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August | 2020 EMERGENCY NURSE NEW ZEALAND The Journal of the College of Emergency Nurses New Zealand (NZNO) ISSN 1176-2691
EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO AUGUST 2020
In this issue
Features
CENNZ Honorary Life Membership Embedded Earrings in Kids
07 Award – ROSIE SIMPSON 16
What are the success factors for Post Graduate Advanced Emergency
08 32
children with obesity having obesity Nursing, University of Auckland
discussions? A cross-sectional
multiple methods study in an
emergency setting Snippets Autumn 2020
33
Regulars
A Word from Regional Reports
03 17
the Editor
Chairperson’s College Activities
05 30-32
Report
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO AUGUST 2020
A Word from the Editor
Matt Comeskey
Editor | Emergency Nurse NZ
mcomeskey@adhb.govt.nz
Letters to the Editor are welcome. Letters In contrast, another issue of concern same old things - but better. Perhaps it
should be no more than 500 words, with has sat like the proverbial elephant-in- is time to push ‘pause’ on dissecting our
no more than 5 references and no tables the-room, going nowhere and occupying differences and re-group to focus on our
or figures. an awful lot of space. There is a dis- common goals. We need to be open to
connect between the NZNO Board, its doing things differently within NZNO in
executive and the NZNO membership. the face on an unprecedented health and
It’s sadly ironic that while our nursing economic challenges.
profession pulled together to go ‘above
I’d like to think that NZNO – and
and beyond’ to achieve unprecedented
At the time of writing the last editorial that’s all of us - would want to be more
elimination of community transmission
we were staring down a crisis. What inclusive, particularly to those whose
of a novel coronavirus, our professional
a difference a few months makes? voices are getting lost in the racket of
body is struggling to maintain unity. All
It is worthwhile reflecting on the press releases, legal action, complicated
this is happening when the core public
achievements in addressing COVID voting processes and social media posts.
health message aimed at addressing the
19 to-date. These include, improved Nobody is served well when we retreat
pandemic is based around altruism and
infection control, increased vaccination into separate camps and shout at each
kindness. I don’t profess to understand
rates, coordination of tertiary and other. A little more kindness might make
the issues or the history of this
primary level care and improved a big difference.
disagreement at NZNO board level but
facilities and equipment. All of which is
the reputational damage caused is self-
well covered in the regional reports in
evident, public and painful.
this issue. My hope is that those gains
will be embedded in our practice and COVID 19 lockdown has given us an
that community transmission remains unforeseen opportunity, to reflect on how Matt
eliminated. to do new things, and how to do the
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO AUGUST 2020
Editorial Info
Subscription: Journal Coordinator/Editor: Natalie Anderson: RN. Doctoral
Candidate & Professional Teaching
Matt Comeskey:
Fellow. University of Auckland.
Subscription to this journal is through a Nurse Practitioner, ADHB
Auckland City Hospital Adult
membership levy of the College of Emergency Email: mcomeskey@adhb.govt.nz
Emergency Department, ADHB.
Nurses New Zealand - NZNO (CENNZ).
The journal is published 3 times per year Peer Review Coordinator: Dr. Sandra Richardson: Dr Sandra
Matt Comeskey: Richardson : PhD Senior Lecturer,
and circulated to paid Full and Associated
Nurse Practitioner, ADHB School of Health Sciences, University
members of CENNZ and other interested
Email: mcomeskey@adhb.govt.nz of Canterbury.
subscribers, libraries and institutions.
Deborah Somerville: MN. Senior
Copyright: This publication is copyright in its Peer Review Committee:
Lecturer. Faculty of Medical and Health
entirety. Material may not be printed without
Margaret Colligan: MHsc. Nurse Sciences, University of Auckland.
the prior permission of CENNZ.
Practitioner. Auckland City Hospital
Website: www.cennz.co.nz Emergency Department, ADHB Submission of articles for
Lucien Cronin: MN. Nurse Practitioner. publication in Emergency
Auckland City Hospital Emergency Nurse New Zealand.
Department, ADHB All articles submitted for publication should
Editorial Committee Prof. Brian Dolan: FRSA, MSc(Oxon), be presented electronically in Microsoft
Word, and e-mailed to mcomeskey@adhb.
MSc(Lond), RMN, RGN. Director
of Service Improvement.Canterbury govt.nz. Guidelines for the submission
Emergency Nurse N.Z. is the official journal of articles to Emergency Nurse New
District Health Board.
of the College of Emergency Nurses of New Zealand were published in the March
Zealand (CENNZ) / New Zealand Nurses Nikki Fair: MN. Clinical Nurse
2007 issue of the journal, or are available
Organisation (NZNO). The views expressed Specialist. Middlemore Hospital
from the Journal Editor Matt Comeskey
in this publication are not necessarily those Paediatric Emergency Care, CMDHB
at: mcomeskey@adhb.govt.nz Articles
of either organisation. All clinical practice Paula Grainger: RN, MN (Clin), are peer reviewed, and we aim to advise
articles are reviewed by a peer review Nurse Coordinator Clinical Projects, authors of the outcome of the peer review
committee. When necessary further expert Emergency Department, Christchurch process within six weeks of our receipt of the
advice may be sought external Hospital. article. CENNZ NZNO Membership:
to this group. Membership is $25.00 and due annually
Libby Haskell: MN. Nurse Practitioner.
