Community nursing services continue despite road closures and liquefied ground.
Subject: Nursing services (Social aspects)
Earthquake damage (New Zealand)
Earthquake damage (Social aspects)
Earthquake damage (Health aspects)
Emergency management (Management)
Disaster victims (Care and treatment)
Nurses (Beliefs, opinions and attitudes)
Nurses (Social aspects)
Pub Date: 10/01/2010
Publication: Name: Kai Tiaki: Nursing New Zealand Publisher: New Zealand Nurses' Organisation Audience: Trade Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2010 New Zealand Nurses' Organisation ISSN: 1173-2032
Issue: Date: Oct, 2010 Source Volume: 16 Source Issue: 9
Topic: Event Code: 290 Public affairs; 200 Management dynamics Computer Subject: Company business management
Product: Product Code: 8043100 Nurses NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners
Geographic: Geographic Scope: New Zealand Geographic Code: 8NEWZ New Zealand
Accession Number: 241179354

The response from health professionals, particularly nurses, in the aftermath of the earthquake showed the health system at its best, said Pegasus Health 24 Hour Surgery clinical nursing director Louisa Sparrow.

"I was at home when the 'quake struck. Having ascertained that my children and I were safe, I texted one of the nurses on duty to check how they had fared at the surgery. With ambulances being diverted to the surgery, rather than going directly to Christchurch Hospital, staff were keen I should come in. They really didn't know what to expect. I also texted a nurse I knew who did not have young children and asked if she could come in too. People responded instantaneously with Little thought for themselves. I found this really heart warming.

"When I got to the surgery, nurses were already beginning to triage patients. Although we had no computers or phones, we did have power, thanks to our emergency generator. We didn't have water either, so relied on what water was stored in our tanks and pipes. Of course we didn't know the scale of what we would see. Initially we imagined a high injury rate, but by about 10 or 11am we realised this was not going to occur.

"No one who was rostered on that morning failed to arrive, except for one nurse Living in a rural area. She arrived a bit later that morning. We all just got on and did what needed to be done. Most of the injuries we saw that morning were limb fractures and Lacerations."

Sparrow was moved by the stories she heard from nurses who were at the surgery when the 'quake hit. A third-year nursing student on her final elective had been rostered onto her first night shift. The student was impressed at how quickly the senior nurse went straight to one of the patients and then helped the patient and a child get under a bed for safety. "It was only when it got lighter and they could see the damage to buildings opposite that the significance of what they had been through began to sink in," said Sparrow.

She has high praise for the Pegasus' senior management team who quickly arrived on site and provided much needed support. Chief medical officer for the Canterbury DHB, Nigel Millar, also called into the surgery on his way into the hospital to discuss contingency plans with Pegasus staff.

Members of the acute community team (working with Nurse Maude staff) did not hesitate to get into their cars and visit people known to be acutely unwell, even if that meant driving through cracked and broken roads. "We made sure people went out in twos," Sparrow said.

When it became clear two practices in the central business district would not be able to operate that first week, their staff and equipment were moved into the 24 Hour Surgery, well supported by information technology.

Over the next few days, staff continued to see people affected by the 'quake, some of whom had delayed seeking medical help. Those on home oxygen were able to come into the surgery to be plugged into generator power. Others needed psychological support and a chance to talk through their experiences. Normalising their experiences was the key to building resilience, Sparrow said. One-off consultations with members of Pegasus' mental health liaison service were also offered to people feeling particularly distressed.

Seeing how all members of the team responded to the 'quake and its aftermath filled Sparrow with a great deal of pride. "To see people's caring ethic coming through so strongly was really heartening."

Pastoral care for general practices

Pegasus Health nursing facilitator Kelly Maw was part of the incident management team responsible for the pastoral care of more than 100 general practices and pharmacies within Partnership Health Canterbury's Primary Health Organisation. It was her role to ensure continuity of services following the 'quake, including organising building inspectors, adequate water supplies and assistance with relocation if needed.

"Every day I rang the general practices and pharmacies we had identified as being at risk to see what support they required. Sometimes just being able to talk to someone was all staff required.

"Everyone has a story to tell and everyone takes the time to listen. The national response has also been great, with members of General Practice New Zealand providing an earthquake relief pool of GPs, nurses, admin staff and pharmacists. Many of the lessons we Learnt during last year's pandemic planning have been put to good use."

