What does living in a Bi-Cultural Society mean?

I have heard said by many, that we are multi-cultural society not a bi-cultural society. While that is correct our history has to be taken into account.

The Treaty of Waitangi was there for the preservation and protection of both parties where they could live in harmony. Well that is how understand it to be.

When a person understands what living in a bi-cultural society actually is living in a multi-cultural society becomes easy.

How is that so? Just think about it. When you understand people differences you also get to see their similarities.

$ value of nursing staff in residential care

On one hand there is a move to improve the care of the elderly thround specialist nurses yet on the other hand there is a devaluing of the those already working in Aged care?

I am talking about pay rates. For the life of me I do not understand why Rn's and Caregivers in both the public and private sector do not have parity.

The media is quick to jump on the aged care when a perceived wrong is noted yet the incentive to have well trained nurses in the private aged care sector appears to be discouraged.

I have to say it is time that this issue was addressed not from a union point of view but a moral point of view. Is this not he same as women getting parity with men? A continual battle for recognition of value?

Go to http://www.insitenewspaper.co.nz/pages/section/article.php?s=Breaking+News&idArticle=17108 for discussion on Taihape nurses being expected to take a cut in pay.

My question on this is. The public sector nurses are looking to get yet another pay rise. I understand it is under negotiation. What about the Aged Care Sector? Will they get the same rise? Will the government top up the funding to cover this for the private sector?

Maybe it is time the way the private sector is funded? Two bundles of money. One for wages and one for business. Just a thought.

Rest Homes hit the media yet again

This time it more about business of Rest Homes. Unfortunately the writer, Geoff Harper does not understand the difference between Rest Homes and Continuing Care facilities which have a different staffing ratio due to the different needs of each group. However he does have some valid points about overseas ownership. ("Country's rest home industry leaves a lot to be desired" written by Geoff Harper NZ Herald 27th July Pg A9)

My concern is not so much the finances going off shore, but the values difference of some people who are purchasing aged care facilities. They are finance focused and more likely to cut corners in the areas that matter most to people in care. Where the owner comes from a country where money is god, the sole purpose for existance people have a much lesser value. This can make it very difficult for Kiwi'a to work in these facilities.

I would like to think we are a "people first" country. Survival tactics are different here. We can get a financial hand up from the government even if it is a meagre one, it does help. Owners who come from a value system where survival is up to them have a totally different focus.

So please let the government consider these factors when assessing overseas ownership. Does this person fit in with the values of this country? Are the people of New Zealand going to disadvantaged by this business owner?

For example how can the onwner of a shipping company know how to look after older people! Zilch in my book. I think you can see where I am coming from.

Trial by Media - again

It is sad that yet again the media want to have a "go" at rest homes. While residential care will never be perfect for many families I know that in most cases you all do a wonderful job.

This recent front page headline proves to me how important it is to have staff well trained. While the facility admits there were some errors in documentation it appears the gentleman was well cared for.

What you will never be able to predict or account for is family guilt and a society that wants to apportion blame. The reality is that older people are more at risk of falling and dare I say it - dying.

As a carer you can only rely on the information a resident gives you. If they say they are not in pain or are fine there is little you can do. Indeed you should empower the person to make their own decision. However you will always come up against people who think a residential facility can wave a magic wand and do the impossible - like stopping a person from dying.

All I can say is the importance of training yet rears it head again. When I am teaching observing, recording and reporting I instill in the Caregivers that this is all about ensuring they write everything down and they cover their butt.

However you will never be able to do the impossible. Sometimes it is just time for a person to die. Can they at the very least do this with some dignity without being plastered across the media. I know at the very least, that is what I would want for my family.

Do you have people with fluid retention who are not responding as well as they could to Frusid?

At a recent Medication Adminstration Training Session for Caregivers, Gigi Lim, Senior Lecturer at Auckland University was saying that if Frusid is given after food, the medication action may be delayed (See below Pharmcokinetics for Frusid from Medsafe Website)

So if you have people who are not responding as well as expected to Frusid Medication administration time may the problem. Discuss with your doctor and Pharmacist and see if shifting the administration time could make a difference.

Pharmacokinetics
Approximately 60 to 70% of an oral dose of frusemide is absorbed. Peak plasma concentrations occur 60 minutes after oral administration and 30 minutes after intramuscular injection. They increase with increasing dose. Administration after food apparently delays absorption producing lower but more persistent blood concentrations.

Full Fact Data Sheet can be viewed at http://www.medsafe.govt.nz/profs/datasheet/f/Frusidtabinj.htm

How well do you understand the medications you are administering?

Registered Nurses and Managers of care facilities, have very high expectations of caregivers. While there is no legal provision made for who may or may not administer medicines are the caregivers actually receiving sufficient information on how the medications they are giving, actually work? Do they understand what happens if the medications is not given in accordance with the manufacturers instructions?

Medications are chemicals. Like all chemicals they are designed to work under certain conditions. If the conditions are not correct, then the efficacy of the chemical will be altered.

So what are some basic actions for medication efficacy?
1. Swallowed with a at least ½ glass of water – not a sip of tea or coffee or put in their food or crushed especially with certain formulations if they are Enteric Coated, Controlled Release or Slow Release
2. Put directly into the mouth on a spoon – not in the hands, or picked up with the fingers
3. Given at specific time – on an empty stomach, with food, after food or morning, noon, afternoon or evening

Every time a medication is given outside of the manufacturers instructions, it reduces the efficacy of the medication.