All articles published in this journal remain Children’s Emergency Department in April. For membership enquiries
the property of Emergency Nurse NZ and Starship Children’s Health, ADHB. please contact: Kathryn Wadsworth
may be reprinted in other publications if Email: cennzmembership@gmail.com
Sharon Payne: MN. Nurse Practitioner.
prior permission is sought and is credited to
Hawkes Bay Emergency Department,
Emergency Nurse NZ. Emergency Nurse NZ Design / Production / Distribution:
HBDHB.
has been published under a variety of names Sean McGarry
since 1992.
Phone: 029 381 8724
Email: seanrmcgarry@gmail.com
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO AUGUST 2020
Chairperson’s
Report
Welcome to the new normal – New Zealand post lock-down is
confronting in many ways, while offering a mix of stimulating and
difficult situations. As we come to terms with integrating social
distancing, routine handwashing and limited travel options into
our everyday routine this alongside a profound gratitude for the
relative safety in which we find ourselves.
Covid-19 response which are likely to be still in place, and partly due to a
carried forward. One of these has been the reluctance from organisations to allow
establishment of on-line CNM meetings. staff to travel for educational or other
While we have traditionally hosted a face purposes. As a result of this, we know
to face meeting to enable the sharing of you will understand why we have chosen
information and ideas, this of course was to formally announce the cancellation of
not possible during lock-down. Instead, the 2020 CENNZ Paediatric Symposium.
we commenced regular zoom meetings, However, we do need to provide a forum
to allow CNMs from around the country to host the College AGM. While this
to share information, techniques, may not have been the favourite part
responses, and pose questions or ask for of the conference or symposium, I ask
Despite the uncertain economic future, specific information as part of the effort that you remember that this is essential
we have managed to maintain a degree to share resources during the pandemic. to enabling us to progress as a working
of control over the covid-19 pandemic While not limited only to issues of Covid- college. This year, the AGM will be held
which is lacking in most other countries. 19, this has certainly been a main stream on-line, via a zoom process, and we
Despite this, emergency departments of discussion. need your support to ensure that we
remain at the forefront of any potential have a quorum of members. We will
Along similar lines we hope to start a series
response, while needing to manage the be minimising this to essential business
of online meetings for nurse educators,
usual challenges of winter surges, staffing only, and including a guest speaker to
to address issues and share knowledge
difficulties and service overload. provide additional interesting material.
around ED topics. The move to zoom has
The details for this (including date and
The College remains focussed on created a greater sense of familiarity and
presentation topic) will follow.
supporting individual nurses, practice willingness to use this medium, and has
settings and the wider profession as we opened up the opportunity to develop CENNZ has continued to advocate for
all seek to maintain the highest possible regular interactive forums. responses to violence and aggression in
standards, and find solutions to the the workplace, with representation on
Cancellation of paediatric symposium; the national NZNO committee working
difficulties and demands that have
need for on-line AGM in this area, and we continue to follow
presented during this period.
We have all realised that travel is the progress of the Protection for First
It is important to recognise the positives Responders Bill which is going through
inevitably limited in the post lock-down
as well as the testing elements, and there parliament at present.
period. This is in part due to restrictions
have been innovations as a result of the
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO AUGUST 2020
Chairperson’s
Report Cont.
There are on-going questions around Are we in a position where this would
how New Zealand and the health system be possible? Is this part of our role? And
can best manage the influx of returning if not, then what systems are in place to Dr Sandra Richardson
kiwi’s, and the placement of quarantine manage such requests? We need to act as Chairperson
facilities. This has impact not only for ED nurse’s always do – to be prepared, College of Emergency Nurses New Zealand
primary healthcare staff, but also for the and with a high index of suspicion for the
ED sector. We need to be mindful of the unexpected. Contact: cennzchair@gmail.com
importance of having clear plans and
I wish you all well, and thank you once
processes for managing the ‘what if ’s’ in
again for the contribution you have
regard to out breaks, to unforeseen illness
always made, and continue to make to
and injury, and how to manage should
the healthcare of New Zealand.
ED staff be called on to assist if current
service provision is insufficient. Kia Kaha
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO AUGUST 2020
New CENNZ
Honorary Member
On International Nurses Day 2020, CENNZ announced a
new Honorary Life Member to the college: Rosie Simpson,
from Dunedin.
Rosie graduated from the Dunedin 2002, Rosie stepped into the newly- representatives. She encouraged
School of Nursing in 1975 and started creates Associate Charge Nurse fellow nurses to be involved in change
working in the Dunedin Emergency Manager role at Dunedin ED, and held at a local and national level. As a CENNZ
Department in 1988. Where at this time the position until 2009. Rosie then spent member she attended a number of
she worked four nights a week, while two years as the Emergency Planner conferences, always willing to share her
raising a family. In 2000, Rosie became for Dunedin Public Hospital, but missed ideas, knowledge with her peers and be
actively involved in emergency nursing, emergency nursing so returned to involved in promoting the education of
on a national level. Having completed Dunedin ED in 2012, where she has emergency nurses.
one of the first triage courses offered continued to support students, graduate
Rosie has been a professional role-
in New Zealand, she became a triage nurses and new nurses. Rosie was
model and has promoted excellence in
instructor - a position that she held involved in the Emergency Department
emergency nursing within Aotearoa New
for ten years. During this time, Rosie simulation governance group, and the
Zealand and is a worthy recipient for an
travelled around the country on her days simulation suite development and
Honorary Life member of the College of
off, providing education for her fellow design. She has been vocal in the need
Emergency Nurses New Zealand.
