Trans-catheter aortic valve implantation (TAVI). The keys to best practice outcomes. Murray Hart

Print Friendly, PDF & Email

Optimal outcomes post-TAVI are based on selecting the best or most appropriate patients for the procedure. There has been growing awareness of the importance of frailty as a determinant of patient outcomes. In many TAVI programmes frailty and cognitive assessment are done routinely using standardised scales. The presence of frailty at an advanced age means that aortic valve intervention is less likely to improve quality of life or mortality. Serum albumin is an important marker of frailty.
As part of pre-procedure patient/whanau education setting expectations is key to promoting and expecting the best outcomes. An example of this is the expectation of discharge the day following procedure.
Patient outcomes have improved through a combination of TAVI cardiologists gaining experience, improved valve design, and the procedure becoming more minimally invasive. The less is best approach has decreased complications and morbidity. With a minimally invasive pathway the procedure is performed under conscious sedation, no central venous line, no urinary catheter, CCU length of stay is 3-4 hours, and most patients discharge the day following TAVI procedure.
The mitral valve has complex anatomy but the technology exists to replace it by a transcatheter or percutaneous approach. This technology is not yet available in NZ, but it represents the next step into the future. With new innovation in practice the best is always ahead.
At a personal level, seek to be the best nurse you can. Bullying or workplace violence is common in nursing. Bullies frequently pick on the best, they seduce others to protect themselves, and they blame the target. If you are being bullied at work it is because you are the best. Remember it is not your fault and you are not incompetent. As nurses progress through their career, they will find their passion. Find your passion and follow it.

 

Murray is a Clinical Nurse Specialist in cardiology at Christchurch Hospital. This role encompasses a coronary care unit, cardiology ward, and the Cardiac Cath Lab. In additional to his CNS role, Murray is the Coordinator for the Transcatheter Aortic Valve Implantation (TAVI) programme at Christchurch Hospital.  His background experience within cardiology includes Cardiac Cath Lab, nurse educator, and cardiology research. He is passionate about teaching nurses and growing their professional development.

C.I.P.R – critical incident peer response team. A welfare intervention for full theatre teams. Neroli Harrison-Katene

Print Friendly, PDF & Email

Background
Two anaethetists who used debriefs after simulated crisis were getting repeated requests to offer service for real life crisis. The theatre manager observed reduced resilience in staff, affecting retention and therefore encouraged these 2 to upskill in this type of intervention. Funded by theatre department.
Today we have a trained team of 14, with 8 currently contributing, consisting of; anaesthetic SMOs, surgeon, PACU and theatre nurses, anaesthetic technicians and midwives.
Programme set up to provide psychological first aid to staff members in the perioperative services and delivery suite, who have been involved in a critical incident. The goal is to help staff mobilise their individual and team coping resources to mitigate the psychological effects of the event. It is a team approach to welfare rather than individual.

Three key learning points:

  • It is unpredictable what events are “critical incidents” for people and which members of the team will be affected.
  • Having the full team is important for sharing of information/knowledge/understanding, and this helps immeasurably with the emotional response
  • Culture change within theatre by having this intervention available: a reminder that we are valued by our colleagues and management; is resilience building.

Conclusion
Team has been operating for over 2 years and held 20 defuse sessions. Anomymous feedback via a QR code has only been positive with all responders saying they would attend again and/or recommend attendance to others.

 

Neroli is currently the Clinical Nurse Coordinator for the ENT theatre at Waikato Hospital. She has worked there for over 30 years in a variety of specialties.
Neroli is looking forward to sharing an initiative they have introduced in their department to support staff wellness.

