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

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.

Clinical handover from the operating theatre nurse to the post anesthetic care unit nurse. Sarah Eton

 

Aim of the study
The aim of this research was to identify current practice in handover from the theatre nurse to the post anaesthetic care nurse in the New Zealand perioperative setting.

Research design and method
A quantitative research design was chosen using descriptive statistics, to gain a broad understanding of perioperative handover in New Zealand, about which little is known. Data collection via an online self-completed questionnaire elicited the opinion, observations and experiences of perioperative nurses from a wide a range of surgical hospitals throughout New Zealand. Interest in the study was solicited through communication with the New Zealand Perioperative Nurses College.

Findings and Recommendations
One hundred and thirty survey responses met the study’s criteria and were included in the data analysis. The results illustrate that perioperative nurses in New Zealand are experienced, adaptable in their practice and regularly engage in face-to-face verbal handover. It is also clear that most perioperative nurses are satisfied with nurse-to-nurse handover.
Barriers to effective verbal handover in the perioperative environment were identified, with the receiving post anaesthetic care nurse being required to multitask, and therefore not actively listening highlighted. In addition, collegiality between nurses and a ‘handover pause’ for verbal handover were important to nurses, and factors identified that enabled the safe transfer of information.
International literature has a plethora of suggestions on how to overcome communication barriers and how to mitigate error, with many of those suggestions being integrated into the New Zealand health care system. Indeed, that a culture of patient safety exists to some extent in the New Zealand perioperative environment is the overriding impression from the survey results. There appear to be systems, such as, standardised models to guide verbal handover, and an awareness of appropriate nurse behaviours which results in nurses working together to achieve safe transitions in patient care.
One recommendation to come from this study was for a formal ‘handover pause’ to be instigated in the post anaesthetic care unit, so all the health professionals involved in handover can actively engage in the communication process. Additionally, in the interests of patient safety, face-to-face verbal handover in combination with a written framework of documentation is recommended. Provision of education on how to conduct effective nurse-to-nurse handover also needs to occur.
The results of the current study have identified numerous opportunities for future research, both in New Zealand and internationally. It is clear there is a dearth of literature specifically on nurse handover in the New Zealand perioperative setting, with this study providing the foundation from which future research can occur.

Sarah is a senior nurse working in the PACU at Mercy Hospital, Dunedin. Sarah is proactive in promoting a high standard of clinical practice in PACU and has a special interest in the transition in care of the post-surgical patient. After completing her master’s thesis, which explored perioperative nurse handover in New Zealand, Sarah has engaged in handover quality improvement, applying the recommendations from her research.
Sarah is an active member of PNC, currently representing the Otago Section on National Committee.

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

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.

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

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.

Kaiawhina Nurse – What’s in a name? Can it influence behaviour? Carmel Appleby.

The ENT theatre had been using a role based model for delegating nurses responsibilities for several years. A few years ago an anaesthetist and the CNC after trying names such as: patient focused nurse, lead nurse, circulating nurse etc decided to try a Maori name to reflect not only the value this nurse has in promoting efficiency but also overseeing the patient journey through theatre. After consultation with a respected Maori staff member, Kaiawhina was the title recommended. Kaiawhina means helper, assistant, contributor, advocate.
The unpredictable and busy nature of theatre today can often cause nurses to lose insight of the holistic needs of our patients and become task orientated. The Kaiawhina role provides patients with a singular nurse who is solely dedicated to overseeing all aspects of their care to ensure the patients’ needs are met accordingly. The Kaiawhina will be their nurse until handover to the PACU nurse. The presentation will explain how it is being adopted within the theatre suite. Most care delivered to Maori patients is by non Maori nurses, and the Kaiawhina role is now being used to develop cultural competence, by supporting nurses to use the Maori health model of care, Te Whare Tapa Wha.

Three key learnings:

Believe in the benefits

Overcoming the barriers

Whakapakari – growing the good

Conclusion:
Kaiawhina causes nurses to pause and think of what and how they deliver their care. Because the name is different, it helps them to be mindful and intentional. Nurses are reporting they are making meaningful connections with their patients.