emergency nurses. to include, develop and to have access
to education for nurses throughout her Rosie retired in June 2020, and we wish
As a triage instructor, Rosie contributed
30 years in the department. her well. Congratulations Rosie!!!
to the revision of the triage course and
development of the Triage Manual Rosie has been an active CENNZ
and course materials and continued to member in the southern region for
ensure the course and materials were many years, being involved in study
kept up-to-date, for over a decade. In days that were run by earlier regional
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO AUGUST 2020
Author: Joanna Thomson,1,2 Teuila Percival,1,2 Affiliations: 1. School of Nursing, University of
Losi Sa’u Lilo,3 Melody Smith1 Auckland, Auckland, New Zealand;
2. KidzFirst Hospital, Counties Manukau District
Health Board, Auckland, New Zealand;
Email for correspondence:
kirsteen.haynes@huttvalleydhb.org.nz 3. Auckland University of Technology, Auckland,
New Zealand.
Joanna Thomson
Kidz First Emergency Department,
100 Hospital Road, Otahuhu, Auckland 2025
Ph 64 9 2760044 Joanna.thomson@middlemore.co.nz
What are the success factors for children
with obesity having obesity discussions?
A cross-sectional multiple methods study
in an emergency setting.
Abstract:
Introduction
In New Zealand, almost 22% of children aged 2-14 are overweight and another 11% are obese. The children’s Emergency Department
(ED) was within the main hospital serving South Auckland, which has even higher rates of obesity. We set out to explore the
experience of families and Healthcare Professionals (HCP) when having an obesity diagnosis discussion (ODD) in the childrens’ ED.
Methods
Mixed method research design comprising interviews, HCP's survey and an HCP focus group. Convenience sampling was used to
recruit eight parents who had had an ODD at childrens’ ED in the previous 2-3 weeks. This article relates only to parent interviews.
Results
Most parents were unaware that their child was obese. Once identified, all parents wanted to have the healthy living discussion with
the HCP. Several factors affected parental engagement in the ODD and the these aligned with HCP's experiences. All parents were
keen to make some of the suggested lifestyle changes, yet they identified similar factors preventing them.
Discussion
Parents have demonstrated an ability to make changes to family lifestyle after a brief ODD. Positivity and non-judgemental
conversations were usually well received by parents. HCP should prioritise ODDs with families when parental engagement criteria
are met.
Keywords: New Zealand; child; obesity; discussion; HCP; parent; eating; Pacific.
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO AUGUST 2020
What are the success factors for children with obesity
having obesity discussions? A cross-sectional multiple
methods study in an emergency setting cont.
Introduction likely converge to act as system barriers or enablers to healthy
nutrition (Swinburn & Wood, 2013).
Childhood obesity has been recognised worldwide as a non-
communicable disease of global health concern (Shackleton, Children who are already classified as obese require prompt
Milne et al. 2017). Obesity in childhood and adulthood is support to mitigate current and future health burden and risk
associated with chronic illnesses affecting quality of life and associated with obesity. This research aims to understand
early mortality (Kohut, Robbins et al. 2019). Children with perspectives on barriers and enablers to their child’s healthy
obesity are at an increased risk of becoming obese in adulthood, eating with parents of children who have received an obesity
and developing related co-morbidities (Lakshman, Elks et al. diagnosis.
2012, Aarestrup, Bjerregaard et al. 2016, Ministry of Health
2016). There has been no published literature having ODDs in Methods
an emergency department. Findings from Primary health have
Study context and protocol
identified that both HCPs and parents find the ODD difficult
and this has led to fear and concern from the HCP, preventing This research was conducted in an Auckland area with higher
ODDs occurring (Turner, Shield et al. 2009, Turner, Salisbury than average childhood obesity rates. Parent/caregiver (hereafter
et al. 2012). parents) interviews were conducted between November 2018
and January 2019.
Aotearoa/New Zealand has one of the highest levels of both
childhood and adult obesity in the world (Organisation for Ethical approval was provided by the University of Auckland
Economic Cooperation and Development 2017). Inequities Human Participants Ethics Committee (UAHPEC; ref 021795),
exist in obesity prevalence rates, with rates highest among the tertiary care provider’s Research Office, and the local
lower income groups. Ethnic differences also exist, with hospital research group. Consultation with both Māori and
the highest rates in the indigenous Māori population and Pasifika cultural safety research advisors occurred. Their advice
children of Pacific Islands ethnicity (Ministry of Health 2016). was incorporated into the research design and when developing
Prevalence rates also differ by geography, with some Auckland interview and focus groups questions.
(the country’s largest city) areas having almost double that of
the national average (Ministry of Health 2018). For the purpose
Participants
of this paper, the term ‘Pasifika’ will be used, to describe people Convenience sampling was used to invite parents who had
of Pacific descent, who are currently living in New Zealand. recently participated in an obesity diagnosis discussion (ODD)
The term “recognises the diversity of Pacific nations and with a Healthcare Professional (HCP) at the tertiary care
their inherent cultural practices, languages and history that hospital emergency department. HCPs gave parents a ‘consent
underscore each ethnic group” (Firestone, Funaki et al. 2018). to contact’ form after their ODD. Parents who consented
to be contacted were telephoned by JT to explain the study
The burden of childhood obesity is not contained to the
and arrange an interview time and location of the parent’s
New Zealand health system as societal and governmental
choosing. Written informed consent was gained in person,
organisations are working towards healthier children, yet
prior to conducting the interview. Recruitment continued until
progress is slow (Swinburn & Wood, 2013). In a review conducted
data saturation was achieved (McKenna and Copnell 2019). To
six years after the 55 recommendations from the Parliamentary
be eligible, parents needed to have conversational English.