Yet if we are honest a lot of medications are administered outside these “warranties” if you like.

Caregivers are trained in the 5 point pre-administration check before any medications are given. This we do well.

So what else should any person administering medications know?

What happens to the medication in the body? Not in fine detail but have some understanding how drugs are absorbed and distributed around the body. This enhances the understanding of the importance of their role.

Is this done well? No it isn’t.

We make it as safe as we can with the limited knowledge that is given to the caregivers. On the whole I believe we do a good job but we could do a better job by enhancing their understanding.

Clinical Update (NZ) Ltd is very fortunate to have been able to contract the services of an expert in the field of medications in Gigi Lim, Senior Lecturer at University of Auckland. Not only is she a Registered Nurse, she is also a Pharmacologist. She decided that she did not understand how the medications she was giving worked, so she did something about it. Now with her clinical nursing knowledge and her Pharmacology knowledge, she can teach in a way nurses understand.

I have been working with her for the last 5 years helping Registered Nurses, Enrolled Nurses and Caregivers understand how medications work in the body. I am fortunate to to be present at all her training. It is part of my business. I have never left any session without taking away some new information.

The bottom line here is we cannot expect caregivers to know everything but we can empower them with knowledge. We can help them understand the importance of their role. Medication administrations errors can be prevenable and many errors are caused by lack of knowledge and understanding of the drug's efficacy. Give them the tools to do their job. Understanding Medication action is but one of them. After all if they don’t understand what they are doing, the how and the why are superfluous. Take the next step. Give your caregivers the knowledge to do their job well. You will reap the benefits of good care.

For the next Medication for Caregiver course in Auckland go to http://www.careadvisoryservices.co.nz/clinicalupdates/medication.htm

Caregivers have a thirst for knowledge that we don't often recognise

Having run two caregiver training courses this week it just never ceases to amaze me of the knowledge they have and the new knowledge they seek.

Firstly Observing Recording and Reporting. Having gained some understanding of the importance of reporting what they see, hear, feel, and writing in a factual way using what where when and how empowered left them buzzing.

At Medications for caregivers with Gigi Lim I was astounded at the questions they asked. They are more highly skilled than we sometimes give them credit for. Some of those who attended had been to 3 of Gigi's classes. That shows a real thirst for knowledge.

Next year there will be more information on specific medications for them to empower them further.

Lets not underestimate the abilities of these caregivers and thank you to the facilities/organisations that supported them in their endeavours.
You and your residents/clients are the winners here.

The integration and transition of home to residential care

It is pleasing to see there is now a move to look more closely at this. A conference coming up in September is taking a good look at this. If you want to find out more about it go to
http://www.insitenewspaper.co.nz/pages/section/article.php?s=Management&idArticle=16289

Did you know??

That cultural safety has been in place in New Zealand for over 20 years and Irihapeti Merenia Ramsden one of the instigators of this. If you are interested in finding out more about the history of Cultural Safety in New Zealand, which has a strong bias for indiginous people then take a look at this article http://culturalsafety.massey.ac.nz/

If you think you alone cant make a difference, just look at what Irihapeti did. She has moved mountains. Now it is time for us continue her good work but to include all cultures, including pakeha New Zealanders. We have our own culture too that needs to be recognised.

The value of training - is it an expense or an investment

With budgets being squeezed, training seems to be the poor relation. Yet some people still find the value in training. This article in Insite outlies the Oceania Living experience on training and how targeted training has save $$$ in ACC levies and reduced attrition.

Well worth a read. Go to http://www.insitenewspaper.co.nz/pages/section/article.php?s=Education+%26+Training&idArticle=16284

What are the benefits of training staff

According to Oceania Group National Training Manager, Mike Knowles, they have reduced the accident rate through a targeted Occupational Health and Safety training strategy. They used to face $20,000 per months in ACC claims and it has now dropped to $5000 per month. So if you think training is a cost, it is actually a saving when looking at figures like this.
This article in Insite is well worth a read.
Go to http://www.insitenewspaper.co.nz/pages/section/article.php?s=Education+%26+Training&idArticle=16284 .

Where do you come from

The Maori people define themselves by there iwi. Where they have come from. This is not where they live. I fell into this trap when I was asked where I came from, and I said West Auckland but the person wasnt asking me that. They were asking me what my heritage was. While I have a strong Irish ancestory from both sides of my parents, i do not identify myself with being Irish. I am a New Zealander and being a Pakeha New Zealander, I have a unique identity. How do you defien your uniqueness?

Who is a Kiwi?

Pakeha New Zealanders have done such a wonderful job of learning to understand other cultures that we are at risk of loosing ourselves. We have apolgised to the Maori for what we our forefathers have done, and so we should. It wasn't right. The Maori people have done a great job of getting back their heritage and claiming who they are. We have welcomed all other cultures to our shores to make us a rich and diverse culture. It is now up to us to claim back who we are and start telling people who we are as a people. If we don't invest time in explaining who and what is a Pakeha New Zealander, then we will be come embittered and unhappy, forever winging about the bad care we get. Lets stand up for ourselves and claim our space and tell our carers just how to care for us or we are going to continue to get more of what we dont want..