UPDATE ONE - DAY ONE
The 19th South Pacific Nurses Forum is underway!
17th October 2018 - Update
Hosted with great energy and generosity by the Cook Islands Nurses Association, day one was action packed right through from registration at 8:00 a.m. until the close at 5:30 p.m.
Then the energy continued through a fabulous buffet dinner and entertainment hosted by the SPNF.
The conference was opened by the Health Minister and there was a performance of the specially written conference song which translates as “Nurses are Transforming Agents”. Only in the Pacific could this be a sexy and beautiful dance performance.
The day had so much packed into every presentation that it was hard for the speakers to keep to their time slots. It was all so interesting that it was hard to write notes, but here are a few highlights from the day…….
Mrs Elizabeth Iro, Chief Nurse with the World Health Organisation gave and inspiring key note speech on the need to build nursing and midwifery capacity to achieve global Universal Health Coverage and meet the Sustainable Development Goals. She reminded us that as a global workforce, nurses are 20 million strong!
The topic of Celebrating Nursing was covered in a wide range of wonderful stories by Mrs Debbie Sorrenson (CEO of Pasifika Futures), Matafanua Hilda Fa’asalele, (Chief advisor Pacific Health N.Z. Ministry of Health) and Dr Neti Tamarua Herman (Cook Island Registered Nurse).
Between them they described the great work that nurses are doing in the Pacific. Debbie outlined the positive impacts that nurses make in the lives of families in their communities and summed up by saying “nurses are the core and the future of health care”.
Dr Neti has continued to work as a mentor and change agent despite retirement and really showed us that you can’t keep a good nurse down at any age.
In conclusion, Mrs Nikki Rattle outlined how her nursing journey took her all the way through to being the Speaker of the Cook Island House of Parliament where she was chosen for embodying the values of the Red Cross, Neutrality, Impartiality, Humanity and Independence. Values all nurses can aspire to!
The next big event was the official launch of the NursingNow campaign.
Launched by Jill White of the ICN and South Pacific Board member of NursingNow, her inspiring speech covered the results of the Triple Impact Report [link] and the recognition that Universal Health Access cannot be achieved without strengthening nursing. She also spoke about the value that nurses bring and how we need to frame nurses as an asset and an investment in all discussions about health.
The NursingNow campaign was launched in Feb 2018 and has now been rolled out in 35 countries.
Dr White reminded us that the Pacific Rim is a “health red light zone” for the whole globe as both infectious diseases and natural disasters often occur here first.
She ended with a challenging question for nurses……
“Why do nurses let doctors define what healthcare is?”
One of the questions from the floor about NursingNow was the inclusion of Indigenous voices. How do we make them heard? Given the shared health issues that many Indigenous groups face, should there be an Indigenous specific NursingNow campaign group?
Dr White has promised to take this question to the next NursingNow meeting in December.
After lunch the session theme was Health Workforce Development.
We had an introduction to the role of the ICN in building capacity and leadership to improve health outcomes by David Stewart.
He reminded the delegates that the ICN is their voice at the UN and WHO.
That the NNA’s (National Nursing Associations) could feed information to the ICN to get them to work with policy makers to enable change.
ICN = a voice at the U.N and WHO for nurse organisations.
After this presentation, a discussion was had about challenges Pacific countries face in developing leadership.
Tonga – spoke about policy and process development to support leadership and structure, they highlighted the value of the 5 pillars of leadership in guiding this.
Fiji – issues such as compulsory early retirement, lack of job security and loss of nurses to other countries and specialist programs remained a concern despite the recent pay rise for nurses. Fiji also expressed concern that junior nursing staff were being pushed into senior roles without adequate leadership training and mentoring.
Cook Islands – spoke about the importance of being an active member of the ICN and the difficulty of being a small, geographically isolated and financially constrained NNA (National Nursing Association). They would like to see the ICN governance work to give them greater voice.
Then we continued on with the workforce development theme with the next session with presentations from George Pego from Solomon Islands speaking on their recent efforts to map and quantify service demand to better plan service delivery and staffing requirements.
Seilini Soakai from Tonga spoke of the necessity of empowering the health workforce in order to fight NCD’s.
NCD’s are responsible for 75% of deaths in Tonga
Nurses are seen as having a critical role in addressing NCD’s
DFAT funding has allowed 20 nurses to graduate since 2014 with a 1 year diploma in managing NCD’s.