Canterbury’s Supportive Perioperative Learning Environment. Sarah Gibbon and Lorna Davies

Print Friendly, PDF & Email

The perioperative environment is one clinical area which involves interprofessional teamwork. A clinical area where team members respect the contribution of each discipline and where Enrolled Nurses can fully participate as members of a collaborative team.
The recent Nursing Advisory Report: Nursing Safe Staffing Review (2022), recommends that over the next 12 months Enrolled Nurses (ENs) need to be factored in to staffing plans and that they can “play a valuable role in reducing pressure on Registered Nurses” (p.74). However, positions in perioperative departments for Enrolled Nurses remain few. This may be due to the lack of exposure ENs have as students, or perhaps the lack of exposure the departments have to ENs!
Over the past 7 years, Ara -Institute of Canterbury and the Canterbury District Health Board, have worked to address these issues, resulting in new graduate ENs working in both public and private Operating Departments. This presentation will discuss the collaboration between the two entities, and their success in creating a supportive perioperative nursing learning continuum: from the students’ Dedicated Education Unit model to the new graduates’ Enrolled Nurse Support into Practice Program.
Reference – Nursing Advisory Group (February 2022) Nursing Safe Staff Review Nursing Safe Staffing Review and Report on the Review of the Care Capacity Demand Management (CCDM) Programme | Ministry of Health NZ

 

 

 

 

 

 

Sarah Gibbon, BA. BN. RN. PGDip.HSc (Nursing),
Nurse Coordinator – Enrolled Nurse Support Into Practice Programme (ENSIPP),
Canterbury District Health Board

Lorna A Davies Gibbon, MA, BA(Hons), RN, PGDip Periop. DTLT,
Programme Leader NZ Diploma In Enrolled Nursing,
Ara Institute of Nursing

New graduate nurse operational capability within the first two years in the operating theatre as a tertiary hospital in NZ. Christina Mason

Print Friendly, PDF & Email

Little is unknown about new graduate nurses first years of employment in the Operating Theatre. This research aimed to determine the timeframes that new graduate nurses achieve competence and confidence at performing core and specialty skills related to scrubbing, circulating and leadership within the Operating Theatre. Pre-registration exposure was established, and the significance of orientation and education explored. Participants included registered nurses (n=39) employed through the nursing entry to practice (NEtP) programme, at the research site operating theatres between August 2018 and August 2020.

Objectives
Overall aim
To establish the operational capability gained by the new graduate workforce within the first two years of employment within the operating theatres.

Specific objectives

  1. To establish the level of Operating Theatre exposure, new graduate nurses, receive before commencing their NETP year.
  2. To establish the skill level competence acquired by new graduate nurses in scrubbing and circulating for minor, intermediate and major speciality cases within their employment.
  3. To establish factors which contribute to skill acquisition within the Operating Theatre.
  4. To determine the timeframe that new graduate nurses are undertaking clinical leadership roles within the Operating Theatre environment.
  5. To establish the confidence levels of new graduates, required to work across the department/specialities.

Methods
A descriptive survey designed to collect quantitative data was chosen to establish associations between the variables and investigate statistical relationships. Data collection from the sample group was via an anonymous Qualtrics questionnaire. Data was exported directly, and analysed in, the Statistical Package for Social Sciences version 26 (SPSS26).

Results
Results showed that NGN acquired basic and intermediate scrub and circulating skills across several specialities within the first year of practice. The number of specialities increased in the second year of practice, and further accomplishment of complex skills could be seen in a minimum of one speciality.
NGN showed confidence in their acquired competence skills. Furthermore, results reported that new graduate nurses undertook basic leadership roles early in the first year of practice. However, complex leadership roles, were not experienced by new graduate nurses as frequently and took longer to develop confidence.

Conclusion
Overall, the research concluded that new graduate nurses became competent and confident within the first year of employment in basic and intermediate surgery, with increasing confidence in complexity in the second year of practice.

Christina has worked as a Theatre Nurse since 2000, in New Zealand and the United Kingdom. Career highlights include working at the Royal Marsden Hospital where she developed her love of Hepatobiliary surgery and working at Christchurch Hospital where she was the Operating Theatre Clinical Nurse Specialist for General Surgery, a role she held for six years. Christina is currently the Theatre Manager for Mercy Hospital, MercyAscot, Auckland.

