Wellington aged-care nursing

Support for the Wellington region’s aged residential care (ARC) sector has increased under a new model focused on better patient care.

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District nursing services improve collaboration with ARC

Building closer relationships with aged residential care (ARC) facilities plays an important role in Capital & Coast District Health Board’s (CCDHB) efforts to reduce hospital admissions through its Community Health Services (CHS) district nursing teams.

CHS nurse manager Emma Hickson says a 2011 CHS project identified that some local ARC facilities would benefit from stronger DHB support. As a result CHS district nurses have made themselves available to ARC facilities, seven days a week with on-call support available from 10pm to 8am.

During the project, CHS also analysed data from Wellington Hospital’s Emergency Department (ED) which identified some of the factors leading to ED admissions from ARC facilities. They found that a significant number of ARC admissions were related to male patient’s catheters becoming blocked or not functioning correctly.

As a result of these findings, CHS decided to focus on improving its collaboration and sharing of knowledge and skills with ARC nurses including building expertise. This has included training ARC nurses in male catheterisation, a procedure that was traditionally performed by male doctors in hospitals and GPs in the community setting, but, more recently, has become a skill required by many nurses in many sectors.

The primary aims of training ARC nurses in how to insert and manage male catheters were to improve patient care and reduce the number of avoidable ED admissions from Wellington ARC facilities because of blocked catheters.

CCDHB district nurse and clinical nurse specialist Louise Mills, who has overseen the training of ARC nurses in the procedure, says uptake from the region’s ARC facilities has been high. The training programme has also led to better continence care for older people in general. ‘Now, if catheters are blocking, we’re finding that the facility’s nursing staff are ringing to talk to us and we’re organising to go out and develop a care plan.’

‘It’s also meant that we’re looking more widely at healthy bladders and bowels for our clients in ARC facilities,’ Louise explains. Related training has also been provided in pelvic floor exercises, dementia and toileting issues,’ Louise says.

Louise believes the project has allowed CCDHB district nurses to develop a much greater understanding for the aged-care nursing role. Emma Hickson agrees: ‘We’re not dissimilar to the nurses working in aged care – we both work with a very broad scope,’ she says.

Changes improve patient care

Title: Showcasing Aged Care Nursing. Wellington – Strengthening clinical skills and nursing networks.

[Introductory shots of the rest home, Kemp Home & Hospital.]

[The video cuts between a training session and staff interviews. In the training session, Louise Mills shoes a group of staff how to perform cathetorisation on a dummy. The staff look over some hand-outs on troubleshooting urinary cathetors and the equipment to be used.]

Louise Mills [running the training session]: ... is having plenty of lubrication, and we recommend ...

Valelia Gibb, Nurse manager, Kemp Home & Hospital: Some of the benefits that we’ve seen as a result of Louise coming in to do some training around male catheterisation has been really positive. I guess the most significant change that we’ve seen is a huge decrease of hospital admissions. And it’s been, I think about seven months, we’ve not had one admission. Not one.

For the staff, for our registered nurses, that has certainly increased their confidence, and they’re far more– the knowledge has given them power. Has really empowered them.

Anjini Nandini, Nurse, Kemp Home & Hospital: Education is really important for NAs, just to keep on top of evidence-based learning, because things change with time, and we really need to be using this evidence-based learning to provide care for residents.

Erwin de La Toree, Nurse, Kemp Home & Hospital: Less stress for us, and like for me, I work after hours, I work afternoons and night shift. So there’s not much support around me, so it’s all my call. So with her coming in to do the training, it’s sort of like being, I mean, I’m gaining my confidence up doing the procedure by myself.

Anjini Nandini: If we don’t know, for example, how to catheterise male, like our policy stated before, that we are not to catheterise our male. We send them to the hospital if our GP is not available. So that used to actually place lots of stress on the residents, and the family, and us as well.

Louise Mills, Capital & Coast DHB clinical nurse specialist & educator: It’s been lovely to have the two-way process, that staff contact us, and they know that by contacting us, we can often troubleshoot over the phone, because of the training, to help them know whether they need to do anything further than they’ve already done.

It’s particularly important to be part of this change of practice, because our population is ever changing, and we know that we’re going to have a greater percentage of population that will be older, and potentially more people will need the supported living through villas, apartments, or residential facilities, requiring some care.

Title: Creating a culture for learning and better residential care

[In this segment of the video, it cuts between a zumba session and staff interviews.]

Valelia Gibbs: The Zumba’s been running now for 14 months. It has motivated the staff. Staff are happier. They laugh a lot more. It’s a great way to de-stress after a hard day’s work. They’re keen to learn. They want to learn. They attend a lot of– we have a higher percentage of staff now attending the in-service training sessions that we run, as opposed to two, three years ago, where very few would attend.

And a lot of them have come from overseas, where they’ve left their family behind, so we become their family. And in order for them to be able to learn, it’s really important that they do feel that they are part of our family.

