Nursing

A growing need for emergency healthcare services in Wānaka needs to be addressed.

Wānaka is a close-knit and friendly community, with people willing to help one another out, but like many rural centres it has limited access to health care services. A health centre provides multidisciplinary services, but the nearest hospital care takes an hour's drive or a helicopter ride. After hours emergency services are provided by St John Ambulance, Land Search and Rescue, and Fire and Emergency. These personnel are under pressure with growing numbers of residents and visitors.

This was one of the health issues identified by our Nursing learners in a research project earlier this year. The learners spoke with stakeholders in the town as part of their community assessment. The review of the relevant literature showed that possible solutions to improve access to healthcare services in Wānaka include: a nurse practitioner led model, telehealth service, education to improve the knowledge base of emergency practitioners, and incentives to attract and retain healthcare staff.

The team of Nursing learners wrote a submission which outlined the need and suggested a range of ways this could be addressed. They sent this to the Minister of Health, Ayesha Verrall, and to Grant Davidson, CEO of the Rural Health Network. Grant Davidson replied, indicating that this reinforced his own thinking and he appreciated having more evidence to help seek policy change. He intended to share their submission with other rural health professionals at an upcoming meeting. 

June 2023

Seasonal workers face barriers to accessing healthcare in rural communities.

The Alexandra and Clyde communities are in a prime fruit-growing area of New Zealand. Orchards employ transient labour at busy periods, including many international workers under the Recognised Seasonal Employer (RSE) scheme. These RSE workers have been identified as a vulnerable population by a team of our Nursing learners. 

The team's community needs assessment of the Alexandra/Clyde area included a foot survey and talking with stakeholders. The RSE workers are disadvantaged by language and culture challenges. They try to minimise their living costs in New Zealand, so that they can send as much of their earnings as possible home to their families. As a result, they often do not own a vehicle, and are dependent on employer provided transport to and from work, or to accommodation provided at work. With limited public transport options, accessing health services is difficult for them, and they may also be reluctant to take time off work to seek healthcare.

These issues are not unique to Alexandra and Clyde; the welfare of RSE workers in New Zealand is a systemic problem. The Nursing learners therefore decided to write a submission to Immigration New Zealand, outlining the barriers and enablers to healthcare access that have been identified in the research literature, and urging them to address these.

May 2023

Our Nursing learners have created mental health promotion resources for Queenstown's children.

The team of learners began their research project with a community assessment of Queenstown, talking with stakeholders and gathering information from online resources. The town's dependence on tourism meant that the COVID-19 pandemic has been particularly stressful for families. Children's mental health was one of the health needs that our learners identified and which they decided to investigate further. They felt it was important to address this with children early, before adolescence, to reduce the harm from drug use and the risk of suicide.

Children aged 5 to 9 are able to talk about their feelings but need help to talk about big emotions such as fear and worry. The Nursing learners therefore developed a resource aimed at this age group, with the message "It's okay not to feel okay". They produced posters for classrooms, in English and te reo. 

The messages on the posters encourage children to identify and name their feelings, and to use this self-awareness to manage their responses to those feelings, including seeking help. There will be good days and bad days, and they should not expect everything to be perfect. An associated resource booklet, for parents and caregivers, includes a list of red flags showing high levels of distress and perhaps the need for professional mental health care services.

A separate health promotion resource was created for children 10-14 years old. This campaign is Kai & Kōrero: Let's get talking, and included stickers as well as a poster. The goal is to encourage conversations about how they are feeling, to normalise talking about feelings. 

These resources have been provided to the charge nurse of the community mental health team in Queenstown to consider how they might best be used and distributed.

April 2023

Nursing learners identify ways to strengthen emotional wellbeing and oral health for Whanganui tamariki.

Using primary data from interviews with community stakeholders and secondary data from research, eight Nursing learners carried out a community assessment for Whanganui. They identified two vulnerable populations with health needs they wanted to address: the emotional wellbeing of primary school-aged tamariki, and the oral health of both pre-school and primary school-aged tamariki. The students chose to focus on tamariki Māori, who statistically have more health needs than the general child population, and because the proportion of Māori in Whanganui is higher than the national population average.