Working in chaos. Rebecca Porton-Whitworth

Print Friendly, PDF & Email

Background

At 1.40pm on the 15th March 2019 a lone gunman entered the Al Noor Mosque in Riccarton, Christchurch and opened fire during Friday prayers.  He then drove to the Linwood Islamic Centre again shooting those engaged in prayer.
The attacks ultimately killed 51 people and injured 49.
This presentation covers a reflection from a perioperative clinical nurse specialist on the many challenges faced by the perioperative team in managing and caring for the mass casualties from the Christchurch mosque shootings which was published in the Dissector in March 2020.  This presentation was prepared and presented at the Tongariro Cardiac Meeting in March 2021.
It addresses the mass casualty response by CDHB, flow of patients through the operating theatre, patient identification, forensic specimen collection, responses by different members of the perioperative team including sterile services and our operating theatre assistants.  As well as addressing communication and wellbeing.

 

The second part of the presentation looks at working in chaos. Again, this is based on an article published in the Dissector in March, 2020.  Mass casualty events are a global phenomenon which tests major trauma systems.  Each incident poses different challenges and injuries from differing environments.  It is important that we learn through debriefing and sharing of information so that lessons learnt can be incorporated into future planning.  An established trauma system delivers a continuum of care for patients and provides a synchronised approach to trauma care offered by first responders, hospitals, community providers and government (HQSC, 2019).  The outcome results in lives being saved, reduced disabilities and a more effective healthcare system.

It addresses the effects of Terrorism on the Healthcare Community and The Aftermath.
There are several key phases to recognise by medical staff in their response following a terrorist incident.

Phase 1: Chaos

Phase 2: Casualty receiving phase

Phase 3: Consolidation

Phase 4: Definite Care

Phase 5: Rehabilitation

Staff Support

Rebecca RComp, BHSc, MNurs (Hons) has worked extensively for nearly thirty years within the perioperative environment working in a variety of specialties and roles.  She graduated from Christchurch Polytechnic in 1992 and has work within the public and private sector in New Zealand as well as overseas.  This is where she developed her passion for cardiothoracic surgery working in both the paediatric and adult acute and acquired congenital.  She has continued a variety of postgraduate education and is tertiary qualified at Masters Level with First Class Honours.  This set her on a new path working as a Registered Nurse First Surgical Assistant within the cardiothoracic specialty.   She is currently working as a Clinical Nurse Specialist of Cardiothoracic and Vascular Theatres at Christchurch Public Hospital and continues to work as an RNFSA.  She has also been involved in volunteer work with the Mutima Project which travelled to Zambia to perform heart surgery and the Friends of Fiji Heart Foundation.  She joined the Dissector editorial team in 2019.

 

Ultrasound guided canulation as the new gold standard for IV access. Peter Ouden

Print Friendly, PDF & Email

Any medical professional with hospital experience knows how crucial successfully inserting a peripheral IV can be. Getting fluids and medications without delays, into a critically ill or injured patient can make or break the effectiveness of their treatment.
Vascular access for the infusion of medications and solutions requires timely assessment, planning, insertion, and assessment. Traditionally vascular access is reactive, painful, and ineffective, often resulting in the exhaustion of peripheral veins prior to consideration of other access options.
At best, a patient with challenging vasculature that involves multiple insertion attempts can frustrate and fluster medical staff while causing the patient to experience pain. At worst, a tricky vein can mean mounting medical complications as a patient condition worsens; and the eventual necessity of a central venous line, which while remarkably effective, carries its own set of risks.
Multiple attempts at cannulation and the placement of IV devices in areas such as the wrist and anti-cubital fossa can increase the risk of thrombosis, infection, and device failure.
“[It] can cause anxiety, patients can develop phobias,” says Dr Evan Alexandrou of Liverpool Hospital in New South Wales, Australia. “They come to us highly anxious, sometimes crying, and they’re essentially at the point of refusing any treatment because of the trauma.”
Veins can be difficult to access for several reasons, such as patient dehydration, a history of previous multiple canulations, including attempts, intravenous drug use, and obesity. Underweight and premature infants are particularly difficult candidates for normal peripheral IV access because their veins are simply so small.
Given the necessity and prevalence of peripheral IVs as a part of treatment, it is no wonder that any solution that would make IV access easier would be eagerly adopted in almost any setting.
Introducing ultrasound guided IV insertion to patients with challenging vasculature is exactly what is happening at Christchurch Hospital. Spearheaded by the Department of Radiology Nursing Team a new protocol for limiting the number of failed IV insertion attempts is now being adopted by other teams within the hospital campus.
Evidence suggests clinical pathways improve outcomes by reducing variations and establishing processes to assess and coordinate care, minimizing fragmentation and cost. Implementation of a vascular access clinical pathway will lead to the intentional selection of the best vascular access device for the patient specific to the individual diagnosis, treatment plan, current medical condition, and the patient’s vessel health. A Vessel Health and Preservation (VHP) programme incorporates evidence-based practices focused on timely, intentional proactive device selection implemented within 24 hours of admission into any acute facility.