Inquiry report of 2006-2007 (Kedgley 2007) was released, it
was found that only a handful were enacted and maintained
Measures
(Swinburn & Wood, 2013). Healthy nutrition is fundamental
to children maintaining a healthy weight (Ministry of Health Semi-structured interviews were conducted using an interview
2016). Parents are ultimately the gatekeepers to their child’s guide. JT led the interviews and a research assistant experienced
nutrition, and play an essential role in their child’s nutrition in conducting research with Pasifika parents (LS), attended as
behaviours (Bradbury, Chisholm et al. 2018). Yet, nutrition many interviews as possible to ensure cultural safety. Before
behaviours do not occur in isolation and are not limited to the the interview began, a karakia was said over the food and
family environment. Social norms, environmental prompts time together. Upon completion of the interview, the research
and barriers to eating well, and economic and pragmatic issues participants were given a $20 petrol voucher and $50 Countdown
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO AUGUST 2020
What are the success factors for children with obesity
having obesity discussions? A cross-sectional multiple
methods study in an emergency setting cont.
voucher (local supermarket) as an acknowledgement of their Understanding the complex and multi-faceted barriers
time and travel costs. Brief notes were taken by JT and LS to making healthy changes
during the interviews. A reflective diary was also written by
Themes generated from the inductive analysis centred on
JT describing the researcher’s emotions during the parental
identifying current unhealthy behaviours and then barriers
interview data collection and thematic analysis.
to supporting healthy behaviour changes. These barriers were
Analysis complex, multifaceted, often inter-linked and present across a
range of social and environmental layers. Fundamentally, the
Interview data were analysed thematically following Braun and
key themes centred on the fact that behaviour change strategies
Clarke (2008) six steps of thematic analysis. Firstly interviews
were often occurring in isolation (e.g., focusing on the child
were transcribed verbatim by JT, read and reread in order to
or immediate family only, with little external support). These
gain understanding of participants’ views and experiences
often combined with the normalisation of consumption of
at the group level (Graneheim and Lundman 2004, Elo and
unhealthy foods. The downstream impacts made sustained
Kyngäs 2008). Notes taken were utilised to provide additional
behaviour change and improvements to child health almost
context or detail where required. The data were then organised
impossible.
through open coding, creating categories and abstraction
(Graneheim and Lundman 2004, Elo and Kyngäs 2008). Next, Social support and the essential role of the extended family
data were examined for themes which had an underlying
Most of the families interviewed reported that grandparents
meaning, linking different categories together. JT and MS then
and extended family members had an active role in their child’s
discussed the analysis and sought agreement. Co-researchers
daily life and child care. During these times, the grandparents’
may come up with different interpretations, due to subjective
normal food of choice for the grandchildren mainly consisted
perspectives, in which case discussion occurred to reach a
of unhealthy foods including fast foods, takeaways and those
mutual agreement (Graneheim and Lundman 2004). For this
with high sugar content for afternoon tea or dinner. Parents
research, decisions regarding this step was documented in
brought up the difficulty in changing this normal pattern in
the writing up, as part of reflexivity, increasing strength in
terms of food given by grandparents. Parents emphasised that
credibility of the qualitative research (Baxter and Eyles 1997).
they had tried to change the food habits of the grandparents or
Once themes had been reviewed, they were named and coding
extended family. They had tried teaching grandparents about
was completed. Finally, excerpts from the participants were
healthy afternoon tea snacks and meals and suggested either
identified to support the themes being discussed.
healthier options for takeaways or advising the grandparents
to eat at home rather than take the children out for dinner.
Results
Parents had reported difficulty in getting grandparents to
All parents who were invited agreed to participate and attended grasp or understand the magnitude of the obesity diagnosis for
an interview (Figure 1). Data saturation was reached after the child, thus the need for changes to food intake. This issue
eight interviews, as no further data or insights were revealed was highlighted in the majority of the families, and caused
by the parents (McKenna and Copnell 2019). Children were the parents stress and worry. The parents reported that they
all between eight and twelve years old, with majority males. needed and wanted a relationship between the grandparent
Family 8 included the mother (P8) and the older sister (S8), and the grandchild/children, but recognised that the issue of
around 20 years old, who was present during the ODD, and unhealthy food consumed during the time together needed to
helps the mother care for the child on a day-to-day basis. be addressed and changed to promote a healthier lifestyle for
Interviews occurred between 4-71 days (median 16.5 days) the children.
post the ODD, and lasted between 26-185 minutes (median 50
P3. So, what my Dad does, is some mornings, he buys them
minutes). Parents self reported ethnicity, with all but one family
pies to eat, and then some evenings when he drops them off
identifying as Pacific, with one identifying as Māori. There is
[to school], he buys them hot chips or butter chicken, sauce
recognition that not all families who identify as Pacific are a
and stuff, [giggle]. I don’t know, I keep telling him, please
homogeneous group, yet strength comes from similar findings
will you try… [healthy options]. Or else he will bring them
from these families.
boxes and boxes of pies or doughnuts, creamy doughnuts
and muffins and… yeah, my boys enjoy those.