The Nursing learners identified that tamariki Māori are at higher risk of poor mental wellbeing due to the persistent and cumulative effects of colonisation of their culture. The learners suggested that schools implement a holistic approach to tamariki wellbeing, including whānau involvement, which would help both tamariki and their teachers to better identify, understand and regulate emotions, build children's resilience and support their mana. The Nursing learners recommend that Whanganui schools provide a culturally appropriate wellbeing tool, such as a poster, that encourages tamariki to identify and express their emotions in te reo Māori or English, at home and at school.

Māori and Pasifika tamariki and children living in lower socio-economic and non-fluoridated drinking water areas have increased risk of dental caries. The Whanganui water supply is not fluoridated. Poor oral health also has a detrimental effect on overall health and wellbeing. The Nursing learners wrote a submission to the Minister for Health with the following recommendations which they substantiated with evidence:

1. Introduce a sugar tax on sugary beverages to discourage and reduce their consumption.
2. Extend the Ministry of Education’s proposed healthy drinks only policy in primary schools to include pre-schools and secondary schools.
3. Fluoridation of all drinking water supplies across Aotearoa New Zealand.
4. Increased investment in preventative and curative oral health care for pre-school and primary school-aged tamariki.

They also designed stickers with the bilingual message “Kia rua ngā wā, ia rā – Twice a day, every day”, to remind tamariki and their whānau to care for their teeth.

January 2023

Why do former prisoners not access health and social services after release from prison?

In Dunedin the Prisoner Aid and Rehabilitation Service (PARS) is contracted by the Department of Corrections to support formers prisoners in the community following their release. A group of our Nursing learners recently worked with PARS to investigate the health needs of released prisoners. 

According to previous research, ex-prisoners have higher rates of mental health problems, drug and substance abuse and overall have poorer health outcomes compared with the rest of the population. Ex-prisoners will often have had poor experiences with health services and this contributes to their hesitation in engaging with health services upon release. Other contributing factors are poor health literacy due to a generally lower education attainment. 

Better pre-release planning and enabling immediate connection with services on release of prison should help provide this vulnerable population with the best chance at reintegrating into the community successfully. Our learners therefore prepared a health promotion pamphlet providing information about available services, to help released prisoners' re-entry into the community. The pamphlet covered financial and support services as well as health care.

They also learned that trauma is found in high levels amongst prisoners in New Zealand. Benefits from trauma-informed care may include improving long-term health outcomes, the opportunity to become more engaged in their own health care and the development of a trusting relationship with the service provider, who is delivering this care. The learners prepared a poster which promoted trauma-informed care, providing access via a QR code to an online training resource. Both the poster and the pamphlet were delivered to PARS for distribution and use.

November 2022

A Fijian village will benefit from a supply of reusable sanitary hygiene products from our students.

A team of eight of our third year Nursing learners focussed on the community of Nasovotava in Fiji for their primary health clinical project/placement. They carried out a Community Assessment Profile in conjunction with community stakeholder Eric Nabalagi, who comes from Nasovotava and has lived in Dunedin for the past 20 years. Health needs identified included lack of water, sanitation and hygiene facilities, poor access to medications and hygiene supplies, and low levels of health literacy. With Eric's endorsement, the team decided to act on improving women’s health through providing a health promotion resource for them.

Lack of access to sustainable period products in rural areas is important because of limited waste disposal facilities for single use products. And if they are unable to manage menstruation well, girls and women are likely to limit their participation in community life. To meet this need for sustainable period products, the Nursing learners found patterns, materials and instructions to make the products, sourcing suitable materials from the wider Otago Polytechnic student community. A working bee was held on our campus on 19 May 2022, for team members to cut and sew together.

The finished products will be delivered to the Nasovotava community later this year, together with posters to improve health literacy and supplies for the dispensary. The Nasovotava community has approximately 250 people, and an estimated 80-100 women will benefit from the student’s work. As well as being supplied 500 completed items, residents will be provided with patterns and instructions to make and use the products. The product life expectancy is up to six years with proper care and cleaning.

October 2022

Drink driving is particularly dangerous on rural roads.

New Zealand has an ingrained drinking culture which attaches no stigma to excessive consumption of alcohol. In rural communities, the association between drinking and socialising is particularly dangerous due to drink driving, with no or limited public transport options and open road speed limits resulting in a high death toll from accidents.

