Otago Polytechnic
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Nurse case management enhances outcomes

Anna Askerud

Anna Askerud, a School of Nursing lecturer, chose to explore patients’ experiences of nurse case management in primary care. In doing so, she helped set up a nurse-led, long-term conditions programme based around care coordination at Mornington Health Centre, a large primary health care organisation in Dunedin.

The meta-synthesis focused on patients with multiple chronic conditions who had poor health outcomes and were high users of primary and secondary care, as well as social services.

A thematic analysis of data revealed three key themes. Firstly, patients with experience of nurse case management valued the focus on their health and social needs, as well as the long-term relationship and collaborative care that this model provided. Secondly, patients perceived their experiences of nurse case management more favourably than those with General Practitioner (GP) or district nurse care. Finally, there was also the potential for dependence on the nurse case manager. This could result in burnout and professional boundary issues for the health practitioner involved unless support and guidance was provided.

These results support findings from research in the United States and United Kingdom that point to economic and psychological advantages of proactive and effective care coordination.  Research also highlights the benefits of ongoing relationships between patients with chronic conditions and health professionals.

As Anna says, “Nurse case managers, who work as part of a supportive multidisciplinary primary care team, can provide highly valued and effective care which can result in an improved quality of life, fewer hospital visits and better health outcomes for those with long-term conditions.”

 

Askerud, A.M. (2015) Patients’ experiences of nurse case management in primary care: a metasynthesis. Master of Health Sciences Nursing (clinical), University of Otago.

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Māori health: an issue of integrity

Mereana Rapata-Hanning & Dr Karole Hogarth

When Dr Karole Hogarth and Mereana Rapata-Hanning were asked to contribute a chapter on indigenous health in New Zealand for an Australasian Pathophysiology textbook, one of the challenges they faced was getting the Māori worldview and language accepted by the publishers. “Māori people identify as Māori, not as indigenous – it’s about giving integrity to the people we’re writing about,” says Mereana.

Their exploration focussed on defining the prevalence of contemporary Māori health, as well as acknowledging the wider social-political factors that determine these statistics. Their discussion of the high levels of diabetes, cardiovascular disease, kidney disease, cancer, asthma, skin diseases, smoking and alcohol abuse, and poor mental and oral health, identified that Māori health is still disparate to non-Māori. “We weren’t really surprised by this. Statistics for Māori reflect those of other indigenous peoples globally,” says Karole.

Both Karole and Mereana had been interested in this topic for a long time. As registered nurses they regularly saw the impact of chronic disease in Māori communities throughout Aotearoa. The discussion continues to highlight the inequality that Māori experience when engaging with health and disability services. They believe that addressing this inequality involves a multi-layer approach involving revisiting funding at government level, improving public education, and taking healthcare directly to the people in the community. Most importantly they cite the importance of individual actions and attitudes of health professionals: “What you do in terms of inclusiveness and engagement directly affects health outcomes for individuals, whanau and communities.”

 

Hogarth, K & Rapata-Hanning M. (2015). Māori health in Aotearoa New Zealand. in Understanding Pathophysiology ANZ 2e edited by Craft and, Gordon (eds). http://www.elsevierhealth.com.au/general-nursing/understanding-pathophysiology-anz-adaptation-paperbound/9780729541602/

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Immersive learning in nurse education

Dr Liz Ditzel, Raewyn Lesa and Dr Karole Hogarth

How can you teach a nursing student what it’s really like to live with a long-term disease such as Chronic Obstructive Pulmonary Disease (COPD)? This was one of the questions School of Nursing lecturers Dr Liz Ditzel, Raewyn Lesa and Dr Karole Hogarth were asking themselves. Reading about conditions in a textbook provides one form of knowledge, and practising on a mannequin provides another, but as Raewyn Lesa describes, “The problem with using simulation alone is that it is harder to give a holistic picture at one snapshot in time and therefore can dehumanise nursing care. Our goal was to bring the person back into care.”

The trio won an AKO research grant for a project which aimed to evaluate the effectiveness of using a technology-enhanced, integrated teaching approach to clinical practice, in order to improve the learner outcomes within nursing education.

Two case studies were chosen for students to learn from, one involving a person living with COPD, and the other centering on myocardial infarction. For those students who were part of the test group, each case involved a five-step learning approach which included theory lectures and online learning, LabTutor session, group tutorial, simulation, and debrief. The LabTutor component was delivered through software technology developed by AD Instruments.

The research showed that students that had received all five steps of the learning process reported improved levels of confidence. This clearly demonstrated that the immersive approach was effective for second year nursing students, and using visual teaching media such as patient case studies was the preferred teaching strategy.

