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Palliation Through the Lifespan in Auckland, New Zealand

Palliation Through the Lifespan in Auckland, New Zealand. Presented by: Hannah Arnspiger, Paige DeLay, and Cena Rasmussen. Starship Community Clinic. Mercy Hospice Clinic. Objectives.

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Palliation Through the Lifespan in Auckland, New Zealand

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  1. Palliation Through the Lifespan in Auckland, New Zealand Presented by: Hannah Arnspiger, Paige DeLay, and Cena Rasmussen Starship Community Clinic Mercy Hospice Clinic

  2. Objectives Hannah: Analyze how palliative care in managing chronic conditions for children can influence their health outcomes later in life. Paige: Educating the community on the services of palliative care is vital in people understanding the variety of ways it can be beneficial to them and those around them. Cena: An objective of this project was to see how starting palliative care treatments at a young age can affect a person's quality of life throughout the lifespan. Population served: Children ages 0-5

  3. Background Information of New Zealand Geographic location/boundaries: Southwest Pacific Ocean, consists of 2 main islands Capital City: Wellington Total Population: 4.79 million Age: average life span is 81.3 years old • Males: 79.1 y/o • Females: 83.5 y/o Gender ratio: 0.97 males: 1 female Income/Poverty level: In New Zealand, the average income per person is 28,500 NZD. 1 in 7 households live in poverty. In the United States, there are approximately 40.6 million Americans living in poverty, totaling 12.7% living at or below the poverty line. https://caseygrants.org/evn/u-s-poverty-rate-falls-but-poor-push-for-more-progress/?gclid=Cj0KCQiAtvPjBRDPARIsAJfZz0oXQIO1hnkfjbrAcN0g3ThKEZaNbEqXtBIfPd8NHxO29FMQaGIMoxgaAi6PEALw_wcB

  4. Background Info of New Zealand cont. Education level: 99% of adults are literate. Over half of the population, ages 15-29, have tertiary qualifications. 14% of adults have a bachelor’s degree or higher. Major sources of employment: large scale manufacturing, tourism, mining, textiles, and finance Political structure: Commonwealth of Nations and Parliament Cultural health beliefs and behaviors: In regards to palliative and hospice care, the two terms are used interchangeably. Palliative care is care for any life limiting condition, at any stage of the illness. Hospice care is end of life care for people with a terminal condition limiting life to 6 months or less. Across the country, knowledge of these services is still low, even among health professionals. Some people still view hospice care as a place for those who are dying, but rather it is a philosophy of care. As a result, most people only utilize it at the end of life, but it can be implemented at any time of life for those who qualify. Health disparities among people groups: Non-residents don’t receive free healthcare, impacting mostly Pacific Islanders

  5. Description of Maori in Auckland Total population: 600,000 identify as Maori (15% of total NZ population) Age: male: 73 y/o, female: 77.1 y/o Gender ratio: 1.04 Maori females for every 1 Maori male Income/poverty level of the population: median income for the Maori is $22,000 NZD, which is $3,500 NZD less than the average NZ European Educational level: 67% of Maori have finished primary education, 33% finished high school, and 10% have a bachelor’s degree or higher Cultural health beliefs and behaviors: Maori value their whanau (family) and the whole whanau is involved in medical decisions. Some Maori still use traditional medicine and rely on prayer. It is very important to focus on the wairua (spiritual force within people), as well as mana (respect of others and the environment). Pain in the Maori culture involves physical, spiritual, and emotional aspects that need to be taken into account. Specific health disparities: higher rates of obesity, less diagnostic tests run, shorter life expectancy and higher rates of diabetes

  6. Description of International Site

  7. At Risk Population Number expected to reach: 0-5 year old children who could benefit from palliative care in the Auckland area. We are hoping to have 50 patients and their caregivers attend the program. Age of the population: 0-5 years old Gender differences: there are no gender differences, we are looking at all children ages 0-5 with chronic conditions Reason this community group may come together: We are targeting children ages 0-5 and their caregivers by enlisting health care providers to act as stakeholders to start palliative care for these children at a younger age. The goal of this would be to better manage their conditions, and improve their health outcomes throughout life.

