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An ordeal with the flu

Kate and Sam Pohe

Sam Pohe (on the right) with her sister, Kate.

Community clinic nurse Sam Pohe’s job was to endorse the flu vaccine to her high-risk patients but, as she lay in a coma at death’s door, her body riddled with complications deriving from influenza, it became obvious she’d forgotten to get one herself. She shares her ordeal with Jodi Fraser.

The Whangarei 45-year-old was usually one to practise what she preached but, last year, got so busy vaccinating her patients, she forgot to get immunised herself.

Sam recalls leaving work early one day in August, thinking she had a cold.

“I was just feeling rather poorly. I left work early and went home to bed. I think I slept for three days. On the third day I woke for some reason, went to the bathroom, as I knew something wasn’t right, and I was blue.

“I text my friend to say ‘Why am I a blue colour?’ I called the ambulance and was taken to hospital ED. My oxygen sats (oxygen-saturated) were about 70 per cent and dropping.”

She was admitted to ICU soon after and placed on a bipap machine to help her breathe.

“I was struggling to breathe for six or seven days – it was terrifying. I never want to experience that again.”

A day later Sam’s doctor told her ‘We have to talk’.

“I remember looking at him and saying: ‘This is it? I’m going to die? … I need to make a few calls.’

That was Sam’s last lucid memory for the next three and a half weeks as she sank into a coma with multi organ failure.

While her beloved dogs pined for their mistress at home, her family and friends rallied round her bedside where she had been flown to Auckland, with her best friend flying over from Australia.

Sister Kate says she was shocked when she saw the state of her close sibling.

“There were tubes and wires everywhere. Just seeing Sam like that – it was awful. It was the worst experience of my life but Sam is stubborn and strong-minded and I never had any doubt that we would lose her.

“We had a family meeting and, despite being told we shouldn’t get our hopes up, looked into all the options.

“A lot of research doctors came in and I just signed her up for everything.”

While doctors considered placing Sam on the ECMO (heart and lung) machine, Kate spent the long tough days giving her sister foot and head massages, singing and reading to her.

“We all handled it differently – our nephew, who is usually really tough, just sat in the corner sobbing his little heart out. I’d wake in the middle of the night and hear dad crying which would set me off.”

While her family fretted and grieved, Sam was off in India having crazy exploits which still give her nightmares today.

“I remember having many vivid dreams while in the coma. I think I was in India with random people and we were at this place praying for forgiveness. I was paying penance I think, but I’m not sure what for. Another time I was in a bus and the oxygen was running out – I kept reaching for the handle to get out but I couldn’t move my arms. It was horrific. Other things happened but I won’t talk about them – they are too freaky.

“After I came out of the coma, a spiritual friend of mine asked me who Renee was. That is my aunt who’s passed so I believe I met with her.”

As Sam came out of her coma she remembers everyone peering down at her.

“I don’t remember what my thoughts were but my nephew told me the first thing I said was **** off to the nurses. I was shocked. I was terrified, frustrated, hallucinating. I could not walk or talk. I had a tracheostomy in situ. I was literally a dead weight. I couldn’t even lift my arms they felt so heavy. My hair was a mess, I hated being turned and my bottom wiped, I was on dialysis, I had double pneumonia, H1N1, influenza A – you name it, I had it all. I was one sick puppy.

“My emotions were all over the place and I heard I was a bit of a struggle for the nurses but I felt hopeless, useless and trapped against my own will. I just wanted to get out of bed and walk home. I said to my brother, ‘Just back the car up and I’ll pull all these lines out’ and I was trying to do just that.”

Despite the odds, Sam made a miraculous recovery and, cited a ‘medical mystery’, was finally told she could go home seven weeks later.

“I would have run if I could. “My dogs were so happy to see me, they were doing somersaults.”

Since then, she has pushed her limits every day, despite a damaged lung capacity which causes shortness of breath – the only long-lasting physical effect.

After four month’s rehabilitation, Sam has returned to work, albeit in a different less stressful job and says she absolutely advises her patients to get the flu vaccine.

“Sometimes they say to me, ‘But it’s just a little chest infection’ and I say, ‘Yeah? I had a little chest infection and it nearly killed me’.”

