NEW ZEALAND WARD 41 VASCULAR AMBULATORY CLINIC Lindsey

NEW ZEALAND: WARD 41 - VASCULAR AMBULATORY CLINIC Lindsey Mehlin January 2018

Kia Ora! [Welcome] to New Zealand The north & south islands that make up the country of NZ Auckland, NZ [where clinical took place]

Objectives • Use evidence-based practices, health care technology, and effective communication strategies to guide the essential public health interventions across the lifespan. • Use data from population assessments to identify the influences of the determinants of health (environmental, social, political, legalethical, economic, behavioral, and cultural) on delivery of care to Maori population. • Assess the health status, health care access, and emergency preparedness needs of the Maori population. • Participate with healthcare providers and community leaders in the planning, implementation, and evaluation of health interventions. • Collaborate with healthcare providers and community partners to promote clinical prevention and population-focused health. Apply knowledge from nursing and related arts and sciences to the care of selected community based aggregates.

Background Information History • 1200 -1300 A. D: first people arrived from Polynesia and discovered NZ • 1642: first Europeans arrived, including one by the name Abel Tasman • The term ‘Maori’ was then established by the Polynesians to distinguish themselves from the new settlers • 1860’s: war broke out in north island due to European pressures for Maori to sell their land • 1870’s: thousands of British began their lives in NZ • 1980’s: many other ethnic groups began settling in NZ • 15% Maori, 12% Asian, 9% Pacific Islander

Background Information Health Issues- • Obesity & smoking are two of the most prevalent issues in NZ • • 32% of adults are obese, 12, 3% of children ages 2 -14 are obese 15. 7% of adults are current smokers, 35% of Maori and 24% of Pacific Islanders are smokers • Obesity is a major risk factor for: diabetes, CV disease, musculoskeletal disorders and various cancers • Smoking kills more people every year in NZ than motor vehicle crashes, alcohol, drugs, suicide, murder, drowning & earthquakes combined Rates of obesity by area

Auckland City Hospital Ward 41 - Vascular Ambulatory Unit • 23 bed unit • Pre/post amputations, diabetic/cardiac/current smokers • Wound care • Medication administration • Vitals, blood glucose • Pre/post op cares • Interprofessional collaboration • Resident team/PT located on floor • Autonomy/independence • Took on full nursing assignment (4 patients) Ward number outside of unit Hallway of Ward 41 Outside of Auckland City Hospital

Health Issue: Diabetes: • Diabetes is a condition in which the body is unable to control the levels of glucose in the blood • Pancreatic cells either cannot make insulin (type 1) or are resistant to insulin (type 2) • Unmanaged diabetes can lead to other chronic and more serious health conditions such as kidney failure, heart failure and extremity ulcerations • Largest and fastest growing health issue in NZ Ward 41 patient population: • • Individuals aged ~45 -70 Most commonly Maori and Pacific Islanders Gangrenous limbs/toes etc. due to unmanaged diabetes or smoking In need of: • Various types of amputations • Insulin administration • Diabetes education

Diabetes Interventions Individual-based interventions: • Identify those with known diabetes or those at risk for diabetes • Blood glucose testing • Insulin administration • Provided handouts with diabetes education and prevention information

Diabetes Interventions Community-based interventions: • Diabetes New Zealand- “Together We Can Help Kiwis with Diabetes” • Works to provide awareness and information to those with diabetes • Lead initiatives to improve health and well-being • Increase access to and effectiveness of resources to provide support • “Ensuring we think nationally, but act locally” • New Zealand Weight Management Guidelines- for children & adults • Healthy Families New Zealand- anti-obesity initiative

Diabetes Interventions Systems-based interventions: • Ministry of Health New Zealand • Improving the quality of services provided for diabetes management • Green Prescriptions Programme- written advice to become physically active • New Zealand Childhood Obesity Programme- reducing childhood obesity indicators • Maximizing technology to provide people with tools to better their health • Greater focus on recruiting/training HCP’s on primary/secondary diabetes care

Conclusions & Suggestions • One of the most prevalent and serious problems in NZ is diabetes, along with the improper management of the disease by those diagnosed • Affects ~257, 700 New Zealanders • Prevalence has been rising at an average of 7% every year for the last 8 years • Diabetes has a major impact on the health system as a whole • Need primary, secondary and tertiary care to manage the disease • In order to better meet these individuals’ needs, ensuring sustainable diabetes services is crucial • HCP’s must provide more education on the disease as well as the lifelong complications it can cause • The overall goal is for those at risk or living with diabetes to have the ability to live well and have access to high-quality, patient-centered care

Clinical Experience Vascular Ambulatory Outpatient Clinic • Clinic runs 8 am-12 pm Tuesdays/Thursdays • See ~20 patients a day • Follow-up visits from post-op/previous Example of physiologic testing patients/newly diagnosed patients measuring arterial BP • Turned down wound dressings, collaborated with residents, re-dressed wounds • Physiologic testing; measures full-body blood pressures; multiple cuffs per extremity • Shows arterial blood pressure in each extremity • Schedule follow-up appointments or referrals if vascular service is needed One of 10 consultation rooms in the clinic

Cultural Experience • Te Kōngahu Museum of Waitangi • Grounds for the signing of the Treaty of Waitangi • Treaty established between Maori and British officials to found a nation / build government • Collection of common laws, legislation and customs • 540 chiefs signed the treaty Maori dancers performing • NZ became part of New South Whales colony Haka dance • Maori cultural performance • Haka- War Dance • Display of pride, strength, unity • Honors guests and ancestors Two documents associated with the Treaty of Waitangi Treaty Grounds Flagpole Ko Waitangi Tēnei

References Diabetes New Zealand. (2018). Who are we? . Retrieved from https: // www. diabetes. org. nz http: //annamap. com/new-zealand/ https: //commons. wikimedia. org/wiki/File: NZC_Reinga-2009 -3008_Map_North. Shore. City_Auckland. png http: //suncoastmedical. net/our-services/echocardiography-andultrasound-procedures/ Ministry of Health. (2013). Diabetes. Retrieved from https: // www. health. govt. nz/your-health/conditions-and-treatments/diseasesand-illnesses/diabetes Ministry of Health. (2017). Key indicators. Retrieved from https: // minhealthnz. shinyapps. io/nz-health-survey-2016 -17 -annual- dataexplorer/_w_30 dde 127/#!/key-indicators New Zealand History. (2017). The treaty in brief. Retrieved from https: // nzhistory. govt. nz/politics/treaty-faqs New Zealand Immigration. (2016). A brief history. Retrieved from https: // www. newzealandnow. govt. nz/living-in-nz/history- government/abrief-history