley, intercut with footage of Dorothy with one of the residents.]

Alan Beasley, Dementia Educator, Canterbury District Health Board: Yeah, I definitely recommend aged-care nursing, and I’m very biased, so I’d recommend dementia-care nursing as well, because everybody who comes into nursing comes in with the best intentions. We come in to do a job because we want to care.

We want to challenge ourselves, and nursing and aged care it will challenge you, and the same with dementia. But it’ll also bring the best out of you as well. With dementia, you get to know the disease. But we get to know people individually as well. We get to learn new skills.

I think dementia care focuses on that biopsychosocial model. So, we’re looking at all aspects of the person. And I think that can help us as nurses and professionals particularly. It’s very rewarding.

[The video ends with Pablo finishing singing Pokarekare Ana.]

Nurse: Well done.

Alan Beasley’s infectious enthusiasm for quality dementia care is making its mark on Canterbury’s aged residential care (ARC) nurses and support workers.

Alan is a dementia care educator promoting Canterbury District Health Board’s (CDHB’s) Walking in Another’s Shoes education programme. He encourages people working in dementia care to consider innovative ways of looking after their patients and supporting each other.

Walking in Another’s Shoes was pioneered by English professor of psychogerontology Tom Kitwood. It is founded on the principle of putting the person with dementia at the centre of care. ‘The focus is on putting the person before the disease: valuing each person as a unique individual with specific needs and abilities that should be supported and respected. We aim to work around the person with dementia rather than have them adapt their world around our routines,’ Alan says.

Walking in Another’s Shoes offers workshops and full-day classes for ARC staff. Alan also visits rest homes and hospitals to provide on-site staff training. Participants in the programme are educated on a wide range of dementia-related topics. The programme encourages staff to work together to find solutions to challenges.

‘For example, “calling out” is a common behaviour that people working in dementia care find difficult to deal with,’ Alan says. ‘Carers can develop appropriate intervention strategies by considering what emotions are behind the behaviour and what needs aren’t being met.’

Carers could ask themselves:

  • Is the patient uncomfortable?
  • Are they in a social setting that they don’t like?
  • Do they call out more when they are hungry or tired?
  • What do we know about this person, and what can their life history tell us?

Carers can develop solutions by analysing such questions. Solutions might include encouraging family members to record a familiar story for the patient to listen to or assigning two people to share the patient’s care.

‘People working in dementia care can feel very isolated. Bringing them together to discuss ideas like this not only helps them improve their practice but is an important step towards building networks that will support them in the future,’ Alan says.

Cashmere View Rest Home and Hospital has 20 residents with severe dementia. Staff have welcomed the Walking in Another’s Shoes programme. ‘It’s been wonderful having the programme and other support from Alan,’ says nurse manager Robyn Hulme. ‘His reflective practice sessions have really helped staff develop ways of coping with residents who have challenging behaviours.’

Lucie Kaal, Nurse Manager at Christchurch’s Rosewood Rest Home and Hospitals agrees. The Walking in Another’s Shoes programme has supported her rest home’s in-service training and general approach to caring for residents.

Aged-care nurses who love their jobs

Nurse Eva Bragat came to New Zealand from the Philippines. Before she arrived here, she had never considered working in aged residential care (ARC) nursing.

One older and one younger nurse sitting outside in a garden.
Nursing Manager Robyn Hulme with nurse Eva Bragat.

‘They really don’t have rest homes in the Philippines. I was a theatre nurse back there,’ she explains. Eva gained her New Zealand registration and went to work for a nursing agency. That’s how she fell in love with nursing elderly people.

Robyn Hulme is Eva’s employer and the nurse manager at Christchurch’s Cashmere View Rest Home and Hospital. Like Eva, Robyn discovered that ARC ‘gets in your blood’.

‘I started my career in aged-care nursing at Burwood Hospital in the days when they had long-term wards. I then made the career decision to work in surgery. Eventually I was made Surgical Nursing Director at Christchurch Hospital,’ she says.

‘About five years ago, I thought it was time for a change. I decided to take up the opportunity to help a struggling rest home get back on its feet. It was a chance to make a real difference, and I loved it.’

As Robyn explains, ‘There are so many areas in ARC for nurses to develop their clinical and non-clinical skills. These range from management and post-graduate study to quality and risk, human relations and all the operational aspects of running a facility.

‘From a clinical perspective, the main difference between ARC nursing and acute care is that most patients don’t arrive with one issue – the problems are multiple,’ she says.

Residents can be highly vulnerable. As a result, it can take a lot to reassure families that their loved ones are being well cared for.

‘Our basic premise is that if it’s right for the resident it’s right for us,’ Robyn explains. ‘Developing that trust with residents and families is a big part of our day-to-day job satisfaction.’

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