And there is no way Sam will get too busy to have the vaccine herself.

“Life is different now. I live like never before. I don’t feel as stressed anymore and I’m happy to be alive.”

Nine months later Sam still gets emotional while recalling her experience.

“When I was in hospital and I’d see the helicopter come in, I’d just cry because they are awesome, just awesome,” she says, tearing up. “I’m into raising money for the helicopter now – they are so good.”

A pioneer in setting up rural health clinics for vaccination, Sam is a strong advocate for making sure that health services are accessible for Northlanders.

“We used to find out which children hadn’t been vaccinated and go out and search for them.  It would be like, down this dirt road, hang a right, down a gully to find the brown house.

“I knew the people from a whanau perspective and they trusted me. Very often they didn’t have a car so they welcomed us to go to them and vaccinate their children. I will never forget sitting in a paddock with sea views, surrounded by babies playing in the dirt, while we watched them for 20 minutes after they had had their vaccinations.”

Her advice to others, having come so close to death?

“Make sure you get your flu vaccination because life is for living – oh and don’t sweat the small stuff.”


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Patients’ rights, nurses’ rights

stress-feature01NZNO delegate, Erin Kennedy asks an important question: “Is unsafe staffing a breach of the Code of Health and Disability Services Consumers’ Rights?”

Like most nurses, I am not easily shockable, but I found myself almost speechless last week on learning that three nurses had been forced into the position of caring for 40 patients overnight on a heavy orthopaedic ward. (A pool nurse also came to help for part of the shift.)

NZNO organisers and delegates have argued strongly for safe staffing for years now, but unfortunately, the level of permanent and pool staffing means that staffing levels including skill mix are often unsafe, with sick staff unable to be replaced. The constant push to avoid financial penalty when the 6-hour Emergency Department rule is breached also leads to patients being moved from the Emergency Department to areas where there are simply not enough nurses to care for all the patients safely.

Under the Code of Health and Disability Services Consumers’ Rights, patients have a number of rights, including the right to co-operation amongst providers to ensure quality and continuity of services, and the right to informed consent. The right to be fully informed means information must be conveyed to the patient in a way that enables the patient to understand the treatment or advice. Right 6 of the code states that every consumer has ‘the right to the information that a reasonable consumer, in that consumer’s circumstances, would expect to receive’. Specifically, it states that patients are entitled to an explanation of his or her condition and an explanation of the options available, including an assessment of the expected risks, side effects, benefits, and costs of each option.

Given the unsafe staffing levels at some of our DHBs, it is high time that explanations around surgery, for example, go further than simply outlining the procedure and its risks and benefits. Patients should ask, and should be told, whether their post operative care will be safe. A “reasonable consumer” clearly has the right to know whether their recovery might be hampered because of unsafe staffing. Certainly, if I have surgery any time soon, I will be asking whether there are enough nurses rostered on to provide all of the care I and other patients require. Will there be enough staff to ensure that I can obtain analgesia or other medications on time? Will the nurses be able to check my vital signs often enough to notice if I am bleeding, or have arrested or need medical intervention? If I need help mobilising to the toilet, will there be someone to help me or will I risk a fall and further injury? Will there be someone to answer my call bell if I need help?

Nurses do not like being forced to ration care, but until all DHBs accept that in many instances staffing levels are unsafe (for both patients and nurses), it is a fact of life and one which can seriously impact patients’ wellbeing and recovery. Not warning patients that their post-operative care may not be optimal, and could be downright dangerous, is, in my opinion a breach of the code.

 

 

 


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Care rationing a sad reality

Care rationing web headerNZNO believes every patient has the right to receive quality care, every shift, every day. Nurses, midwives and health-care assistants also have the right to work in safe, supportive environments and be enabled to provide quality care.

The Safe staffing healthy workplaces unit defines care rationing as: “Any occasion when an aspect of a patient’s required care is either missed altogether, unduly delayed, performed to a suboptimal standard or inappropriately delegated to someone not qualified to perform the activity.”

Is care rationing the “new normal” in patient care?  Are failing to take observations and administer medications on time, inability to turn bedridden patients two hourly, skipping hygiene cares, inability to mobilise patients  regularly, failing to provide comprehensive patient education, not answering call bells, all too familiar aspects of too many nurses’ shifts, too often?

