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In the heart of rural nursing

22 February 2018

Colleen Murphy Te Whare Wānanga o Awanuiārangi Nursing Kaiako and third year Student Puti Keane.

A nursing student finds herself caught up in a life and death situation that teaches her the importance of teamwork and community.

Today is Tuesday and I am on my third week of a primary healthcare (PHC) placement. My role is to help the registered nurse (RN) with a health clinic at a rural community in the North Island. I am very excited about this opportunity for first-hand experience in a rural health setting. I am a little bit nervous as well, as I wonder how the people will respond to my presence.

We arrive at the clinic at 8.30am. The building is very small and already there are clients waiting to see us. I help take what we need from our vehicle into the clinic. The building is rather quaint. It has two consultation rooms, a waiting area, bathroom and a storage room for medications and other equipment. Even though the consulting rooms are small, I notice they are well organised, with everything a nurse and doctor would need to treat clients.

The morning consultations are progressing well. The clients are friendly and seem quite at ease with my presence. I introduce myself to each client and ask if they are happy to consent to my being there during their consultation.

Preparing for a home visit

Later that morning, I am to accompany the RN on a home visit, so we gather our equipment and head out to the client’s whare. A local police officer escorts us to the whare, due to a river crossing we have to navigate. There have been some heavy rains recently so he wants to make sure we get across safely. Our four-wheel drive manages the river crossing just fine. I feel I really am in the heart of rural nursing.

As we head to the client’s whare, the RN fills me in on his health history. He is 78 years old and has a history of asthma and chronic obstructive pulmonary disease. We are visiting him today because he has been complaining of a sore puku.

When we arrive, we are greeted by a local woman who has been helping clean his whare and bathe him, following an episode of diarrhoea. I later discover the woman is a volunteer ambulance officer.

We remove our shoes and are invited inside. The kaumātua consents to my being there. I feel privileged and humbled to meet him and to be welcomed into his home.

The RN converses with him in te reo. Seeing this interaction is enlightening. It’s a clear demonstration of the rapport and trust that has developed between nurse and client.

The RN and I begin an assessment. I take his vital signs, while the RN palpates his puku. His blood pressure is low and hard to measure. I can’t get an oxygen reading because his hands are so cold, as are his feet. He is also dehydrated. The pain is radiating from his puku to all quadrants. He is also displaying shortness of breath. He has no inhalers in the whare and we need to get him some enerlyte for the dehydration. We go back to the clinic to get the medication and the RN updates the doctor about his condition.

When we get back to the whare, the RN gives him his inhaler medication, which seems to help. We mix his enerlyte drink and give that to him too. Suddenly his condition deteriorates. He is gasping for breath and he doesn’t look good. The RN tells me to get the bags from the truck and the oxygen tank. I do this as quickly as I can. The RN proceeds to attach the oxygen tubing but, by this time, his heart has stopped. We place him on the floor and begin cardiopulmonary resuscitation (CPR).

I am in shock and upset, but I know I have to keep calm so I can help him. I have had CPR and first-aid training, but nothing prepares you for the real event. It is what it is, and you must deal with it as best you can.

What helps me is remembering a CPR lesson in our first year of study. I recall the technique demonstrated, the timing, position and depth of the compressions. This helps me get through. I also set up the defibrillator and attach the pads. There is no shockable rhythm, so I continue with CPR while the RN gives adrenaline and inserts the bag-valve-mask resuscitator.

Communicating with the doctor

During this time, the nurse is on the phone with the doctor at our main clinic. She puts the call on speaker phone so we can all hear the doctor’s instructions. The nurse decides I should leave her and drive to meet the doctor at the road end. The doctor is fairly new to the area, so doesn’t know it well. I get into the four-wheel drive truck and find my way around the manual gears. I haven’t driven a truck for many years. All I can think is, “please don’t stall and get me to the doctor ASAP!”

Thankfully, I make it to the doctor ok. She was already heading to meet me, helped by the volunteer fire brigade and ambulance officers. Again, I am struck by how well organised and connected this community is, and how quickly they respond to the emergency.

As we travel back to the whare together, the doctor asks me to give her an assessment of the situation. I relay all the information as best I can. It feels such a relief to have the doctor and ambulance officers there. They try to resuscitate the kaumâtua for a further five minutes until the doctor calls a halt. The kaumātua has died.

Throughout the whole experience, I have felt like crying but I push those tears back, keep calm and do what I can. The ambulance officers and fire brigade are there, along with a couple of neighbours. They all help to notify the whānau, clean his room and get things ready for visitors. The fire brigade officers place him back on the bed, and the RN and I wash and dress him, so he is ready for his whānau.

The RN, who is also a minister, says a karakia for the kaumâtua, who now looks peaceful. Concluding our time there with karakia provides spiritual cleansing for us all.

I am impressed with the work the RN has done as she tried to save the life of the kaumātua. This is an experience I will never forget.

Being with this kaumātua was a very humbling experience. Even though the outcome was sad, I gained valuable knowledge of rural PHC nursing because of him. I will remember this place; the caring, closely-connected people; the wairua so evident in this whare. My experience that day has become a significant part of my journey as a student nurse.

He aha te mea nui o te ao? He tangata, he tangata, he tangata – What is the most important thing in the world? It is the people, it is the people, it is the people.

He aha te huarahi? I runga, i te tika, te pono, me te aroha – What is the pathway? It is doing what is right with integrity and compassion.

Puti Keane is a third-year student at Te Whare Wānanga o Awanuiārangi, Bachelor of Health Science Māori (nursing), Whakatāne.

This complete version of this article was first published in the November issue of Kai Tiaki Nursing New Zealand”.