 

2014 Ditzel, L., & Lesa R. Immersive Learning in Nursing Education. Ako Aotearoa Southern Hub Projects in Progress Colloquium 11 Christchurch

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Advancing patient care

Dr Karole Hogarth

Otago Polytechnic has become the first nursing school in New Zealand to embed the online LabTutor technology into its curriculum.

Pioneered in New Zealand and accepted internationally as a teaching tool for medical students, LabTutor is created by Dunedin-based AD Instruments. The company is currently working to adapt and refine its existing programmes to meet the specific requirements of nursing students.

Using a computer interface and plug in components, LabTutor increases student’s engagement with the sciences and enhances their understanding of difficult concepts.

It enables students to measure their own physiological outputs and also perform laboratory tests such as ECG, Spirometry and EEG. It provides students with a safe platform to engage in practical experiments and enables them to compare their own results with a real life patient’s data.

“Students need many different blended delivery techniques to integrate the theoretical aspect of their studies,” says Dr Karole Hogarth, Senior Lecturer and Curriculum Leader at Otago Polytechnic’s School of Nursing.

Dr Hogarth recently presented a paper on the implementation of LabTutor into nursing bioscience teaching at the Australasian Nurse Educators Conference in Wellington.

“Real life case studies engage the student’s interest through client interviews, personal history, medical notes and test results,” she says.

“Through this process, students gain a realistic perspective of the complex background required to have an informed discussion about patient care.”

Results and case studies are discussed in tutorials to help students to integrate their theoretical knowledge. Through this practice they learn how to integrate the complexities of disease processes into their practice in all clinical areas.

 

Hogarth, K. (2013) Implementation of Labtutor into nursing bioscience teaching. Paper presented at the Australasian Nurse Educators Conference, Wellington.

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Supporting stability

Jean Ross and Laurie Mahoney

Primary Care nurses are becoming more aware of the impact that parental mental health can have on children. Research shows that children who live with a parent with unstable mental health are at an increased risk of abuse and neglect.

“The effects of parental mental illness should be seen as a public health issue that requires appropriate support to be given to children,” says School of Nursing Senior Lecturer, Laurie Mahoney.

Her article, ‘Parental Mental Illness: The effects on children and nursing responsibilities in primary health care’ was published in the June issue of LOGIC, the journal of the College of Primary Health Care Nurses.

“Children who live in chaotic unpredictable environments respond in many different ways. Some externalise their behaviour and become aggressive and violent while others internalise their suffering and develop conditions such as eating disorders,” she says.

Often the problem is a generational cycle of parental mental ill health. The primary goal is to find methods that will help to build children’s resilience.

Research shows that resilient children can have good outcomes in spite of the major environmental risks they face. Their resilience can be linked to their temperament, ability to sustain separation from a parent and above all their social and intellectual capabilities.

Children’s resilience can be supported by reducing their feelings of guilt and shame through education about their parent’s illness.

“In the past, children’s perspective was mostly ignored.”

Today, primary care nurses learn how to assess children’s behaviour and, when required, intervene to provide carefully coordinated care to support these children, while parents are guided towards programmes that teach the benefits of consistent parenting.

“Children with a good relationship with at least one parent or who have a supportive external adult role model, quality peer relationships, and an extended social support system outside the home, are more likely to thrive.”

You can view more of Laurie Mahoney's research here

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Middle ear care

Emma Collins

Chronic middle ear disease is an invisible condition posing a serious health risk throughout New Zealand.

Repeated episodes of the disease can result in hearing loss, language delay, difficulties in literacy and lowered school achievement. Particular communities – including children in the Hutt Valley – are affected severely by the disease, making effective prevention, detection and intervention significant public health challenges.

In 2011, Emma Collins, now an Otago Polytechnic Lecturer in Nursing, strengthened the case for greater resourcing for ear nurse specialists and clinics to reach at-risk children. Collins analysed cases of childhood middle ear disease as part of her Master’s dissertation: “We ran a mobile community ear clinic – basically a converted campervan – for children in the Hutt Valley.”

The research investigated the difficulty of reaching “marginalised populations” effectively. “We stopped at places where there were children who had failed hearing tests at school. We also visited areas with larger Māori and Pacific Islands populations, because we know that children of these ethnicities are more prone to ear disease.”

Collins She hopes that her enthusiasm for lifelong learning will inspire students to consider a career in research alongside daily nursing practice. “The level of resources at Otago Polytechnic is exceptional for research. The potential is absolutely there, and it’s up to the individual to make it happen.”

Collins, E. & Ram, F. (2011) Rates of Ear Disease in Children Visiting a Mobile Community Ear Clinic in New Zealand—Two-Year Study of Over 2,000 Children. Asia Pacific Journal of Speech, Language, and Hearing, Volume 14, Number 2, 119 –128.