Kemp Home and Hospital nurse manager Valelia Gibb is excited about Capital & Coast District Health Board’s (CCDHB’s) changes to better support aged care. In particular, she is thrilled by the opportunities to work alongside district health nurses.

‘We want Kemp to have a relationship with CCDHB,’ Valelia says. ‘And we know we can access support if we need it, through both the district nursing scheme and the clinical governance group.’

The clinical governance group was set up as part of CCDHB’s Health of Older People Review and includes aged-care nurse managers and DHB staff. Issues discussed by the clinical governance group have included catheter management. For example with male GPs historically responsible for catheterising men and in some instances responsible for their routine care, this was creating problems and delays in early-stage treatment at rest homes. This was one of the reasons that the group supported ARC nurse training in male catheterisation.

‘We nurses decided that we wanted to get rid of that old fallacy,’ Valelia says. ‘We wanted to get trained and do it ourselves. And we’ve done it.’

The male residents at Kemp welcome the policy change. Now they have regular catheter care. This translates to less infections and issues with catheter management. In the eight months following the CCDHB training in 2011, there were no hospital admissions for catheter problems or infections.

‘I’d always felt that the DHB was in one area and the ARC sector was isolated in another,’ Valelia says. ‘We don’t feel alone anymore, which is great.’

Creating a family environment for staff

‘If you’re not passionate or excited, no one else will be either,’ says Kemp Home and Hospital nurse manager Valelia Gibb. Valelia wants to create an environment that staff enjoy working in.

‘We try to do things together, especially if we feel morale is dropping. We think of something fun that we can do as a group.’

A group of people doing zumba exercises.
Kemp Home and Hospital staff at their twice-weekly Zumba class.

This includes a twice-weekly Zumba® dance-based exercise class for staff. This exercise class is part of the staff wellness programme. ‘Everyone involved has lost an enormous amount of weight, but most importantly, we have heaps of fun,’ says Valelia. She has lost more than 15 kg since classes began.

Moreover, Kemp staff view themselves as a unit. ‘Everyone is a link in this family.’

There is not one set way that the team orientates a new staff member. ‘It’s about getting to know the person: everything about them, including things like, do they have everything they need? We’ve provided staff with food and blankets while they’ve been getting themselves established.

‘It’s also important to know how our staff work and think. How do they perceive the information we’re giving them? How can we structure a supportive environment for them to learn in?

‘We have a multicultural team here with four or five different nationalities. For some of our registered nurses, adjusting to work and life in New Zealand has been quite tough, so we also have a support programme in place,’ Valelia says.

Nursing practices in other countries can be very different. Cultural backgrounds play an important role in how people operate in the workplace. ‘It’s about their set-up – different values, different cultures, status. For some, it would be very rare to see a woman in a management role,’ Valelia explains.

‘It can take a lot of work, but it’s worth it in the long run. Staff and residents alike benefit from staff bringing their culture and skills to our workplace.’

If you can put the time and energy into your staff and let them know that you’re there, then they grow, and they shine,’ Valelia says.

A nurse practitioner role focusing on the health of older people

A nurse practitioner employed to focus on the health of older people in the Kapiti area highlights the value of such a role for other areas in the Capital & Coast district.

Julie Hollingsworth was employed by Capital & Coast District Health Board (CCDHB) in 2010 and provides advanced nursing support to health professionals dealing with complex problems in older people. Since November 2012, she has graduated as a nurse practitioner in this role, supporting both aged residential care (ARC) facilities and older people living in the Kapiti community.

Julie says that forging strong relationships with the aged-care sector was vital. ‘When it came to residential care and supporting the nurses who work in ARC, I was really aware that the staff had been doing this job without me for a long time. I needed to establish a relationship with the residential care facilities first so that they would be able to identify the value that I could add.’

Initially this included providing the support that staff requested, such as education sessions and training in wound care. It also included reviewing patient care plans and providing clinical advice and support to nurses.

‘The relationship with my rest home and hospital colleagues is crucial. The staff and facilities need to feel comfortable that they can ring me, and I’ll be available to assist with what’s required.

‘There are a number of very skilled staff. However, I also know that there are areas where I can provide useful advice, education and mentoring.’

Trena Omunsden is nurse manager at Summerset on the Coast in Paraparaumu. She says that staff at the 41-bed hospital facility receive dedicated support from Julie whenever they need it.

‘We do get into unfamiliar territory sometimes, and it’s just about asking if we’re going about things the right way, in terms of a clinical decision or with advice and support for families.’

Julie also works closely with a CCDHB geriatrician and local GP who carry-out a six-weekly review of residents in aged-care hospitals together.

Two years into the role, and sector support is strong. As CCDHB Associate Director of Nursing – Practice Development Helen Costello says, ‘There has been very positive feedback from a range of services and evaluations over time. And the role is continually evolving.

‘In fact, the role has been so successful that the DHB is looking at other areas where nurse practitioners could assist with the health of older people.’

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