This issue was investigated by some of our Nursing learners, as a result of their research into the health needs of the South Otago community. They asked what would be effective strategies to help address the problem. They identified that drinking is frequently associated with socialising amongst rugby players and their supporters after a game. This would be a key audience to reach because they are at higher risk of accidents due to drink driving.

Our learners developed a positive health promotion message that appealed to the value of team responsibility: 

"Take one for the team - Don't drink and drive."

This message could be printed on both sides of a rugby ball, to raise awareness of the issue by connecting with people. A prototype rugby ball was produced and discussed with the community stakeholders for them to consider this initiative.

September 2022

What people with disabilities can do is limited by service design and unsympathetic attitudes.

A team of our Nursing learners have been investigating the health needs of disabled people in Ōtepoti Dunedin. People who live with disabilities have many barriers to participating in life. Limited transport options for example, affects the accessibility of health services, limits their recreational opportunities, and makes it harder for them to get to and from a job. As a result, their involvement in social life is limited and they are more isolated and lonely. Loneliness itself has an adverse effect on both physical and psychological wellbeing. As a group they are particularly vulnerable to COVID-19, so fear of the disease has reduced the social participation even further.

The learners decided to do something to address the transport issue, as so many other aspects of life depend on transport. They wrote a submission to the Otago Regional Council, which is responsible for bus services in and around Dunedin. They explained that the negative attitudes of bus drivers is a problem that discourages people living with disabilities from using the bus services. They recommended that the Council provide training for bus drivers. The Council was pleased to receive their submission and discussed it with the learners. The intention is to survey bus drivers to find out what the Council can do to help the drivers to support bus users with disabilities.

The learners also developed a prototype for a badge that can be worn by people with disabilities and which invites others to initiate a conversation with the wearer about what they are able to do. As a pilot, the Otago Polytechnic Students Association has funded production of a set of these for distribution at Otago Polytechnic.

August 2022

Encouragement to seek help with their mental health may be just what some young men need.

The mental health of young men is an issue in New Zealand, especially for those living in rural communities. Rural communities have limited access to mental health services locally, which means longer travel times and more time off work or school to seek help. The time required also makes it more difficult to seek help confidentially, so stigma is also a barrier to accessing services. 

The Lumsden community is typical in this regard. Some of our Nursing learners adopted this health issue for their recent research project, after investigating the community needs with local stakeholders. 

To help encourage young men not to delay seeking help they might need, the learners produced a health promotion message which could be stuck onto a keyring/torch, something which the men would be likely to carry around with them. The message is: "Shine the light on your mental health - free text 1737."

• Find out more about the free text 1737 mental health service

July 2022

Having a vegetable garden has health and social benefits.

In Whakatāne and surrounding districts about half the population is Māori.  Being Māori is one of the risk factors associated with Type 2 diabetes, which has a range of adverse effects on health. A team of our Nursing learners chose to focus on Type 2 diabetes in their recent project, to try and improve equity in health outcomes for Māori.

In their research into Type 2 diabetes, these learners learned that healthy eating is beneficial, with fresh fruit and vegetables. They also found that it was unclear whether tenants in Kainga Ora housing were permitted to have their own vegetable garden. 

Our learners took a two pronged approach to help address this issue:

• They wrote a submission to Kainga Ora, seeking a change in the policy and/or practice so that tenants are aware they can have a vegetable garden.
• They developed a fridge magnet with a seasonal planting guide for the Whakatāne region. This fridge magnet design was provided to community stakeholders with whom they worked, for distribution.

The learners hope that growing their own vegetables will empower the community, including through sharing of both produce and gardening skills.

• Listen to a podcast discussing this project

June 2022

Family members who care for people with Alzheimer's in their own homes would benefit from greater support.

Alzheimer's disease is a brain disorder that progressively erodes memory and thinking skills, eventually resulting in people unable to care for themselves. But many older people with Alzheimer's in Dunedin live in their own homes with family support. Māori are more likely to present for memory assessment, and do so at a younger age than the general population, so culturally appropriate services are needed. 

