In the Wake of the Quake… A Lesson from Nature

Elizabeth Culverwell IV Nurse Educator Professional Practice Development Unit Department of Nursing Christchurch Hospital

13th IVNNZ Inc. Conference 2012

Demographics CHCH second largest city in NZ CPH one of 13 hospitals that fall under umbrella of CDHB Largest tertiary hospital in the SI -approx 650 beds Provides complex services One of only four main teaching hospitals in NZ Otago School of Medicine Christchurch – 4th & 5th year medical students & medical research centre • Busiest ED in Australasia (CDHB 2011) • One IV Nurse Educator • • • • • •

Now widely known –sited at close proximity to several side fault lines(Geonet,2011)

Canterbury District Health Board(CDHB) CWH Christchurch Hospital Campus

TPMH

Burwood

Partnering Organisations • West Coast DHB • Nelson Marlborough DHB • Private Hospitals – St Georges – Southern Cross – Oxford Clinic

• Nurse Maude District Nursing Services • GP Practices – Pegasus Group – PHO

Clinical Skills Unit

SUPPORT • SHARING EXPERIENCES • DRAWING STRENGTH FROM EACH OTHER • COLLABORATION

EDUCATION • TOOLS & RESOURCES TO SUPPORT PROCESS • PROGRAMMES PARTNERING ORGANISATIONS

ADVOCACY • WORKING TO IMPROVE PATIENTS JOURNEY

RESEARCH • THE TOOLS OF KNOWLEDGE & RESEARCH • PROVIDE SAFE & EFFECTIVE PATIENT OUTCOMES

NATURES First Lesson -7.1 • September 4th 2010 20km from the hospital campus

The Narrative Ward 32 5th Floor Riverside Block

(Byrne & Lyneham 2011)

Reflection & Response... Personal ‘knowing’ – how this influences your actions. Exploration of actions and beliefs (Johns 1995-1996) • • • • •

Change - acceptance -‘the new norm’ Coping mechanisms - humour Analysis of teaching & learning environment Sense of fear even after 4 weeks A sense of waiting for the BIG one (Byrne & Lyneham 2011)

The Second Lesson 6.3

Issues getting to work & from work Road closures Liquifaction

DISCOMBOBULATION !

The Military Support

Dangers around us...

Helicopters landing on our doorstep...

TPMH unload patients from furniture truck using empty milk crates & plywood

Pegasus 24 hr Surgery under pressure

Christchurch Hospital site - water support

The Challenges • • • • • • • •

Relocation & the move Skill acquisition- demands for PIVC/up skilling IV orientation – new staff Unsuitable temporary venues Safety issues Car parking issues Constant interruptions from aftershocks Staff refusing to attend education sessions Maintained Education to ensure patients’ safety outcomes

In search of a venue... IV Cannulation becomes an essential skill

The new item added to the IV Cannulation trolley...

More Challenges • Post earthquake syndrome – Anxiety –anger – health issues (Van Manen,M) – Anti emetics for ‘swaying building syndrome’ (Byrne,H & Lyneham,J)

• Communication – Internal mail – Implications for staff competencies

• Resignations / new recruits /staffing levels/skill mix • Cancellation education - groups /nurses • Noise – internal & external

Relocation TPMH

• • • •

3 medical wards’, stroke unit + nursing staff Effects on staff (evoking anxiety & uncertainty-Bradfield,2006) Becomes a triage centre GPs covering as MO Urgent need develop new skills to meet changes in practice - cannulation & phlebotomy

Location, Location, Location!

Welcome to the PDU/CSU @32!

Preparing for cannulation post quake 2#

The Nurse Educator must provide the best learning environment for staff. Sometimes reality dictates that the environment is only second best. Accepting reality & using resources in the best possible way...’(Saville-Smith 1983)

Valuable Lessons • COMMUNICATION: – Mobile phones - text messaging – Colleagues home contact details -emails – CDHB sets up Facebook

• Electronic data /documentation - identified deficits • Memory stick/flash drive • Always expecting the unexpected! And then came June 2011,6.0 & December 2011

What Else? • New location – reduced space & numbers

• Planned Medical staff education affected – N.E’s educating Drs

• • • •

Demand for ‘short courses’ within hospital Rural Hospitals–up skill Pressure on PDU /CSU resources Financial impact –contracts relocated to other DHBs Need for innovative strategies to deliver education

Cascade Effect 1

2

3

• Demand on community Health Partners • Identified lack IV skills /skill decay • Pegasus Health group(private) & PHO’s (govt) • GP’s • Practice nurses • Urgent need for skill acquisition – IVT & PIVC • GP practices – first line patient care ‘hospital in the home’

Working smarter Standardisation & portable competencies – ‘Train the Trainer’ education progamme for local partnering organisations – Up skill ‘Train the Trainers’ -Level one IVT & PIVC – Introduce role of IVLS throughout all GP practices • Provide IV education resources –in line CDHB policy • Provide moderation - initial sessions • Pegasus & PHO working together – amalgamate & streamline process

•

Creating space in PDU/CSU > numbers

• Catalyst to move projects forward • Revitalise Intranet/internet – Electronic learning resources – Shared Care Record View (eSCRV) – Sharepoint

• Creation Health Hub Nth Canterbury (MoH) • Electronic prescribing

What’s changed ? • The success of change requires: – Strong leadership, perseverance & understanding – New willingness to work collaboratively – Adaptability in new environment

• Silo mentality • As health providers need to be: – productive, flexible, effective

2012.

10,000 + shakes and counting!

Our landscape has changed Our attitudes have changed Our priorities have changed The experience has drawn us all closer together - we are working as a team

IV Excellence - Raising the Standards ‘Standards of Excellence are intended to provide clear research based guidance in clinical practice to ensure we deliver safe & effective patient outcomes...’ Through the spirit of leadership, collaboration, co-operation, and shared accountability the CDHB has ensured the future of health care for our patients.We are now better equipped to meet the challenges ahead.

From the Rubble of winter...

Acknowledgements The Staff of the Professional Practice and Development Unit & Clinical Skills Unit Christchurch Hospital

Jacqui – Christine - Joanne – Neil –Chris & THE COURAGE OF CDHB NURSES & MIDWIVES He aha te mea nui o tea ao? He tangata! He tangata! He tangata!

Dedicated to The Memory Of our Colleague Owen McKenna – RN Clinical Team Co-ordinator Christchurch Hospital 22/2/2011

References • • • • • • •

Byrne.H.Lyneham.J(2011) Nurses’ experience of what helped and hindered during the Christchurch earthquake. Kai Tiaki Nursing Research. vol2 no1.June 2011 Bradfield,J.,(2006). Challenges of changing culture. Available from: http://www.bizcommunity.com/Article/196/181/10447/html. Canterbury District Health Board.(2011,May 20). Retrieved from http://www.cdhb.govt.nz Geonet.(2011,May 20.) Retrieved from http://www.geonet.co.nz Johns,C (1995-1996) Saville –Smith(1983) Towards defining the role of the Clinical Tutor Van Manen,M(1990).Researching lived experiences: Human Science for an action sensitive pedagogy.Albany,N.Y: State University of New York Press.