The last session of the day included a thought provoking presentation from Assoc. Professor Rachael Vernon and Professor Mary Chiarella (Australia) on competence, performance and the role of insight in nursing.
Heaven Isaia (Samoa) and Rouruina Taraare (Cook Islands) gave a well constructed breakdown of the process of developing perioperative nursing in the Pacific.
Catelyn Richards and Lucy Osborne (Australia) delved into the journey to leadership, speaking of their pathway from new graduate to emerging leader via the leadership program of the Australian College of Nursing.
And finally Doris Taripo, Parau Nio, Tohoa Cummings (Cook Islands) took us on a trip around the Cook Islands as they shared their stories of delivering care as part of the Universal Health Coverage for the remote islands.
Whoah!! What a day.
But it’s not over yet – dinner was hosted by the South Pacific Nurses Forum at the Edgewater Function Centre with fantastic drums and dancing from a cultural dance group
By Angela & Bronwen
UPDATE TWO
18th October 2018
SNPF Interview Bites - Day One
We have asked a random selection of SPNF participants the same few questions to share their thoughts on some important issues for Pacific Nurses
Associate Professor Dr Alisi Vudiniabola
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What is your role?
Head of School
Fiji College of Medicine, Nursing and Health Sciences, Suva.
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Have you been to the SPNF before?
Yes, I’ve been coming since the 1980’s
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If there was one thing you could change for Pacific Nurses, what would it be?
I’d like to take away the Ocean, so we could bring everybody together more easily. The distance divides us.
Maui Jesse
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What is your role?
Emergency Nurse at Cook Islands Hospital
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What is one thing you’ll take away with you from the conference?
The Cultural diversity of the Pacific Region
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If there was one thing you could change for Pacific Nurses, what would it be?
I would like to see more opportunities for education and development with greater exposure to other ideas and systems to encourage nurses to look outside their own areas and take up evidenced based best practice. It would be good if Pacific nurses had more opportunities to visit and learn in other countries.
Joshua Pierce, an Australian and a Torres Strait Islander
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What is your role?
I am a Registered Nurse, a board member of CATSINaM – Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, and also teach at the faculty of Nursing, at the Australian Catholic University.
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What is one thing you will take away from the conference?
Raising Indigenous voices. There was a quote here, “that without the voices of midwives, women and children would be invisible”, I would also say that if we don’t hear the voices of Indigenous people in health, then the Indigenous experience is invisible.
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If there was one thing you could change for Pacific Nurses, what would it be?
That their voices are heard!
Clemency Goldie
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What is your role?
Surgical Outpatients Clinical Nurse, Cook Islands Hospital.
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What is one thing you will take away from the conference:
Once a nurse always a nurse even if you retire! It’s a way of life.
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If there was one thing you could change for Pacific Nurses, what would it be?
More education and more health promotion. We need to encourage health awareness by promoting important health messages in places like airports.
UPDATE THREE - DAY TWO
19th October 2018
After opening the morning with a heartfelt prayer from Tonga we got a wrap up of the events of day one and moved on to the key note speaker, Mary Kirk, Vice President of the ICM (International Confederation of Midwives).
Mary spoke passionately about the value midwives bring to communities. She informed the audience that a skilled midwife can provide 87% of the necessary care for a mother and her newborn. She also spoke about the problem of obstetric interventions in maternal care of “too little too late – too much too soon”, and reinforced the need for nurses and midwives to work together. Her final message to the crowd was that midwifery care was not about us as midwives, it’s about women. That we need to take the services to the women, not push women to services.”
After the key note speech was a presentation from Nancy Pego (PNG) detailing their collaboration with ANZCOG and Australia to ensure more midwives are trained to meet the needs of women in PNG. She also highlighted the need for nurses to continue on to do midwifery training as many of the mothers also have other morbidities and their midwife needs to be able to manage not only the pregnancy and birth, but also their chronic health conditions.
After the presentations we heard from PNG, Tonga, Kiribati and Vanuatu about the state of midwifery services in their countries.
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PNG – they currently don’t have enough midwives, but they are working with others to train more. They are also looking to create a midwives’ association.
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Tonga – note the increasing rate of C-section births and increasing numbers of mothers delivering in remote areas. They echo PNG in needing to train more midwives to ensure service provision. Although they don’t have many midwives, they did report that their basic nursing training included 2 units of maternity care.