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What are the success factors for children with obesity
having obesity discussions? A cross-sectional multiple
methods study in an emergency setting cont.
P2. Like, my brothers and sisters and my in-laws, and when While parents found it difficult to encourage children to eat
they see my kids, they think, ‘Aahhh lets go and buy a healthy food at home, their control over what children ate at
chocolate, or you want chicken and chips? Or what you want school was even lower. Parents reported the importance of
to eat?’ kind of thing. their child eating food during the school day. This led to some
parents providing children with unhealthy food options in their
Parents discussed a mixture of feelings such as exasperation,
lunchbox, knowing that this would be eaten, rather than letting
failure and concern when having these discussions with
the child go hungry
extended family members, particularly their parents’. Parents
reported the difficulties arose as it was not culturally acceptable P5. He will have like 3 different kinds of fruit [in his lunchbox]
to question elders, particularly their parents and I guarantee you that he’s never eaten them, but they are
always there. And then not so good stuff, but just so he has
P7. I cannot say no to kids or Grandma. Yeah, because
something.
sometimes, I feel like I will upset my Mum, because I don’t
like her to do that to my kids, it is too much, like, you know P5. So, I’m like, as long as you eat… I’m OK, you know... so
feed them... that’s why their weight goes high. that’s where we are at… yeah…
P7. Very hard, yeah, coz they are my parents, and I can’t tell P3. It was like a happy thing to see him eat.
them ‘stop that’. Na, I can’t do that.
Time scarcity and accessibility and availability of unhealthy
Conversely, some parents discussed the changes towards a food options
healthier lifestyle with their parents and reported that she felt
able to trust the grandparent to mirror what the changes she Parents acknowledged that when they were time poor, they fed
had made at home. children easy-to-grab fast food. In these instances, quantity
of energy, rather nutritional quality of food, was prioritised.
P5. Yeah, she [Grandma] does it, [what Mum does at home], There was discussion about the differences between living in
and then she makes sure that everyone else has it as well. So, the [Pacific] Islands and in New Zealand with respect to the
he is not singled out, so whatever he can have, everyone else food available. Parents highlighted that there was easy access
has, so she is into everything. She is really good, and it makes to takeaways in New Zealand, which served parents well when
it a whole lot easier. they were rushed, due to the day-to-day business of life.
Some parents highlighted that once they had heard the P2. ‘It was just me, [going to] university and then doing the
information at the ODD there were differences between the kids trainings and trying to work at events and stuff, and
parents of the child as to the importance of making changes to it all got too much, so I would always pack, you know, the
the child’s lifestyle. cheapest, the fast food, whatever I could get that would
P2. So, my partner [C2’s father] … this is his first son, so he feed them, until I had finished my meetings or finished
was thinking… he was thinking along the lines of, it is ok, it whatever I was doing to cover them… and they are not going
is our his first born, you know, my first baby, my first son. He to interrupt me, you know, they are going to be hungry and
can eat whatever he wants, treat him like a king. then people are going to look at me and say “why aren’t you
feeding your kids?”
P3. [We, the parents are] Not on same page. That was my
struggle this week, because yeah… I tried to serve my kids the P8. [In NZ] The veggies are expensive, the fish is expensive,
right amount of food, and then he [Dad] says to them, have so we are going to resort to cheaper meals and takeaways
some more, don’t worry about it, or he’ll say, erm… is that all and all.
that the kids are eating? And I say yup. Obesity (and the downstream consequences) as a rite
Child preferences for unhealthy food of passage
Children, themselves, also played a role in determining the food Normalisation and acceptance, even a parental desire to want
they ate. Parents expressed concern due to an inability to get the a larger child was discussed frequently. There was recognition
children to eat vegetables, in a range from any to advised quantities. from the parents that part of this was cultural. Yet there was
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What are the success factors for children with obesity
having obesity discussions? A cross-sectional multiple
methods study in an emergency setting cont.
no discussion as to what it meant for the child’s health and I want to snack, yeah. So, it will be good for him, in the
longevity, prior to the ODD. The normality and desire for a family with his cousins and stuff, let them explore something
larger child was reinforced by grandparents and sometimes at different instead of having a big meal and just being so lazy.
church or within their social group. And it affects them in the long run.
P3. That is what really got me [that he was heavier than me, Food was identified as a very important cultural component
when he stood on the scales] … but normally people are like... of being in a Pasifika family. Food’s importance came from
‘O my God, he is sooo chubby’, it was like… I loved it. I loved its link with bonding time with family members and rewards
it. That my kids were chubby, like... you know... like... and or methods of expressing love; it was not seen exclusively as a
I didn’t want my baby to lose like... I didn’t want them to nutritional component of a healthy lifestyle. This meant that,
[reduce their] weight… for some families, on a daily basis, much emphasis was put on
the children eating with the extended family. Parents reported
P5. You know so from when he was born, he was born, he
that the children would receive large portion sizes, with not
was born big. He is big for his age... like in my culture, in
much attention put into providing healthy meals or snacks for
comparison with my family, that is like our normal. He is
the children.
actually small in our family, like weight wise’. [Dad’s family]
they are like … ‘Ahh we need to feed you’. They think he is P7. My Mum and my sister, they don’t have any kids. Only
too small. Like in my family, he is... he is just like all the other me have kids. They give them like coke, chips, chocolate all
kids. He is bigger and he is taller than all the other kids, than the time. Takeaway, McDonald’s, KFC. Yeah, they always go
my sister’s kids, but they are all European, but erm... but he outside [to] eat, every day.
does not look overly big, just tall, you know, nothing out of
the norm, like with my brothers and sisters and their kids. Relationships with extended Pasifika family and food
Some parents were aware Pasifika people living in New Zealand
Pacific relationships with food culture as both barriers and
are represented negatively in health statistics. Knowing this,
opportunities
Parent 8 had a desire for this not to be the case for her family.