Aim/Objectives: The learning objectives for this presentation are:

  • Early identification of the Difficult IV Access (DIVA) patient
  • Early identification and insertion of the correct IV access device
  • Ultrasound Guided Cannulation as the new Gold Standard for vascular access

Peter gained his Nursing Registration in 2001 and joined the Canterbury District Health Board soon after. After completing the New Graduate program, he joined the Orthopedics nursing team, where the Charge Nurse was very proactive in encouraging her nurses into post-graduate studies. He completed two Post-Graduate Certificates (Health Sciences Endorsed in (High Dependency Nursing) through University of Otago and Clinical Teaching through University Canterbury) in this time.
In 2009 Peter joined the Radiology Nursing team, a steep learning curve going from Orthopedics to theatre nursing, he loved it.
2011, he completed the PICC learning package, and has not looked back, since then he advanced into Paediatric PICC insertion and tunneled PICC lines.
His passion and skills have also led me to become very competent at using an ultra-sound to place an IV line, especially those with difficult IV access (DIVA).
He enjoy teaching especially one on one, whether it is focused on ultrasound canulation or passing on skills learned with adult PICC insertions too the next generation of vascular access nurses.

Components of job satisfaction for nurses, with a focus on Generation Y. Gabrielle Alchin

Print Friendly, PDF & Email

There exists significant concern internationally about the ability of the nursing workforce to meet the growing health demands of populations. Contributing to this concern is a globally aging population, increasing life expectancies, and an ageing health workforce that is approaching retirement age. Strategies to address this issue relate to recruitment and retention of staff within the sector. As job satisfaction is shown to be associated with employee retention, understanding the requirements of the nursing profession with the aim to further engage staff has been a focus in international literature. Different generations have been shown to hold varying desired traits from their place of employment, with some authors suggesting that generation-specific retention strategies would be most effective.

Results

Three themes and nine subthemes relating to job satisfaction have been identified, and are as follows:

  • Challenging Practice Environments, which encompasses concerns around heavy workloads, challenging scheduling, and availability of professional opportunities.
  • Positive Relationships, which relates to beneficial and supportive relationships with peers and supervisors, and a connection with the nursing profession.
  • Feelings of Contribution, Value, and Safety within the Workplace, which describes the importance of feeling supported, recognised and appreciated as a nurse within the employment setting.

Conclusion
Across countries and health systems, there exists relatively consistent findings relating to the job satisfaction factors. Despite some specific examples of differences between the generations in regards to job satisfaction, there are significantly more similarities, demonstrating that retention strategies may not need to be targeted.
Although there are concerns about the engagement of Generation Y nurses with their chosen profession, there are currently programmes being implemented both locally and internationally, designed to address the negative components of nursing.

