A C A D E M I C R E S E A R C H
AUD I T I NG PAT I ENT - NUR S E ENCOUNTER S AT A KAUPAPA MĀOR I HEALTH PROV I DER
ASHLEIGH BROUGH + KYLE EGGLETON UNIVERSITY OF AUCKLAND
background
failed attempts to contact the patient, appointment reminders, or booking calls. 330 encounters were included and coded using the Omaha System1 to identify the problems patients presented with and the interventions that the nurses performed. The Omaha coding system is inclusive, comprehensive and is included within the SNOMED nomenclature, with codes such as “disrupted spiritual rituals” or “structurally unsound residence” that enabled the varied and complex patient presentations to a Kaupapa Māori health provider to be acknowledged. Patient problems could be classed according to domain (physiological, psychosocial, environmental, health- related-behaviour), and further divided according to presentation details. Interventions performed by nurses could be classed as teaching and guidance, treatment and procedure, surveillance or clinical management, with targets specific to the area nurses were working on. Nursing feedback, discussion and blind coding checks by a secondary coder were conducted to increase reliability of coding. Results analysed include the number of documented problems patients
present with, their nature, the number of interventions performed by nurses per patient or per problem, and the nature of the interventions performed. Analysis performed can inform the needs of patients, the clinical activities of nurses and better support and resource both groups. Further research carrying out a similar audit in other primary health settings would be valuable to examine differences in patient needs and nursing activities. Furthermore, the practice is considering using a coding system while documenting encounters in order to more easily automate the collection of summary data. During collaborative sessions with nurses, retrospective coding of patient encounters led to concerns being formally recognised as problems and prompted nurse reflection on interventions that could follow. It is possible nurses could find coding useful as a prompt and a tool to help guide interventions.
There is an absence of literature comparing the work of iwi health provider nurses and nurses employed in general practices. We sought to assess patient encounters with nurses at Ki A Ora Ngātiwai, a Kaupapa Māori primary health provider based in Whangārei, to understand the health needs of patients seen by these nurses and the work that is done to care for these patients. Ki A Ora Ngātiwai conducts outreach clinics over the Ngātiwai rohe, with approximately 2000 patients utilising its services. The mobile team consists of five full-time equivalent (FTE) nurses, supported by a Kaupapa
Māori medical officer (0.5 FTE) and a nurse practitioner (1 FTE), as well as support workers in social services/ housing/specialty nurses. PREMIUM TO CONT I NUE READ I NG TH I S PAGE JO I N HiNZ TODAY FROM $1 7 PER MONTH WI TH NO M I N I MUM TERM . OR $1 9 8 PER YEAR . analysis
5897 nurse-patient encounters in 2020 were identified through a MedTech query build. 500 encounters were randomly selected (through random number generation). Encounters were included in the audit if the patient was seen face to face or clinical information was exchanged over the phone. Exclusion criteria were encounters simply documenting hinz.org.nz/page/JOIN
reference
Martin KS. The Omaha System: A key to practice, documentation, and information management. 2nd ed. St Louis, MO: Elsevier Saunder; 2005. 484 p.
WANT TO KNOW MORE ? Ashleigh Brough | abro467@aucklanduni . ac .nz
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