Care rationing is unacceptable because it means patients do not receive all the care they require, it exposes patients to unacceptable risks, it can have serious consequences, it increases patient morbidity and mortality, and contravenes people’s rights to health services of an appropriate standard.

Drawing on national and international research, NZNO’s newly-released position statement attributes care rationing to a systems failure due to inadequate staffing or inappropriate skill mix or insufficient time or a combination of these factors.

The position statement was developed to articulate that care rationing is a systems failure, not a failure of individual nurses. We have chosen the term ‘care rationing’ because terms such as ‘missed care’ or ‘care left undone’ imply that an individual nurse is to blame.

Care rationing is not just another form of prioritisation. Prioritisation occurs at the start of a shift when nurses consider the work that has to be done over their shift and what needs to be done first. Care rationing happens in a chaotic way when there are simply not enough staff to do the work and nurses have no control over the situation.”

It doesn’t have to be this way. NZNO has a plan to eliminate care rationing. What we need is:

  • increased funding for DHBs;
  • nursing care made a priority in decision-making;
  • nursing seen as an investment, not a cost;
  • patient-centred models of care;
  • a focus on early intervention and prevention, and nurses working to the full extent of their scope;
  • full implementation of the care capacity demand management programme in all DHBs;
  • effective workforce planning;
  • transparency about staffing levels;
  • funding to address its cultural impacts;
  • immediate action when staffing requirements are not met to ensure patients get the care they need; and
  • patients who are empowered to complain when their needs are not met because of inadequate staffing.

To find out more about care rationing and what NZNO is doing to eliminate it, go to www.nzno.org.nz/carerationing

 

This blog post was developed from an article first published in Kai Taiki Nursing NZ, vol 20, no 6, July 2014.

 

 

 


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Our health, our taonga

233_Hui_a_Tau233

Inspired attendees at the Indigenous Nurses Aotearoa conference 2014

Kerri Nuku is NZNO’s kaiwhakahaere and is of Ngāti Kahungunu descent. As a leader for Māori within NZNO she sees it as her responsibility to ensure that equity is achieved for all Te Rūnanga members.

The other day someone asked me what the highlight of my year has been so far. Usually that kind of question causes me to ponder for a while, but not this year. The absolute highlight of my year is the very first Indigenous Nurses Aotearoa conference, held in Tāmaki Makaurau in August.

The theme for the conference was “Our health, our taonga”, which really resonated with me – as I sense it did with every other attendee. We were stimulated and challenged in our collective responsibility to protect our fundamental right to good health and wellbeing.

It was so energising to be with over 250 indigenous nursing leaders, including nurses, midwives, nursing students, kaimahi hauora and health care assistants. Our combined enthusiasm and commitment to make sure health is a taonga was infectious. It is a privilege of our te ao Māori (Māori worldview) that we see health/hauora as a part of our whakapapa, our whanau, our environment and our culture.

As indigenous nursing professionals, we are committed to reaffirming our rights under the United Nations Declaration of Indigenous people’s article 3, to self determine, and this must underpin any future Māori nursing strategy. We must have faith in ourselves and be courageous in our aspirations for the health of our whānau, hapū and iwi. We must look towards the imagination place to see what could be.

We honour our early Māori nursing pioneers, like Te Akenehi Hei, who halted the death of Māori from introduced diseases. We have nothing to fear as we move into the future – our tipuna made sacrifices and we will too, so that our mokopuna, whānau, hapū and iwi receive the best health care available in Aotearoa.

As indigenous health professionals, we must have the freedom to determine what is best for us.

We will continue to advocate for Māori nursing and workforce issues. We will lobby for change and challenge the barriers that are placed in the way of Māori nursing and workforce success.

Kaimahi hauora:  be brave, take action when you can! Ko te kai ā te rangatira he kōrero!

No reira, tēnā koutou, tēnā koutou, tēnā tātou katoa.

 

Click here for more information about Te Rūnanga o Aotearoa, NZNO.