Many parents attributed lifestyle around food choices being
S8. Mum said that we are not going to be like that [poor
intrinsically related to cultural practices and their wider
Pacific Island statistic]. She said “we should not just do the
community. This cultural aspect came from both the parents
whole ‘leave it, she will just grow out of it…’ lose the baby fat
who were of Pacific Island descent born in New Zealand,
type of mentality. And if we start doing that, then when she
and some who had been born and lived in the Islands, then
becomes older, it will be harder for her, where you said you
immigrated to New Zealand. Most of the parents interviewed
should not be like... Food isn’t everything. You should eat to
had their parents, who had been born and brought up in the
live, not live to eat”.
Pacific Islands, living in New Zealand. Parents reported that
there was direct cultural conflict between the lifestyle that the Parent 4 identified with her Māori culture. She discussed her
parents or grandparents had been brought up with overseas journey of learning the Māori culture, as an adult, and what this
and the New Zealand lifestyle. This is intermingled with the meant for her. She referred to the values of respect and dignity.
value placed on children and spoiling them with food, while When applied to food she said:
they are young.
P4. It is about respect, respect, about others respecting self.
Parent 2 reported that healthy food was not the normal in her But how do we do that, with food? With kai? It is love. Yeah,
extended family, and she has used the ODD as an opportunity you know respecting the things, we karakia [prayer] over the
to educate the extended family around healthier food options. food that we have.
P2. Yeah, being in the Pacific family, we always turn around P4. ‘Because life matters, quality of life. And all its aspects is
and screw our nose up at stuff that is healthy… So, my in laws a gift, and it is about respecting this life we have, the food we
[do]. I live around people who are like ‘why is there olives in have, our body. My body.
here, why is there lettuce? And I just say, it is just for when
P 12EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO AUGUST 2020
What are the success factors for children with obesity
having obesity discussions? A cross-sectional multiple
methods study in an emergency setting cont.
The conflict that these parents have expressed seems to indicate her children to Movies in the Park, a free event at a Māori
that maybe there are conflicting values as a parent particularly university, where there were only unhealthy food stalls.
with respect to food. Conflict identified here is around the
P8. But it does not help when you go to Movies in the Park,
nourishment that the food provides and also the role of the
and everything is around there for the children. Then the
mother who wants to demonstrate her love to her child through
children walk past and saw her and were ‘Wow, I want one
food.
of that Mummy!’ [candy floss]. Even me, I felt bad, I said
P4. My love language is quality time. In that quality time, ‘Damn it, buying it for her, just because she wants it, and
food is how I love my kids, so being respectful of what we are what am I advertising to the other families, and to the other
eating, erm, the times we are eating, eating together children. You know, educational and awareness out there.
The Wãnanga put up that Movie in the Park, why don’t they
P4. Food… not matter what the event. Love them with the
put up a healthy fruit stalls for free?
food.
Easy access to, and normalisation of, unhealthy foods Discussion
There was discussion on some of the differences between ‘living The aim of this research was to understand perspectives
in the Pacific Islands’ and in New Zealand with respect to the on barriers and enablers to their child’s healthy eating with
food available. The focus of the discussion was on the easy parents of children who have received an obesity diagnosis. Key
access to takeaways in New Zealand and the more rushed day- findings were that a range of barriers existed across the socio-
to-day life which required quick meals. ecological spectrum, including social norms and relationships,
environmental factors, and time and financial barriers. Parents
Parents also pointed out the cost of fresh fruit and vegetables discussed many problems that they faced with their children
and the accessibility in South Auckland. For Parent 2, the cost particularly with the child’s desire for treats and being spoilt by
of fresh fruit and vegetables was not a hindrance, but was new extended family members. Parents reported that the extended
concept for her to start buying vegetables every few days. Parent family continued to give treats to the children, either with fast
8 reported that the high cost of fresh fruit and vegetables was foods during contact time or lollies, even after being explicitly
prohibitive to her providing enough for her family on a daily requested not to do so by the parents. Further examination on
basis. the nature or reasons for grandparents spoiling the children
P2. I don’t think so, I think it’s… because if I can afford fast was not discussed within this research.
food, I can afford fresh veggies. I know it goes off, but I like It could be concluded that a level of parental resilience is
to pick different varieties, so that I know… So I’ll pick say, a required to overcome child demands and negotiating with
lettuce, and it will last us say 2-3 days max, and when that family members. This aligns with the notion of ‘pester power’
lettuce has gone, I’ll quickly grab something else to replace (Mikhailovich and Morrison 2007). In working with families,
it, so I just buy as it goes. HCPs might need to acknowledge that this could happen. This
P8. Yeah, like here fish is expensive, veggies, the type of might support parents by making them aware of the need to
veggies we eat here is not the same… Financially you cannot build resilience and strategies to bring the child on board with
afford the healthy… You know, OK we had healthy meals, but the journey deal with children pushing for unhealthy treats or
it is much healthier here [in New Zealand]. The veggies are being resistant to an activity.