 

After a career spanning 24 years in administration Carmel retrained and graduated as an RN 8 years ago.
She currently works as a senior nurse in the Plastic Surgery Theatre at Waikato Hospital. Carmel is passionate about patient centred care and looks forward to sharing their efforts to integrate Te Whare Tapa Wha Health Model of Care in the department.

Tunnelled central venous access devices. Gretta Moffat

At the CDHB we have been on a learning journey for some time.  In 2016 we introduced tunnelling of PICC lines using the methods that were picked up at WoCoVA 2016 by my colleagues who attended the conference.  We also had the introduction of Tunnelled CICC (PICC type of catheter) which was supported by the radiologists who taught the nurses how to do this.
I attended the AVAS/WoCoVA conference in 2017 and after engaging with the radiology consultants about the method, was able to bring back to the CDHB another method for tunnelling of PICC called Modified Seldinger Technique Tunnelling (MST-T), This method has also now been documented several times in journals and allows us to tunnel with a small variation in technique from a standard PICC Insertion.
I will talk about how to insert using this method, which allows us to follow the vessel health preservation tool that we use and maintain the skin insertion site within the green zone of Dawson’s ZIM. The limitations and advantages of using this method, and the clinical implications for us as a result of this.
I will then talk about what the other options of line we can offer if this is not suitable for the patient and a few of the cases that we have had.
We have continued to develop our practice as new innovations and evidence-based practice are introduced. I want to be able to give an overview of what we do as a vascular access service, challenges that we have faced and then newer techniques that we are using to improve that patient journey.

Gretta Moffat, RN, Diploma in Nursing 1995 CPIT
Gretta has worked in a variety of areas since training, General surgical/vascular, paediatric oncology and haematology, NICU and Radiology.  She has been in Radiology for 9 years now and had an interest in vascular access since starting in radiology. She also assist with all the other procedures that we perform within the department.
Gretta has been a PICC inserter for 7 years, Paediatric PICC inserter (From age day 0 and up including preterm babies) for 6 years, Tunnelled PICC inserter for 3 years, and Tunnelled CICC (chest inserted central catheter) inserter for 2.5years.  She has CVAD certification for implanted and non-implanted devices. She also did nephrostomy tube changes for the doctor’s, this enables them to be free to do other work as required.
Her ideal world would be a patient getting the right sort of access as soon as practical, so that they don’t end up coming for a line with ten dots up their arm, and extravasations from all of the IV lines that they have had, before getting what they need.  She would love to see a vascular access team set up at Christchurch Hospital to try and facilitate this happening.

 

The experience of nurses working in the managed isolation and quarantine facilities. Isabel Jamieson

Background: The aim of this research project was to discover the experiences of New Zealand nurses working in managed isolation and quarantine facilities. The research question was; What were the experiences of New Zealand nurses working in managed isolation and quarantine facilities during time of the COVID-19 pandemic?
Method: A qualitative descriptive project using purposive sampling.
Inclusion criteria: nurses (registered nurses and enrolled nurses) who have worked in, or are working in, managed isolation/ quarantine facilities in Christchurch, New Zealand.
Data collection: via one-on-one semi-structured interviews via Zoom.
Findings: Interviews undertaken with 14 registered nurses December 2020 – January 2021. Data analysis is in progress, initial findings indicate: a rapidly evolving nursing role, an ever-changing work environment, caring for guests and stigmatisation of the nurses and their families.


Dr Isabel Jamieson, RN, PhD, MNurse(Melb), CertAT,  is currently employed by the Ara  Institution of Canterbury (Ara), Department of Health Practice as a principal nursing lecturer and as a senior lecturer, University of Canterbury, Christchurch New Zealand. Other roles include Chair of the department’s research committee, thesis supervisor and thesis examiner. Her research interests include health care workforce issues, clinical models of teaching and learning, nursing student’s readiness to practice as well as the graduate nurse experience. Isabel’s clinical background was perioperative nursing, surgical assisting, and infection control.

 

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

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.

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

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.