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Kiribati – report that progress on increasing midwife numbers is slow. There is currently no midwife training program in the country as they education of nursing is undergoing restructure, with the responsibility of nurse / midwife education moving from being the responsibility of Ministry of Health, to the Ministry of Education.
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Vanuatu – Reported that they’ve had their first ever accredited midwifery program and that the 14 graduates also completed PEMNET train-the-trainer.
After morning tea, the theme was Transforming the Profession of Midwifery.
Topics ranged from the developing Pasifika midwifery workforce in NZ, to the need for sexual and reproductive health systems in Tonga, to the challenges of pre-conception health and primary prevention and strategies to put a culturally appropriate structure around crisis support for Maori women in pregnancy.
After another extensive and delicious lunch we gathered ourselves for the afternoon session which started with an overview from Associate Professor Judith Mc Ara-Couper and Sharron Cole on regulations in NZ both to protect mothers and babies and also to protect midwives.
The countries perspectives highlighted the need to include indigenous voices in the development of midwifery.
The mid afternoon presentations began with a fascinating pilot study by Nga Masters and Assoc Professor Judith Mc Ara-Couper examining the reasons that Pasifika women in NZ prefer to birth in Tertiary centres and ways in which birthing in primary health centres could be supported.
Mele Tu’angalu raised the worrying data about gestational diabetes from Tonga and ways in which the government is trying to address this epidemic, which now affects 40% of mothers, leaving them at greater risk of developing Type 2 DM at a later date.
Professor Mary Steen explored ways to change diet and eating habits during pregnancy via an education program for midwives and tools such as the Eat Well Diary.
Finally Dr Diana Austin from NZ looked at strategies for supporting midwives when outcomes are poor.
The final session of the day was on the theme of Breaking the Cycle of NCD.
Akesa Halatanu from Tonga discussed clinical approaches to making every patient feel valued.
Timaima Koroibanuve from Fiji gave a positive talk on the right to eye health and shared the positive news that eye surgeries were up to 500 per annum in 2016.
Loli Channing from NZ raised the idea of Healthy Village Action Zones from the Parish Community program in NZ. This initiative of breaking the NCD cycle via community, language and caring for others, was one that was very relevant to the Pacific culture.
Alisa Ili of the Pan Pacific Nurses Association discussed Pacific people’s experience of Bariatric surgery.
Salome Ravonokula and Julia Kingi gave an inspiring account of the way in which a nurse led model of care with a whanau approach was improving cardiac rehab outcomes in NZ.
And finally Ellaine Ete-Rasch from NZ shared research insights into why the rate of hospitalisation of Pasifika children with preventable conditions in NZ is so high (35% of all such admissions) and strategies to reduce this figure.
Closing prayers were from the Solomon Island nurses and dinner was hosted in the Auditorium by the Honourable Minister for Health.
To set a good health example, fresh coconuts were on offer instead of alcohol and dessert was replaced by fruit. For exercise we watched the very energetic young dancers burning calories on our behalf!
UPDATE FOUR
19th October 2018
SNPF Interview Bites - Day Two
Teina Stringer & Tuvaine Avanui
What are your roles?
We are retired nurses. Teina worked in Mental Health and Tuvaine worked as a registered nurse, midwife and in public health. Tuvaine graduated as a nurse in 1956!
We both worked in New Zealand, Teina in Nelson and Tuvaine in Middlemore and then also in the Cook Islands.
Have you been to the SPNF before?
Both have been to SPNF before, but unsure of dates.
What would you like to see for Pacific nurses?
Both felt that nurses should be able to travel for nurse or midwife education, but that once skilled they should return home to care for their people
Helirson Siro
What is your role?
Nurse in Charge,
Paediatric ward,
Northern Provincial Hospital
Santo, Vanuatu.
Have you been to the SPNF before?
Yes, this is the third time.
What is one thing you will take back from this SPNF?
We need to find ways to organise pathways for research and resources that will give us assistance with this. We also really need to build a strong nurses association.
If there was one thing you could change for Pacific nurses what would it be?
We need to make our education pathways stronger, especially in Vanuatu. We need more exposure to what is happening in other countries so that we are not isolated in our practice.
UPDATE FIVE - DAY THREE
20th October 2018
Opening hymn by the Samoan nurses.
First up was a panel discussion with Elizabeth Iro from WHO, David Stewart and Jill White from ICN and Mary Kirk from ICM answering questions from the country delegates. The theme was how can Pacific nurses engage more with the WHO, ICN & ICM and how can these organisations best support nurses.