expensive, the fish is expensive, so we are going to resort to The parental need for support in this journey has been found
cheaper meals and takeaways and all. in a study which documented of the struggle of the ‘lead parent’
The environment where they lived or the area the children when having to battle the extended family who undermine their
went to school was not supportive of healthy food options. actions (Stewart, Chapple et al. 2008). Usually, parents reported
This was demonstrated by parents reporting hot chip shops that still the grandparents were found to have undermined the
and unhealthy cheap foods so close to the schools. This lead parent both verbally and physically, in changes towards a
was encapsulated by Parent 8’s frustration when she took healthier lifestyle. In future, parents may need further support,
P 13EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO AUGUST 2020
What are the success factors for children with obesity
having obesity discussions? A cross-sectional multiple
methods study in an emergency setting cont.
after an ODD to keep their resolve strong. The parents might within the HCP focus group were around the awareness over
also need strategies to help communicate with grandparents differences between Pacific culture and westernised beliefs
and bring them on board with the healthy lifestyle, as well. surrounding body size and health
Stewart, Chapple et al. (2008) also recorded it was difficult for
The quotes from the parents showed the pull between Pasifika
the parents to have the discussion with grandparents, with
people’s cultural desire for bigger children and healthy children,
respect to asking them not to feed children certain foods, as
as thinness was often equated with ill health (Firestone, Funaki
demonstrated here. Although this was discussed in the current
et al. 2018). It could be determined that prior to the ODDs,
study’s interviews, a solution was not apparent. A solution
the parents interviewed for this research were unaware of the
to developing support for parents and families must include
detrimental effect that higher BMIs could have on the child’s
allowances for those who have time pressures or children who
health. This was an uncomfortable discovery for most parents
pester them.
and caused distress. The latter was due to the conflict between
Parents spoke about the difficulty of holding conversations previous thoughts on increased food intake for their child and
with grandparents about making changes as this could seem new realisations of potential long-term health complications.
disrespectful and, in any event, appeared to have little effect.
Firestone, Funaki et al. (2018) conducted focus groups
These findings align with previous evidence showing that
discussing health and well-being with Pasifika people. It was
parents need family support to maintain changes. Stewart,
found that they identify with a unique and strong sense of
Chapple et al. (2008) undertook 17 interviews with parents
well-being. Pasifika well-being is associated with the well-being
who had completed a six-month intervention programme, in
of the “family unit”, as opposed to the “individual being sick”.
Glasgow; they found that the lead parent, usually the mother,
“Health” was found to be a state of “doing”, that is, having a
needs support from someone outside the family to continue to
work-life balance which leads to a healthier lifestyle. It also
motivate the child. They also found that the lead parent needs
includes “feeling motivated and a healthier life” embracing the
help as other family members continue to offer treats and
physical and mental well-being of the family unit (Firestone,
undermine the parent’s action and lifestyle changes. These
Funaki et al. 2018). This could be applied to these findings,
findings also support the current study, which found that many
with recognition that Pasifika do not view health and well-
of the parents said that they had difficulties with their partners
being in the traditional western views. HCPs might be better
or grandparents understanding the need for both the changes
able to understand the Pasifika’s holistic view of the child
and ongoing support for the mother on this journey.
within the family as demonstrated by the use of ‘weight’ per
Eli, Howell et al. (2014) interviewed parents and grandparents se was not a specific health determinant for Pasifika people,
regarding body weights and found they reported on the whereas increased childhood weight indicated poorer health
difficulty of having intergenerational discussions on a child’s outcomes for westernised families. Health for Pasifika families,
weight. This equates with the findings of the current research. is measured by a desire to live longer so as to look after the
Whereas Eli, Howell et al. (2014) reported on difficulty in next generation. The desire for parents to make a change to the
words used in discussing weight with their child/grandchild, child’s current lifestyle, could be related to the desire for the
the findings from this research are around a parent engaging child to live longer.
the grandparent in understanding the health risks associated
with continuing current lifestyle choices, mainly in relation to Conclusion
food. Further research in this area might yield better advice for
Parents care passionately about their children. Universally,
parents to enable these discussions.
these parents were able to associate obesity with being
Parents’ reported their rationales were cultural and generational, unhealthy and they did not want this for their child. Parents
with grandparents specifically wanting larger grandchildren. valued the ODD which enabled them to reflect on current
Parents reported that traditional Pacific culture demanded that lifestyle practices that they employed, that they now realise to
larger children were wanted without awareness of determinants be unhealthy, and were making changes. Changing children’s
of health. Discussions in Firestone, Funaki et al. (2018) and nutritional behaviours was commonly discussed by parents.
P 14EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO AUGUST 2020
What are the success factors for children with obesity
having obesity discussions? A cross-sectional multiple
methods study in an emergency setting cont.