 


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My journey, my patient’s journey

emotional-intelligenceHere’s another blog by West Coast mental health nurse Teniah Howell. This blog is cross-posted with permission  from the Nurses Station blog “The Tea Room”. You can read Teniah’s previous post here.

The topic of emotional intelligence has come up multiple times in my journey through nursing school and into the “real world” of nursing. When the topic was first mentioned to me, I had never heard of such a thing before, and really never considered the need to become competent in this area.

Emotional intelligence, essentially, is the ability to recognise your own feelings, emotions, and responses, as well as those of others. Now, we recognise these emotions in different ways – some people journal, some people simply contemplate, and others discuss with trusted mentors/supervision/work place support etc. The importance in understanding where we are at in our own lives allows us to more easily interpret the emotions and responses of the patients we work alongside. It is easier to help our patients find strategies for coping that work for them, if we have first acknowledged and recognised our own strengths and abilities to cope. Nurses cannot relate to patients and help them if they are themselves in an emotionally unstable place.

One thing that I have noticed in my own practice, is that in order to truly develop a therapeutic relationship with a patient, I must be able to differentiate between my own thoughts/emotions and the situation. I have to be able to know what I think and believe about myself and yet not push my own thoughts and beliefs onto my patient. I have to be able to recognise that my patient’s strengths and ways of coping will be different than my own. In my experience this ties into the idea that we all possess a “shared humanness”. While we share a lot of the same emotions, experiences, desires etc.; each one of us is unique and individual. While we all have different strengths and ways of coping with the challenges of life, we all still share the experience of being human. Therefore, we can offer each other grace, knowing that we are in many ways the same.

A patient’s journey can be made easier by having a nurse who will walk alongside them, who understands that human experience; a nurse who has her/himself faced challenges and experienced a range of emotions; a nurse who can relate to them, and also recognise their uniqueness. It takes an emotionally intelligent, competent nurse to do this. It takes someone who has explored their own thoughts and beliefs; someone who is not only able to recognise their own strengths, but can also recognise the individual strength of their patient.


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Katrina Coleman – Young nurse of the year

DSC_0005The NZNO Young Nurse of the Year for 2014 is Katrina Coleman, 27, a Plunket nurse in Newtown, Wellington. She works with a large number of new migrant families, and helping improve their health outcomes is just as likely to see her advocating to move them to better housing, as assessing children’s growth and development. The communities have changed since Plunket began over a century ago, but Katrina’s work today in building trust with families, and connecting them with the people and services they and their children need to thrive has a lot in common with those first Plunket nurses. It draws on every bit of her nursing experience across mental health, hospital and public health.

Katrina has won the NZNO young nurse of the year award, but it’s clear the real winners are the new migrant families she works with in Newtown. She learned early on to adapt her schedule to their needs: “I do four to five home visits in the morning, and then four to five in the afternoon, and I remind everyone that I’m coming that morning. Often the people I’m seeing, their lives are so incredibly complex that even if I tell them the day before, they may forget.”

She acknowledges the high number of home visits is unusual for many communities: “It is a high amount of home visiting in Newtown – but it’s definitely the way to maintain engagement. If you imagine being a Somali mum with seven kids under 7, arranging transport to get to a Plunket clinic is just not able to be a high priority, because how could it be? It’s about making the service accessible and comfortable – arranging visits at their home, at a time they choose.”

Newtown is the most diverse community in Wellington, and one of New Zealand’s new migrant centres. Along with Somali families, Katrina works with families from Ethiopia, India, China, the Middle East – some New Zealand/European, and very few Maori and Pacific Islanders. For many, Katrina is often their only link: “We’ve seen women at the most vulnerable time of their life when they’re scared and sometimes they don’t have any real option but to trust you, because they don’t have anyone else.” You only have to imagine for a moment that you’re a newly arrived mum in Newtown, you don’t speak English, you can’t read or write, and you have no local connections, to get a small insight into the difficulties her clients face – and the significance of Katrina’s role.

Her work brings her into the homes of families living in appalling conditions, and a large part of her day is spent working with other agencies to get families’ basic needs met: “I remember sitting with a family last year who had been placed in a horrendous house, they had six kids under six. I was sat on the couch, and the mother said to me – ‘can you help me, there are rats living in my couch’ – the couch I was sitting on. You can imagine, I jumped pretty quickly. The situations people are living in, the poverty is appalling and often, these are people who don’t have a voice.”