RN, RNFSA, M.H.Sc (Hons)
Gabrielle has nine years experience in the operating theatre, in both the public and private sector. Currently she works as both a surgical assistant and a theatre nurse in Christchurch.
Professional highlights include volunteering in Africa in 2017, and being involved in both implementation of the surgical safety checklist and participating in a review panel for the University of Otago.
Gabrielle completed her Master of Health Sciences (while welcoming her son to the world) through Otago University in 2020, which had a focus on workforce planning and job satisfaction of nurses. The research component of her study explored components of job satisfaction for nurses, with particular interest in Generation Y.

Nurse Practitioners in Perioperative care: One NPs journey and an analysis of their value. Amelia Howard-Hill

Print Friendly, PDF & Email

Amelia’s session will cover her journey to NP as NZ’s first NP who was a RN first surgical assistant (RNFSA) and beyond and analyze the value of NPs working in the Perioperative setting.

 

Amelia Howard-Hill is a  Nurse Practitioner, who has spent much of her career in the Perioperative environment.  NPs in the Perioperative environment are a rarity, with the majority of NZ NPs working in primary care.

 

Transitioning into the kiwi nursing workforce: Lived experiences of a Filipino Nurse. Jerald Ugdoracion

Print Friendly, PDF & Email

A study commissioned by the Nursing Council of New Zealand done by BERL (Business Economic and Research Limited) on 2013 looked into the future of the nursing workforce in New Zealand and its supply projections on the year 2010- 2035. This report illustrates the predicted nursing shortage on the year 2035 as the general population factors continue to change.

In order to bridge this gap, the New Zealand health system has relied on migrant labour from internationally qualified nurses.  According to the 2018-2019 Nursing Workforce report by the Nursing Council, approximately 3 out of 10 (27% of 52,711) of New Zealand’s overall practising nurses are Internationally qualified nurses. The biggest proportion of these nurses comes from the Philippines accounting to 28%. This compels the New Zealand health care system to be more proactive in their attempts to understand this population of nurses and the rest of the IQN population as a whole. Considering the worldwide shortage of nurses, the NZ health care has the moral and ethical responsibility to not only attract IQN to NZ, but to as well help in their successful integration to their new health system.

Transitioning into a new health care system is not an easy task. This discussion will encompass the different struggles and conflicts internationally qualified nurses undergo in their transition which includes social factors, communication styles, marginalisation and discrimination, assertiveness and cultural displacement. The aim of the talk is to give better understanding behind the cultural differences between Philippines and New Zealand allowing Filipino nurses to be better understood and supported in their journey towards becoming New Zealand nurses.

Jerald finished his Bachelors of Science in Nursing – Cebu Normal University Philippines (2008); Masters in Nursing Major in Medical Surgical Nursing – Cebu Normal University (2008).  He worked in the operating theatre 2008 to 2013 – Vicente Sotto Memorial Medical Center Philippines.  Jerald then worked as a Nursing Educator and Tutor – Cebu Normal University (2008 to 2013).  He completed his Competency Assessment Programme – Otago Polytechnic 2013; Karadean Court Life Care (Aged Care) Registered nurse 2013-2014.  He worked at Southern Cross Hospital Christchurch as a registered nurse in the operating theatre 2014 – 2017.  Present Southern Cross Hospital – Clinical Nurse Specialist General Surgery and Vascular Surgery Operating theatre.

Waikato Cyber Attack. Speaker to be confirmed

Print Friendly, PDF & Email

The nation’s spy agency has been scrambled in the aftermath of a crippling cyber-attack and ransom demand that has brought Waikato District Health Board services to their knees” – NZ Herald on 18th of May 2021.
“Cyber attack on Waikato DHB’s IT system won’t be fixed until the weekend”. –NZ Herald on 19th of May 2021.
You probably read the headlines or listened to the news about Waikato DHB’s cyberattack and you probably knew more about this incident than some staff who actually worked here. But let me tell you this, it wasn’t fixed even after that weekend!  Attend my presentation and I will be sharing with you an inside story of how it was in the perioperative complex during the cyberattack. It wasn’t easy but it was quite a journey.  It would be great to learn a thing or two on how to prevent a cyberattack. After all, cybercrime might become the biggest threat to every person, place, and thing in the world (Devon, 2020).