Community mental health response

Getting an acute response service started was top priority for team leader of the Pegasus' Mental Health Liaison Service, Cerina Altenburg. By the end of the third week, about 100 people had been seen by members of the multi-disciplinary team, including children and their parents, mostly referred by GPs and the affiliated 24 Hour Surgery.

"Largely, we are seeing capable, professional people who are used to having their lives in order and who are seeking help to manage unexpected stresses," said Altenburg. "Our aim is to help people normalise their experiences, not to medicalise understandable fears. We offer suggestions on how people can enhance their strengths, using the support systems they already have (ie friends and family) and getting back to normal just as quickly as they can. We Listen to them, acknowledge their experiences and offer recommendations on how to manage their stress."

Altenburg believes the acute response service will be needed for some time yet. When frustrations relating to sharing accommodation, loss of jobs and financial pressures play out in families and communities, a knock-on effect of attendance at general practice and psychiatric services is only to be expected. She is also concerned at the proliferation of organisations offering help with "post-traumatic stress" or claiming to be "trauma response" services. "They are misinforming the public and can often do more harm than good, pathologising what is a normal response. Feeling on edge or irritable, having problems sleeping, poor appetite etc are to be expected. People will work through their experiences at their own pace. Only those suffering from more severe or Longer term symptoms will need more specialised help," she said.

Despite road closures and the problem of Liquefaction around a number of homes, Nurse Maude district nurses and home care staff were determined they would make their usual Saturday morning visits, only hours after the 'quake struck. At-risk clients had already been identified, so these people were contacted early on to check on their welfare.

"Part of our emergency planning involves keeping a list of our at-risk clients. Contacting these people was just part of our emergency response systems," said Nurse Maude's director of nursing Sheree East. "At first, information was a bit sparse. We were monitoring radios and the internet using the backup generator at our hospital and hospice site. Our telephone operators were briefed and kept updated so they could advise callers on the current situation.

"A lot of people were ringing in to tell us they had picked up their relatives and taken them to their own homes. Some people had left their homes and we were not always sure where they had gone to. There was a tot of phone work checking people were safe. Nurses were having to go into homes that weren't necessarily stable and had to cross Liquefaction areas. Some put on their gumboots and just went in. Fortunately we had no major injuries to deal with.

"Some clients were surprised to see us turn up, white others showed their gratitude by hugging our staff with sheer relief at actually having someone turn up on their doorstep."

One of the biggest challenges for the nurses was attending to wounds in homes where there was no longer a guaranteed safe water supply.

"We went back to using saline rather than water when re-dressing wounds and also advised people not to take showers because of the fear of wounds becoming infected," said East.

At the Nurse Maude Hospital, some patients had to be moved out of their rooms due to water damage from the sprinkler systems following the aftershocks, and the lifts were also disabled for some time. This meant staff and volunteers having to "chain gang" the meats up and down the stairs.

Nurse Maude's volunteers were put to good use, becoming drivers for nurses anxious about the road conditions and risk of aftershocks, particularly at night. Help also came in the form of four nurse volunteers from outside Christchurch. "We realty needed this extra help, especially tater in the first week," said East. "Our own nurses were beginning to get tired and sensitive to the continued aftershocks. Dealing with road closures, aftershocks and broken steep was stressful, and it was great to be able to relieve them for a while.

"The weekend following the 'quake was quite challenging, because many people who had gone to stay with relatives for a white had gone back home. Our managers and educators also pitched in to help. It was a case of at[ hands on deck.

"We had a lot of calls about palliative care pumps and did consider using bolus injections at one stage, but we didn't have to do this in the end. With the road tunnel dosing quite regularly, getting to our patients in Lyttelton became a challenge. As much as possible, we called on the help of services based in Lyttelton or drove the tong way around over the Port Hills."

Making sure people could get their medications was another issue, especially with pharmacies in the inner city being dosed for much of the first week. Much work was needed to ensure people who needed medications got them.

Nurse Maude management is aware that several staff will need a tot of support over the next few months, particularly those who have lost their homes. Some are still without water and having to shower at work. Some are "camping" in their own homes, not sure whether they will be condemned or repaired.

"It's still early days," said East. "Nurses respond well in an emergency because that is what we are trained to do. Their own personal reactions might come later."
Gale Copyright: Copyright 2010 Gale, Cengage Learning. All rights reserved.