A team of Nursing learners talked to service providers and identified that greater support for carers was needed. Caring for people with Alzheimer's living in their own home is a physical and psychological burden. To encourage these carers the learners produced a sticker and fridge magnet with the message "The heart remembers what the mind forgets" in English and Māori. They also designed a cloth tote bag with the same message on one side and on the other some practical advice: 

• Be Patient
• Always Reassure
• Reminisce Together
• Stay Calm and Repeat Yourself

Our learners also realised that there was no specialised respite care for people with Alzheimer's, which makes it more difficult for their carers to get a break. They presented an oral submission on this issue to a meeting of the network of service providers facilitated by the Dunedin City Council.

December 2021

Step by step instructions will help isolated older people to stay connected online.

Nearly half of the people living on their own in Dunedin are aged 65 or older. With advancing age, many older people may develop problems with mobility or have difficulty accessing transport, which can contribute to their social isolation and loneliness. It is well known that loneliness has a detrimental effect on both physical and mental health.

A team of our Nursing learners partnered with Age Concern to understand this issue. They identified that technology is very important, to help isolated older people stay connected online. However, many of these people do not have strong digital literacy skills.

Our learners developed pamphlets to help educate older people in the use of technology. They chose basic tasks that would be useful for people to know how to do online: banking, online grocery shopping, and using Messenger and Facebook. Each pamphlet sets out simple step by step instructions about how to do one of the tasks. They also designed a fridge magnet with the message "Don't get left behind, get online". These resources have been given to Age Concern for distribution.

November 2021

Coping with a newborn baby is not always smiles and joy.

Suicide is the leading cause of death amongst women who have just given birth in New Zealand. Fifteen per cent of women suffer post partum depression, and more than 50% of them are Māori women. Contributing factors include the lower socioeconomic status of many Māori and there being too few Māori midwives. 

This is the issue which a team of our Nursing learners have focussed on in their research project. Currently pregnant women are not routinely being given information about post partum depression. To address this, the learners developed information cards:

• One card is for new mothers. On the front it tells them the signs and symptoms of post partum depression, and on the back is has information about how to access mental health services. It is available in English and te reo.
• The second card is for health professionals. It encourages them to use one of two screening questions printed on the card, and includes a follow up question to ask if the person they are seeing would like help.

These resources have been produced and distributed to the Neonatal Intensive Care Unit and Queen Mary maternity ward at Dunedin Public Hospital, to Plunket, and to Arai Te Uru Whare Hauora. Our learners also wrote to the Southern District Health Board drawing attention to the issue and the need for Māori specific mental health services.

August 2021

Regular cannabis use by adolescents is associated with poor mental health.

In New Zealand adolescents are the age group most likely to use cannabis. It is being portrayed positively in the media and in music, and there is a perception that it is safer than tobacco. However, there is increasing evidence to suggest that regular cannabis use can have negative effects on mental health, particularly for adolescents.

Nursing learner Lucy Melchert reviewed the literature and found that adolescents who have used cannabis between 10 to 50 times are three times more likely to develop schizophrenia than non-users, probably due to permanent changes to the brain from repeated exposure to THC. There is also a strong relationship between frequent use of cannabis and development of mental health issues such as depression, anxiety and suicidal thoughts.

Lucy recommends that the best way to decrease cannabis use amongst adolescents would be a school-based educational programme, targeted at 12 to 16-year-olds and delivered by health professionals and/or people with personal experience of drug abuse. The programme should focus on the effects that cannabis use can have on day-to-day life including relationships with friends and family. To be most effective such a school-based programme should be supported by a media campaign, to reduce cannabis use amongst adolescents and improve their mental health.

• Read the full literature review

July 2021

Hospital discharge planning is critical to ensure a good recovery at home.

High hospital readmission rates at South Canterbury District Health Board (SCDHB) indicated that there was room for improvement in the discharge process. Some patients may have been discharged too soon or without suitable arrangements in place for their care in the community. A team of Timaru-based Nursing learners undertook research into discharge planning to find out how it could be done more effectively.