  8. The Health Issue Primary Issue: Palliation of chronic conditions throughout the lifespan • We are focusing on children ages 0-5 because we have seen how palliative care can be beneficial not just for patients who are in the dying process, but also for pain control, medication management of chronic conditions, and overall increase in quality of life throughout the lifespan. Some examples of chronic conditions for this group include asthma, diabetes, and respiratory diseases. Healthy People 2020 Objective: Health-Related Quality of Life and Well-being • Quality of life and well-being can be increased by starting palliative care earlier in the diagnosis. Consulting with palliative care does not mean that a patient is dying, it just means a patient has a complex condition that requires detailed management and coordination. The better managed the condition is early in life, the better it will be managed as the patient ages. Sustainable Development Goal: Good health and well-being

  9. Health Promotion Model For our literature review, we analyzed the CBPC model and discussed how it could be useful. For our CHIP, we decided to focus on the Diffusion of Innovation Model, which we found outside of our literature review. They both have steps that aim to establish a reliable model that is effective in its purpose. The CBPC model was designed to implement home based care, while the Diffusion of Innovation Model analyzed how a behavior/product adapts over time. Diffusion of Innovation Model (Rogers): emphasizes the dissemination of health behavior interventions. It looks at how a behavior or product is adapted over time and how long it takes for the idea to take hold in a population as well as how long it lasts. In order for an idea to be widely adopted, it must be sustainable and have a large positive impact on the population. • Step 1: The innovation • Step 2: Communication Channels (spreading the word) • Step 3: Time • Step 4: Social Systems The underlying assumption of adoption is the perceived value placed on the new behavior or innovation.

  10. Conclusions/Suggestions • Palliation of chronic conditions in New Zealand is not as widely used as it could be. Many people have the misconception that palliative care is the equivalent of end of life care, so they avoid talking about it with their health care providers. We worked with many Maori patients with chronic conditions that had not been managed well throughout their lifespan and therefore had worse health outcomes than their counterparts who had not lived with chronic conditions all their lives. • According to the literature, palliative care can be improved by making current resources more accessible to meet the specific needs of those in the community. The CBPC model created in Korea aimed to standardize and improve quality of services provided at all centers (Kim, Choi, Shin, Ryu, & Baik, 2017.) Similarly, for our CHIP, we are aiming to standardize palliative care services for our young population to foster a higher quality of life by intervening with chronic conditions as soon as possible. Additionally, reducing the gap in knowledge of palliative care will be achieved through further educating both the healthcare professionals providing the services and the public receiving them. By doing these things, we will hopefully achieve our SDG of good health and well-being for all people.

  11. Professional Experience Highlights • Hannah- This experience has allowed me to develop as a nurse in a new way. Most of my experiences have been in the acute care setting, so this experience was tremendously valuable. Having a population health clinical in New Zealand enabled me to meet amazing nurses who inspired me and taught me what it looks like to promote the highest quality of life for each patient. • Paige- From my time in New Zealand, I’ve gained a better understanding of how to interact with people of diverse backgrounds and different value systems. This international educational opportunity has helped me become more culturally competent and further my interpersonal skills, which I look forward to applying in my nursing career. • Cena- I have been able to work on forming an intervention as a student, whereas throughout the rest of our education, we follow policies, procedures, and interventions that have already been created. I have appreciated the opportunity to think outside the box and be creative in my nursing care.

  12. Personal Experience Highlights • Hannah- By having this clinical experience in New Zealand and creating a Community Health Improvement Plan, I have been enlightened by the reality that there are many barriers and steps that are involved in making effective change in the community setting. I have realized that there will always be work to be done and improvements to make. I feel so fortunate for the people I met and the lessons I learned that I will carry with me my entire life. Traveling and nursing are priceless to me, and I am grateful that I was able to do both for this clinical. • Paige- The people in New Zealand were sincerely so very kind and welcoming. The healthcare professionals took the time to be relational with their colleagues and patients, giving each interaction their full attention. I appreciated working in an environment where the common goal was truly to connect with and better the lives of others. • Cena- This experience has allowed me to see a new culture first hand. It was a very unique way to see how patients are treated differently on the other side of the world and I hope to be able to bring many of the lessons I learned there to my care as a nurse here to help my patients have better outcomes and experiences while in the hospital.