She says some of the mums are illiterate: “They will ask me to fill in these forms for everything, not only for health services. It’s not in the role, but at the end of the day that’s why my relationship is strong – it’s about leaving my objectives of the visit at the door and doing what they need me to do, whether it’s filling in a form or looking for lice in people’s hair. It’s not always glamorous. It means having hard conversations with providers of social housing, but I refuse to back down when I’m advocating for a family.”

It goes beyond the Well Child schedule, but she does it because it’s a determining factor to a child being sick or well: “I can truly say there are families I visit now who would be sick every time I saw them, they’re now in insulated homes, they’ve access to kindy – and their overall health outcomes are improved.”

And it’s how she builds her relationship with a family – and the community. “I always knew when I started the role that it wasn’t just about building the relationship with families but with the broader community. In some cases, I’m the only NZ European person they know, or the only person who can link them in to the system.”

Which means maintaining boundaries can be a problem: “They say – can you stay and look after the kids I need to take this one to the doctors. Or can you drive my parent to the hospital. And I have to say no, and you can see this realisation – that we’re not friends, I’m doing a job. It’s an honour that people trust me with their parents and sick children, but it’s important I maintain those boundaries.”

Along with connecting families with services, she works to connect families with the people who have the resources and help they need. Not least, this means drawing on the Newtown Plunket committee of volunteers:  “We came up with the idea of Christmas parcels  – sunblock, beach towels, food and gifts. But the winter ones are the best, they have slippers, warm clothes, blankets and nutritious winter food – brand new and donated stuff. Newtown is an amazing place – we got $1000 of toys from the City Mission last year – just incredible generosity.”

And with the help of Plunket volunteers, she launched the Link database at the beginning of the year – a way for women of the same culture to be linked with each other. The idea started when one of her clients, a mum with two children under two, had come out of violent relationship but had no social support, spoke little English, and couldn’t leave the house as she had agoraphobia: “It was tragic – she was in an awful place. I knew another Chinese mum who was unhappy in her marriage, she was brought here soon after getting married, and she was living in huge apartment building, she knew no one, she had no transport. I wondered if it would be beneficial to link these two mums together. So I got consent, and over the next 6 months I saw the most incredible transformation in these women’s lives – the mum with agoraphobia was able to get out of the house. The other mum had a purpose to leave the house, and every time I see these families now you can see the change in these women, in how happy they are with their children and how connected they are in the community. I thought – this is totally the most amazing thing I’ve ever achieved.”

She says that sometimes it doesn’t work out because of social hierarchy, but the link database is now offered to all Wellington mums, and run by a Plunket volunteer.

Katrina is celebrating her 3-year anniversary as a Plunket nurse in Newtown this month and describes the community support system she’s helped set up as a ‘finely oiled machine’ – though is quick to acknowledge others: “I can’t take credit for the generosity of the people of Newtown. For example, the other day The Warehouse gave me 27 brand new winter jackets. They wanted to help – it’s amazing how many people will say yes when you ask. And five years before I stared, Jess, the Plunket nurse here laid a huge foundation – she built a lot of that trust building in the community – I picked up on her vision and her dream for Newtown. It’s a great place.”

“I came from public health nursing from Waikato – it’s so isolated there, getting to hospital appointments is a nightmare. Here we’re right in the thick of it. If you’ve got a hospital appointment – you can walk there.”

Her enthusiasm isn’t worn by the challenges – instead, it’s clear she loves the job, and thrives on helping the people she works with: “There’s a huge aspect of social work involved in it. Possibly some of the nurses before me would have said ‘this isn’t my job’. I truly believe I have a working relationship with the migrant families – I decided I was going to be “that” person. It’s about triaging the need, meeting their needs one by one.”

She acknowledges it’s an intense role, and has worked out tactics for conserving her energy – like not looking too far ahead: “I never look at what my next day is going to look like until I get there because of how big they’ll be – I don’t want to start the day feeling exhausted by the day’s work I’m about to do.”