Several families discussed difficulties and challenges such to start making changes after a very short ODD. Comprehensive
as the cost of food, time, extended family, and cultural and approaches that support families in their journey to healthy
social norms. These difficulties are similar to those previously nutrition are urgently needed.
identified and published yet this study showed parents were able
Organisation for Economic Cooperation and Development. (2017). Obesity update 2017. Retrieved from
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Turner, K. M., Salisbury, C., & Shield, J. P. H. (2012). Parents' views and experiences of childhood obesity
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t&D=med8&AN=25500371 bjgp09X472269
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doi:10.1136%2Fbmjopen-2014-006609&issn=2044-6055&isbn=&volume=4&is-
sue=12&spage=e006609&pages=e006609&date=2014&title=BMJ+Open&atitle=%22A+lit-
tle+on+the+heavy+side%22%3A+a+qualitative+analysis+of+parents%27+and+grand-
parents%27+perceptions+of+preschoolers%27+body+weights.&aulast=Eli&pid=%3Cau-
Figure 1. Consent to contact forms leading to interview flow chart:
thor%3EEli+K%3BHowell+K%3BFisher+PA%3BNowicka+P%3C%2Fauthor%3E%-
3CAN%3E25500371%3C%2FAN%3E%3CDT%3EJournal+Article%3C%2FDT%3E
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in Taupo
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People. (ISBN: 978-0-947515-95-9). Wellington: Ministry of Health Retrieved from https://www.health.
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da38/_w_796994bd/#!/compare-regions. https://minhealthnz.shinyapps.io/nz-health-survey-
2014-17-regional-update/_w_b4bbda38/_w_796994bd/#!/compare-regions
P 15EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO AUGUST 2020
Embedded Earrings in Kids
On occasion you will encounter a child with an earring stuck in their ear lobe.
This most commonly occurs in girls younger than 12 years of age.
Assessment
Typically, at least part of the earring is visible or palpable. It is common to see the back
of the earring +/- with butterfly attached
The stud is usually buried in the ear lobe itself
The area may be tender to the touch
with localised redness and swelling
Analgesia Removal
- Apply Ametop to the back of the • A quick clean with chlorhexidine
earlobe (by default often covers the
• Make a small incision in the posterior
front too)
portion of the ear lobe. Never make an
- Consider continuous flow nitrous incision to the front for aesthetic reasons
for younger patients
• Use small alligator/artery forcepts
- Local infiltration can be used for to remove the embedded earring
older kids, or you could consider
just using cold spray
Outcome:
Once the earring is removed, the area can be dressed with a simple dressing i.e. small Primapore (island dressing) cut to size
Leave the incision to heal by secondary intention
Oral antibiotics are not needed after removal of an embedded earring from the ear lobe. NB: earrings removed from
the helix should have a 5 day course of ABx i.e Ciprofloxacin, which will cover Pseudomonas Aeruginosa
Usually takes 6-8 weeks for the site to heal
Re-piercing may be possible after this
Kathryn Johnson NP
Starship Children’s Emergency Department
P 16EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO AUGUST 2020
Regional
Reports
Northland/Te Taitokerau | Auckland
Midland | Hawkes Bay/Tarawhiti
Mid Central | Wellington | Top of the South
Canterbury/Westland | Southern
Vacancy
The position representing
Hawkes Bay/Tarawhiti
on the CENNZ National
Committee is currently
vacant.
Please see application
information on
page 23
P 17EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO AUGUST 2020
Northland/Te Taitokerau Region
My last report seems a lifetime Operationally, in ED the green and
rather than a few months ago. Our red zones are merging. Potentially
people did an amazing job, rising infectious presentations are placed
to meet the recent challenges with in single cubicles as much as
energy and all the resources that we possible, and aerosol-generating
could recruit or develop. May this procedures continue to require
teamwork continue to flourish not negative pressure cubicles. Slowly,
only in ED but across the hospitals processes are returning to business
and communities. as usual - or the new business as
usual. Emergency Q continues to
Self-awareness of our well-being
be an option offered for appropriate
can help us to access the supports
presentations.
to manage issues and to be aware
of our colleague’s situations. ED Community COVID testing clinics
Sue Stebbeings
piloted the Mayo Well-being Index are likely to stop by the end of July.
Nurse Practitioner in February this year, which has now Medical centres and iwi providers
Emergency Department been rolled out across our DHB. Staff will continue swabbing as necessary.
can monitor their well-being through It remains to be seen if this will
Whangarei Hospital
regular quick surveys, and resources increase ED presentations.
Contact: sstebbeings007@yahoo. are available to explore. Another
Recently there has been increased
co.nz well-being initiative promoted
acuity in ED presentations amongst
in our department just before
the 30 – 65 year age group. Usual
COVID19 was the Workplace Well-
respiratory illnesses are more visible
being at Emergency Departments
now that social distancing is less
(https://www.woweated.com/)
of a thing. Sadly, we have also seen
which aims to measure and facilitate
the evidence of increased aggression
improvement in staff well-being.
and stress in the community with
Data analysis from the staff surveys
more family violence presentations,
is underway.
and an escalation in aggressive
I attended one of the COVID behaviours from patients and
debrief sessions arranged across families. We have CCTV cameras
Whangarei Hospital. The session covering many areas of the
focused on personal factors, not department and more to be installed
operational processes. It was a to improve visibility of the area,
valuable opportunity to listen to particularly at night. Our security
the facilitator offering an outside alert has been updated so that a
perspective and uncovering impacts silent alarm can be sent directly to
that I had not considered amongst security staff from 4 points – 3 at
the small ED group present. We are front of house / triage. Plans are
so-often focused on getting on with pending to increase security staff
‘what’s in front of us’ and working presence in ED.
with ‘what it is’, especially when
We are delighted to welcome many
we have been working in emergency
new staff – many who have had the
nursing for some time. The thought
additional challenge of joining the
I took away from the session was to
team during COVID restrictions.
be mindful of the changes, choices
We appreciate their input and fresh
and challenges we experienced so
perspectives.
that we can be kind to ourselves as
well as others. Sue
P 18You can also read