A robust discussion followed, with many of the delegates highlighting the shared difficulties for nursing of resource scarcity and isolation.
Fiji – raised the issue of not having a Pacific nurse / midwife representative at the WHO. Elizabeth Iro responded that she has raised this with the Director General and encouraged member countries to ask their Ministers of Health to push for this.
Solomon’s – seconded the statement from Fiji, believing that a Pacific representative would facilitate regional planning.
Samoa – request support to develop professional pathways for nurses.
Cook Islands – stated the need to provide in-country training for nurses and midwives to avoid draining country resources. They are looking to build local capacity.
PNG – spoke with great emotion about the difficulty of nursing being stuck under a Medical Act. Without a Nursing Act the work and needs of nurses is not well understood or valued.
Australia – suggested that there is a need to develop actions at the SPNF meeting to address the issues, and went on that achievements are driven by clinical, industrial and political actions. She urged that nurses collectively “be bold”.
Vanuatu – spoke of their shortage of nurses, both at the clinical and managerial level. They are working with MoH but state there is limited funding for overseas training and WHO no longer sponsor education. They also highlighted the difficulty of having other agencies (such as DFAT) who have priorities that don’t always align with the local needs.
Elizabeth reminded the delegates the POHLN ?? (need to google) offer technical rather than financial support and could be used to help support in-country training.
Tuvalu – said that one of their main concerns was the lack of midwife training in Tuvalu. They have had no m/wife training for 6 years.
The response from the panel from Mary was for nurses to engage with the ICM via their website, use the tools provided there, to become a member of ICM and to always provide feedback if there are improvements to be made.
Liz encouraged nurses and midwives to call her, email her, and engage her in her role. She reminded the room about the importance of collecting data to create a picture of the status of nurses and midwives in each area for the 2020 Status of Nursing paper to better inform and push for change.
David urged nurses to engage with key decisions makers. To raise the profile of nurses and ended by saying that empowered nurses make the biggest impact on health and on NCD’s.
The session after morning tea was themed “Health Responses to Climate Change, Disasters and Outbreaks” and was chaired by Baaua from Kiribati.
First up was the Kiribati Emergency Nurse Training Program team, presenting on the program and the impact of having a cohort of skilled nurses designated to the ED on patient care.
Next we heard from Norma Goulolo from the Solomon Islands about the lessons learnt from researching nursing care delivered during a dengue outbreak. With some excellent recommendations for improving care during outbreaks in the future.
Then James Asugeni from the Solomon Islands gave an informative and sobering presentation about the mental health issues occurring as a result of rising sea levels and climate change. His research is published in the JOURNAL OF PSYCHIATRY and has implications for many other Pacific communities.
The next session, led by New Zealand focussed on “Extended Practice and Nurse Prescribing”
Dr Jill Wilkinson and Dr Mark Jones looked at the regulatory situation around extending nurse prescribing in New Zealand.
Pauline Sanders and her colleague Piri discussed the improved outcomes for patients under a community health extended prescribing program in Counties Manukau Health. Piri shared her story of the way in which completing the program has enriched her career, enabling her to work with families as an extended unit and provide education that they may not be willing or able to source elsewhere. A discussion followed on the ramifications of this model for nurses in other parts of the Pacific.
Mele Kaufusi, an RN nurse prescriber in Auckland, spoke about transforming Pacific nurses into a force for change.
She reminded us that NCD’s account for 4 million deaths worldwide A YEAR! and that they are responsible for 85% of premature deaths in low and middle income countries.
This is a challenge to our existing models of care, and the Pacific must adapt. Moving care into the community has advantages for patients and is more cost effective.
Georgina McPherson, a nurse practitioner in a colposcopy unit, shared her inspiring journey as the first Pasifika Nurse Practitioner, pushing many boundaries in her practice to create an expanding role involving education, research, undertaking a range of procedures including colposcopy and patient care.
Her work has important ramifications in the Pacific where rates of cervical cancer are high. She is working on a self sampling HPV screening program which would reduce cultural barriers to seeking testing, and a ‘One Stop Shop’ approach that will stop people being lost to follow up treatment.
The next Colposcopy Conference is in March 2019 and has a Pacific Theme if anyone is interested in attending.
Closing prayers and hymms were from Vanuatu
Another delicious dinner was hosted in the Auditorium by the Cook Islands Nurses Association, and every country performed an item – much dancing and singing until very late!