Nurses present diversity of practice.

BOTH DAYS of the conference featured concurrent sessions in which primary health care (PHC) nurses presented aspects of their practice under four strands: collaborative practice; personal health; Maori health and improving access; and child and youth health.

The second day began with a presentation by a group of Hutt Valley District Health Board (DHB) and PHC nurses on the development of a programme to place new graduates in PHC settings. It began this year and four new graduates are taking part. They are given a thorough orientation and strong support. While working in the community, they also undertake masters-level papers in the PHC family nursing speciality through Whitireia Community Polytechnic The programme was developed by the PHC nursing leadership group, which has representatives from many PHC practice settings in Hutt Valley. The group was formed in response to the key directions in the primary health care strategy.

A new graduate Laisene Tala is working for Pacific Health. Via a video, she said she was "honoured and privileged" to be in the programme. Her work included advocacy, translation and helping Pacific people achieve.

Complementary and alternative medicine (CAM): Asian liaison lecturer in Auckland University of Technology's division of healthcare practices and practice nurse Helen Chan discussed the results of a study of three European and four Asian participants' use of CAM. It revealed that most patients turn to CAM without open discussion with their doctors or nurses.

Involving fathers in Plunket service delivery: A collaborative research project between the the Nelson Marlborough DHB's public health unit, the Plunket Society and the School of Health and Social Sciences at Nelson Marlborough Institute of Technology (NMIT) looked at how a group of Plunket staff involved fathers.

Plunket nurse Carol Hunter said the project had led to changes in her practice and how she delivered well child services. Nursing lecturer David Mitchell said it provided local solutions for local people and showed the benefits of working with people from the coal face. Recommendations included developing an organisational culture which made fathers more visible and the need for more research on fathers' particular service needs, involving men's advocates.

Clinical supervision: Canterbury DHB public health nurse (PHN) Julia Anderson outlined clinical supervision in her practice area, underway since a pilot programme in 1995. All PHNs in Canterbury receive clinical supervision, the aims of which are formative, restorative and normative. The session provoked many questions.

Post-polio syndrome:: Two Kapiti Coast district nurses, Liz Francis and Chris Sharma, outlined the causes, symptoms and treatment of post-polio syndrome. It is estimated there are between 3000 and 5000 polio survivors in New Zealand.

Eating an elephant: Nursing co-ordinator with Pinnacle Independent Practice Association (IPA) Hillary Graham-Smith outlined how second-year undergraduate nursing students at Waikato Institute of Technology participate in "structured inquiry" in collaboration with community based organisations. She said it was a pleasure to observe students bring research to life.

Family-centred care: Otago Polytechnic nursing lecturer Kim Chenery gave an historical overview of the development of family-centred care, and how views of motherhood influenced the application of family centred care in hospitals. Describing the care as "paradoxical and problematic", she said nurses needed to consider the extent to which historical assumptions inherent in family-centred care remained embedded in current understandings of the concept.

Collaborative practice: Nursing manager with First Health IPA in Taranaki, Deb Parry, explained the development of a clinical governance committee with representatives from a range of PHC practice settings. The committee aims to create collaborative practice and advanced roles for PHC nurses in New Plymouth.

From Nightingale to Now: A time of challenge and change for public health nurses: PHN Elizabeth Farrell discussed the development of Kidz First PHN services over the past 10 years in response to the health needs of children, young people and their whanau/family living within Counties Manukau. This region has around 104,000 children under 14, 26 percent of the total population. Over half are tamariki Maori and Pacific children. Thirty-eight PHNs provide a co-ordinated management role to assess and implement a range of population health projects such as the recently developed ear health resource and the planned Meningococcal B vaccination programme for 2004.

Sisters in Health: South Auckland Health Promotion Strategy: This is a community project funded by the National Screening Unit to encourage more women in the Clendon/Manurewa region to have cervical smears and breast screening. It is run as a partnership between Maori, Pacific and European PHC nurses. At a hui/fono at Manurewa Marae in March, 13 women were given training on barriers Maori and Pacific women face around cervical smear tests and breast screening. The new "sisters in health" were given certificates and resources so they can promote screening to their whanau and communities. They have visited sports events, schools, marae, kohanga reo, churches and anywhere else women gather to educate then) about the importance of health screening. Extra funding is available to transport women for smears and follow up colposcopy treatment.

Te Puna Hauora Kaupapa Maori Services, Tauranga Hospital: This service has been existence for 12 years, based on the concepts of whanau and whanaungatanga. It is staffed by mostly Maori health care professionals who are actively involved in care delivery at grassroots level as well as in an advisory capacity. The service is the first of its kind operating within a secondary health service. "We provide inpatient and outpatient services, a kai awhina service for social support and cover all wards including mental health. We offer whanau counselling, a culturally safe environment within the hospital and a model of health based on Te Whare Tapa Wha, the four-sided house. This means each of the cornerstones has to be in balance to create health," explained nurse manager Pat Cook. Clinical support nurse Shirley Lyford said the long-term aim was for the service to become autonomous and managed by nurse practitioners.

Death of a Handmaiden: Two nurses from Piki te Ora ki Te Awakairangi, the first primary health organisation (PHO) to be established in the Hutt Valley, showed how the role of the nurses has moved from being the doctor's handmaiden to an equal partner working with and for the community. The PHO has three partners: the Kokiri Marae Kerlana Olsen Trust (a health promotion, training and education centre), Whai Oranga O Te Iwi (a health centre in Wainuiomata) and the Hutt Union and Community Health Centre. Three representatives from each body sit on the board, with 50 percent or more of them Maori. The PHO uses a multi-disciplinary approach and a variety of community settings for delivering health services and health education. The service looks at the family unit as a whole, as sickness effects all members. The PHO is hoping to employ two nurses to run a mobile clinic in the near future.

A full list of the workshops is available on www.nzno.org.nz.