They looked at what was happening at Timaru Hospital, working with the Associate Director of Nursing and with the Allied Health Nurse, a qualified physiotherapist. The learners also examined some international models of discharge planning to help identify the opportunities for improvement.  They recommended adoption of a checklist and a bedside poster with a traffic light system, that will clearly communicate which specialist/s the patient needs to see before discharge and track progress. Such specialists might include a physiotherapist, occupational therapist or social worker. The learners designed these resources for the SCDHB.

They also learned that nurses can be too risk-averse, referring patients for specialist advice as a matter of course when in fact that might not be needed. A decision to refer can also be revisited if the patient's situation improves while waiting for the specialist. There is an opportunity to reduce hospital time if nurses are encouraged to trust their own judgement.

May 2020

Nursing students have explored a range of health issues for West Coast localities.

The West Coast of the South Island of New Zealand is a special place, remote and beautiful, with a strong community spirit. But it is a challenge to provide equitable access to health services for a small population scattered along the ribbon of land between the mountains and the Tasman Sea. 

A large team of final year Bachelor of Nursing learners worked with the West Coast District Health Board, under the supervision of Amy Simons, Cynthia Mullens and Jean Ross. The learners identified, investigated and addressed various health issues in the small and large communities within the district, from Karamea in the north to Haast in the far south:

• Mental health: A poster for the youth club at Karamea promotes access to mental health services. A fridge magnet raises awareness of ante-natal and post-natal depression and encourages those affected to seek help in Whataroa. And a brochure and a coaster provide information about relevant websites and apps so that help is only a few clicks away.
• Children's cycle safety: A "stay seen, stay safe" poster encourages children to wear high visibility vests when cycling, to help keep children safe and encourage more children to cycle to school in Westport.
• Social isolation of elderly: A penpal project was designed to help decrease loneliness among Greymouth's elderly.
• Dental health: Stickers for a lunchbox, fridge or pantry encourage Hokitika youth to eat healthy foods. A submission to the mayor of Westland District Council advocates for fluoridation of water supply for Fox Glacier, a cost-effective measure to reduce tooth decay.
• Caregivers of the elderly: With no local rest homes at Franz Josef, care of the elderly often falls to family members. A brochure raises awareness of existing support services.

When permitted by COVID-19 lockdown conditions the resources which our learners developed will be distributed to the communities they sought to help.

April 2021

Adolescent mental health in rural areas is a multi-faceted issue.

One fifth of young New Zealanders have been affected by depression by the time they reach the age of 18. This affects their mental health in adulthood, but New Zealand also has the highest rate of suicide in OECD countries for young people aged 15-19 years old.

A team of Nursing learners investigated health issues in Owaka, South Otago. They found that rural communities face additional challenges for mental health, with fewer opportunities for work and entertainment for young people, the fear of gossip in a closeknit community, and limited access to mental health services. 

Our learners decided to create health promotion resources to improve adolescent mental health. They produced a pamphlet for the teenagers, a caregiver resource, and a fridge magnet, for distribution through the Catlins Area School. They also wrote a contribution for the school newsletter introducing the resources. The Nursing students' hope is that more young people will seek help when needed.

• Read more about this project

October 2019

Talking helps farmers navigate the storms of life.

Gore is a Southland town servicing a predominantly rural community. It shares many public health issues with similar rural communities, including the mental health of farmers and farm labourers. Long working hours, isolation, and external environmental factors such as storms, droughts and disease outbreak can be significant sources of stress.

A group of our Nursing learners investigated this issue. They found that the problem is compounded by difficulties seeking help, due to social stigma and having to take time off work to travel in to Gore. Social activities and connections, for example through sport or over a drink, can be helpful for mental health. The team decided to create a resource that would encourage farmers to talk about mental health, to reduce the social stigma and strengthen social ties. They designed and produced a drink holder with the message "Crack open a cold one and crack on with the conversation". 

Having provided samples to a contact in Gore, the learners were delighted to hear that their initiative was commended to organisers of a national mental health event in Balclutha on 31 July 2019. The learners and their supervisor Jean Ross had the opportunity to attend and speak briefly at the event, and our School of Nursing provided 200 of the drink holders which were distributed to farmers there. The drink holders will now be paid for and distributed by organisers of the next 'Will to Live' national tour.

• Read more about this project

January 2020

Nursing learners have been working on a locally appropriate resource to help address Type 2 diabetes.

