Community based nursing - a job to be proud of.

Jill Tresize RN. PG Cert, MCNA(NZ)

Jill Trezise, College member, shares her story on how the influences of her early life led her to a position as an independent community nurse, proud of the differnce she is making in her community.

I wanted to be a nurse for as long as I can remember, my dolls had nursing uniforms and my baby dolls regularly had all manner of invasive procedures conducted upon their poor plastic bodies.

Early life experiences form the basis of perceptions and ways of knowing. From my early years my perceptions around health were of wellness, very healthy lifestyles, among a predominantly elderly community within a very tight coastal beach  environment. Socialisation occurred at church every Sunday and inviting new members to share a  Sunday roast with new friends from church was a pre-requisite to belonging to the local community.

So.....how has this early life experience influenced my nusing practice?

Moral imperative forms the basis of my caring attitude which is characteristic of my hospital trained peers (1975-1978). Social injustice raises my ire which I believe has roots in the classless and endearing traits of a community that formed very many protective layers upon it’s members through “thick and thin”. On reflection it is the formative early years that consolidated my own personal nursing philosophy.

Learning experiences and resiliency are increased through adverse conditions. Many of my generation will be familiar with hard work, low incomes, lack of child care and a the male chauvinistic attitudes of the males, suiting the menial and subservient nature of nursing in that time.  I have learnt much, gained strength  and become very resilient  following lifes’ bitter sweet blows.

Secondary healthcare was the foundation of my nursing experience but from the aforementioned strength I have assumed collective responsibility for those less fortunate than myself. I believe the moral imperative attiditudes of my local community influenced my compelling need  to offer something back to those women.  I can still taste the hot chocolate served up after school by elderly spinsters, I can smell the violets that we picked together from the retired missionary’s front garden, I can feel the fur coat that we were given by the high society widow to play dress ups in, and I can remember the sorrow of our neighbour as she sat by the fire getting warmth on the evening that her blind husband died. These  wonderful elderly folk nutured me through childhood, so it is natural that I would feel a strong sense of déjà vue in visiting other old folk within any community. Growing old has a commonality that crosses all cultures and classes.  Hence my sojourn into primary care after 15 years in secondary care.

The knowledge gained from working many years in a small hospital, in various roles such as; after hours supervising, A&E work , CCU, ICU and Neonatal work have given me a broad set of skills to consolidate into chronic- care long term conditions. It also raised my awareness of the need to stem the burgeoning health crisis in diabetes and cardiovascular disease among disparate populations such as Pacific , Maori and the elderly.

This is my new found passion, well after 4 years I still feel a novice. My experience is now firmly integrated within the patient’s own experience and sense of being within their own health continuum. My personal  professional health development centres along the needs of my patients. Therefore if I need to integrate with Non Government, allied health, secondary care specialist and my peers I can.

In order to become more effective within this wider scope of nursing I became independent. No I am not academic, in fact I am dyslexic . I am reassured that the most innovative and creative New Zealanders such as Richard Taylor and the Mad Butcher are also dyslexic, this notion sustains me.

Independent nursing autonomy  gives me political freedom and allows me to chair an interdisciplinary cell group of all my peers working in South Auckland. As  I struggle through post graduate education I am cheered at a group of nurses that voluntarily give up their precious time. These nurses meet occasionally  in order to share experiences, network and learn from others in an evidence based informal learning environment.

This freedom also means that if I develop a relationship with a client that exceeds the prescribed hourly   commitment I   can see them when I want. My friends never ever abuse this privilege and try to ensure that I don’t either.  In this capacity I have witnessed elder abuse, gastro intestinal haemorrhage at home, legalities of relations accessing power of attorney, unsafe and unhealthy living conditions within the governments housing schemes, and poverty and starvation on a scale that no New Zealander should have to experience. Hence I try to build personal strength, subsequent family/whanau   strength and build protective community layers to prevent this happening.

Nursing practice within primary care settings is becoming increasingly complex. My own set of personal professional development this year has involved immunisations, long term conditions (another post graduate paper), respiratory (CNE) continuing nurse education , diabetes update , community health worker teaching sessions, depression modules, sexual health standing orders, smear update, and CVD. My next paper next semester was to be rural health as I felt this paper content most reflected my professional development needs working within an outreach setting. However sadly this paper has been postponed due to lack of applicants. I am now resigned to either education or leadership papers.

My community outreach work is where I feel truly valued. My relationships with people in this setting are one of trusted friend which itself brings a sense of mutual respect, kinship, caring and loving. There is a strong sense of advocacy in these roles but most important is the respect shown to me by family members.  With their permission I can then co-ordinate various agencies to address their own  social determinants of health.
Case management needs to be recognised within the primary health care sector. District health boards (DHBs)  can lead innovative pathways into integration with other allied health professionals. These multidisciplinary teams such as physiotherapists, dieticians, speech therapists, pharmacists. GPs, administrators, housing and income support workers,  diabetes nurse specialists, respiratory nurse specialists and cardiovascular nurse specialists can make a difference.

Unfortunately there is still no agency (that I know of) within primary health care that pulls it all together.
Primary healthcare generalist nurses are the way of the future. They have the level of knowledge and networking required to co-ordinate the plethora of services involved in order to make a difference.

I have held the hands of three dying patients recently. Their co-morbidities comprised principally of congestive heart failure, diabetes, lung  cancer , COPD and liver failure. These presentations included end stage lung cancer, haematemesis and maleana, and septic shock.

These experiences continue to inspire me. Two out of three of these patients died but  those two  both died knowing that someone cared. The other has recovered, is surrounded by loving family and is committed to living life with an improved quality.

I am proud to be a nurse, my mother was also proud and my daughter is also proud to be a nurse. I look forward to an exciting time within nursing of innovation, value, respect and above all being recognised by all as an integral part of people’s communities, and assisting those same communities in meeting their personal and collective community health needs.

Jill Trezise
Nurse to anyone and everyone that I meet including the dogs!