  13. References Giddens, J. F. Concepts for Nursing Practice (with Pageburst Digital Book Access on VST). [VitalSource]. Retrieved fromhttps://bookshelf.vitalsource.com/#/books/9780323374736/ Kim, S., Choi, S., Shin, S. H., Ryu, J., & Baik, J. (2017). Development of a Community-Based Palliative Care Model for Advance Cancer Patients in Public Health Centers in Busan, Korea. Cancer Research and Treatment, 49(3), 559-568.doi:10.4143/crt.2016.276 Map of New Zealand. (n.d.). Retrieved February 4, 2019, from https://www.lonelyplanet.com/maps/pacific/new-zealand/ New Zealand. (2018, August 23). Retrieved fromhttps://www.state.gov/r/pa/ei/bgn/35852.htm Nyhan, P. (2017, September 13). U.S. Poverty Rate Falls. But Poor Push for More Progress | Marguerite Casey Foundation. Retrieved from https://caseygrants.org/evn/u-s-poverty-rate-falls-but-poor-push-for-more-progress/?gclid=Cj0KCQiAtvPjBRDP ARIsAJfZz0oXQIO1hnkfjbrAcN0g3ThKEZaNbEqXtBIfPd8NHxO29FMQaGIMoxgaAi6PEALw_wcB

  14. References cont. Our system of government - New Zealand Parliament. (2013, May 1). Retrieved from https://www.parliament.nz/en/visit-and-learn/how-parliament-works/our-system-of-government/ Sustainable Development Goals: Knowledge Platform. (n.d.). Retrieved from https://sustainabledevelopment.un.org/?menu=1300 The World Factbook: NEW ZEALAND. (2018, September 26). Retrieved from https://www.cia.gov/library/publications/the-world-factbook/geos/nz.html Topics & Objectives. (n.d.). Retrieved from https://www.healthypeople.gov/2020/topics-objectives

  15. References for International Site Chart Community data: describe how you see it and what it does if no community data to provide. (from site) Provide comparison to US international country and community (see chart) United States data: https://www.urmc.rochester.edu/senior-health/common-issues/top-ten.aspx International data: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death Incidence and prevalence of first 2 under US data: https://www.hhs.gov/fitness/resource-center/facts-and-statistics/index.html Tobacco data under US data: https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html Substance abuse under US data: https://www.drugabuse.gov/publications/drugfacts/nationwide-trends Mortality due to overweight/obesity under US data: https://www.wvdhhr.org/bph/oehp/obesity/mortality.htm Mortality due to substance abuse under US data: https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates Mortality for ischemic heart disease and stroke for international data: https://www.tctmd.com/news/ischemic-heart-disease-leading-cause-death-globally Mortality due to lower respiratory tract infections: https://www.who.int/gard/publications/The_Global_Impact_of_Respiratory_Disease.pdf Mortality from obesity: https://www.who.int/gho/ncd/risk_factors/obesity_text/en/ Incidence of stroke globally: http://www.strokecenter.org/patients/about-stroke/stroke-statistics/ Global cancer prevalence: https://www.cancer.gov/about-cancer/understanding/statistics Incidenc of lower respiratory tract infection globally: https://www.who.int/gard/publications/The_Global_Impact_of_Respiratory_Disease.pdf Community data-Cancer (incidence and morbidity): https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12064758 End stage organ failure, community data, incidence: https://www.kidneys.co.nz/resources/file/nz_care_processes_and_treatment_targets_report_2015-1.pdf Community data, incidence and mortality of heart disease: https://www.stuff.co.nz/national/health/76476289/null

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