Type 2 diabetes is a significant health issue in New Zealand. The DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) programme, developed in the United Kingdom, is currently being used by WellSouth in Otago and Southland under sub-license from Diabetes WA in Australia. The programme is educational, providing information for people with Type 2 diabetes and helping them to successfully self-manage their condition.

Type 2 diabetes disproportionately affects Maori New Zealanders, so a team of Bachelor of Nursing learners decided that something more locally and culturally appropriate was needed. The DESMOND programme is a valuable existing resource, so the students set about adapting it in collaboration with WellSouth. Diabetes WA has been supportive. The learners have worked through three of the nine steps to adapt DESMOND for a New Zealand context and intend to continue to work together to develop, run and evaluate a pilot, that would enable WellSouth to then apply for approval to deliver the modified programme.

Our learners also conceived of a frisbee health promotion resource. The frisbee promotes physical activity, and can be printed with information about healthy eating, both of which help contribute to the successful management of Type 2 diabetes.

October 2020

It's OK to seek help.

Nursing learners have been helping a rural community protect their health.

On farms and in small townships around New Zealand water tanks are a common sight. Some collect water from roofs, others store water pumped in. In the community of Warrington all dwellings for the population of 450 are reliance on tank water. Their water comes from the Mount Grand water treatment station, but is it still clean by the time it comes out of the taps?

Nursing learners Laura Shaw, Devon Kilkelly and Charlotte Hay, supervised by Dr Jean Ross, investigated the health issues associated with these water tanks. Tanks that are not maintained regularly accumulate sludge in the bottom - a combination of algae, sediment, and slime which can even include bird or animal faeces and carcasses. The recommendation is that tanks should be inspected every six months, for example to ensure that the lid is well fitted, and cleaned out every three years.

Our learners developed a campaign to raise awareness of this health issue. They produced prototypes of a fridge magnet, and a leaflet which provided information about the risks and recommendations and also advised how residents could clean out their tanks themselves. They wrote a contribution to the Blueskin Bay community newsletter, which is published in hard copy and online, and have written to the Dunedin City Council to ask for the leaflet and fridge magnet to be included in a mailout of rates bills to this district.

August 2018

Nursing students have helped reduce the public health risks from unsafe disposal of "sharps".

Back in 2016, twelve second year Nursing learners investigated health issues in the Dunedin suburb of Green Island. This catchment including the city's landfill, and the learners learned that waste management company staff suffered on average 11 injuries per month from sharp objects that had been improperly disposed of in Dunedin's waste.

Three of the learners, Hannah Beadle, Rebecca Bates and Tessa Dawson, chose this issue to investigate further, under supervision from Principal Lecturer Josie Crawley. The learners applied the Ottawa Charter, which identifies five areas for action to ensure that all causes and obstacles are considered and addressed in public health policy. They found from their enquiries that:

• Diabetics and others who are prescribed medication to be injected, or are required to test their own blood, are not consistently given information about how to safely dispose of the sharps (needles and lancets) which they use.
• These patients needed to go somewhere other than their pharmacy to purchase a container for safe disposal of sharps, and then pay again for disposal of the container once it was full.
• At that time illegal drug users had easier and cheaper access to safe disposal methods for their needles than those using prescribed medicines.
• The District Health Board was legally responsible to ensure that safe disposal of sharps was available through pharmacies and/or GPs.

The learner team considered a range of possible actions which would help ensure sharps were safely disposed of. They also provided a copy of their report to Catherine Gladhill, Waste Minimisation Officer at the Dunedin City Council. Catherine welcomed the report as she was aware of the issue with injuries and hence the need for safe disposal of sharps. She liaised with Greg Sheffield at the Southern District Health Board about how they might fulfil their responsibility. 

As a result funding was secured for pharmacies to provide the safe disposal containers to patients, along with advice about using the containers and bringing them back when full for safe disposal - all at no cost to the patients. A letter to all 83 pharmacies in the Southern region resulted in initial take-up of this service in 2016 by 17 pharmacies. Now in 2018 70 pharmacies are offering this free service. This initiative, together with other changes in waste handling that have been put in place, has reduced the number of sharps injuries for waste management employees to zero.

July 2018