But while she takes each day at a time, when she decided to work for Plunket, she took the long view: “I always saw the role with Plunket as a long-term commitment – it’s not like working with the hospital when you have short-term, intense relationships of trust. It takes years to become trusted with in the community and when you take on a role with Plunket, you’re aware that you’re going to invest the time with the community as well as the families.”

“I always wanted to be a Plunket nurse – I was sitting in class and remember the Plunket nurse coming in working with well children in the community – I wanted to gain as much experience as I could and I’d recommend that to all new nurses. I worked in mental health and did my first post grad certificate in mental health – it’s priceless in this role, dealing with mums who are struggling with their mental health and have been through so much.”

As for the future, she’s a year away from completing her masters in nursing: “I don’t know where I’ll go next, but I can’t imagine not being in Newtown.  I’m from Hutt Valley originally and I’ve lived on the coast for seven or eight years –I think it helps being so far away. It would be hard to do this job while living in Newtown.”

And news of the award itself still hasn’t sunk in: “I think everyone’s blown away – it’s such an honour. My friends and family are my number one support. They always think you’re the best of the best anyway, but it’s hugely pride evoking.   The award is nice because it makes missing out on family functions and catching up with friends only occasionally all for something.”

The photo shows Plunket nurse Katrina Coleman with Rebecca Brown and her 12 week old daughter, Juniper Johnson. Thanks to Rebecca for allowing us to use this wonderful photo.

 

 


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Building confident nurses

bigstock-D-Knob-Confidence-Level-46141444-583x437Teniah Howell is a newly graduated nurse, NZNO member and advocate for young nurses. She currently works as a mental health nurse on the West Coast having spent the previous 18 months in the medical surgical unit at Grey Hospital. This blog is cross-posted from the Nurses Station blog “The Tea Room”

I have had many recent conversations with young nurses from my graduating class, as well as the new graduates who joined our nursing team in January, about the process of building confidence in nursing practice.

It would seem that for many, confidence is something that progressively builds over time. As our skills, knowledge, and experiences increase, we become more certain that the decisions we make are indeed the right ones. We learn to adapt more quickly, and to trust our instincts. For me personally as a new grad, I found that it took several months to really feel that I could trust my instincts and my decisions and stand strong in advocating for my patient’s care and for the decisions that I believed were the right interventions for my patient. I would say that there was probably a significant jump in my confidence at about five months into my nursing career. I felt at that point that I had learned to trust myself a bit more, and had gained valuable skills and experiences along the way.

At our DHB, the new graduates do a department switch at six months. This meant getting “knocked back” a bit with my confidence as I was then in a completely new environment and relying on skills and judgment that I had not yet developed. I found, however, that this time around my confidence grew faster and within a few months I felt much more capable. In talking to others it would seem this is a common theme.

I have found that confidence is something that grows (almost in a step-ladder type of fashion). It builds on the experiences and skills that you gain as you continue your nursing career. I say this to really encourage those young nurses out there who are starting out and are only just beginning to realise your potential within the nursing team. Remember that it is a process. It will come with time. Offer yourself the grace to recognise that it will take time to build the trust in yourself, and for the team in which you work to trust your judgment as well.

It has also been my experience that the team you work with can either build or break down your confidence depending on how they respond to your nursing practice and your suggestions for patient interventions and care. Working with a nurse who is demoralising and cuts you down every moment of the day can really make you feel small and insignificant. It can be extremely hard to build your confidence in this circumstance. On the contrary, when someone encourages you and says that you have made the right decision, it can do wonders for building your confidence and your trust in your own decision making. I would like to challenge you to be type of nurse that lifts others up. Be the one who helps to build other’s confidence by offering words of encouragement to your colleagues. (Especially the young nurses and student nurses whom you might be working alongside).

I am moving into a new role next week, and will once again be starting off in an area where my experience is limited. As I embark on this new journey, I am aware that at first my confidence may “take a hit”, but through my past experience I know that it will quickly build back up again. I am encouraged by this, and do hope that I will be lucky enough to be supported along the way by my colleagues. We can only hope that if we give good out, we will have good returned to us.

As Mahatma Gandhi said, “Be the change you wish to see in the world.”