Tui Ora Ltd Presentation for

MIDLANDS REGION PRIMARY HEALTH CARE NURSE LEADERS FORUM

Date 30TH May 2014

Tui Ora Ltd

Tui Ora

• Background

• Vision • Mission • Funding

Geographical Area

Services offered

Child & Adolescent Mental Health Service

Alcohol and Drugs,Supported Accommodation

General MentalHealth

Wellness TeamTPC

Taranaki Primary Connections

Long Term ConditionsYouth Services

Alt EdTui Ora Family Health Public Health

Cultural Advisor,Kaiawhina. Koroua Kuia

ServicesHomebased Support

POPULATION – TUI ORA FAMILY HEALTHMHN Locality: North Taranaki

Proportion of MHN: 4%

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TUI ORA FAMILY HEALTH – POPULATION AGE

Population Age

0-4 5-14 15-24 25-44 45-64 65-74 75+313 593 481 911 701 138 72

Population Ethnicity

Asian European Maori Pacific Island Other197 1,015 1,796 130 71

TUI ORA FAMILY HEALTH – POPULATION ETHNICITY

Q1 Q2 Q3 Q4 Q5 Not recorded169 364 601 912 995 168

TUI ORA FAMILY HEALTH – POPULATION QUINTILE

Population Quintile

Female Male1660 1549

TUI ORA FAMILY HEALTH – POPULATION GENDER

Population Gender

POPULATION – TUI ORA FAMILY HEALTHMHN Locality: North Taranaki - Proportion of MHN: 4%

POPULATION – TUI ORA FAMILY HEALTHMHN Locality: North Taranaki - Proportion of MHN: 4%

POPULATION – TUI ORA FAMILY HEALTHMHN Locality: North Taranaki - Proportion of MHN: 4%

Role of the Nurse in Whanau ora

Clinical Practice

Holistic Approach

Culturally aware

NAVIGATOR/KAIAWHINA

In a GP environment the clinical team has limited time and resources to attend to patient’s holistic wellbeing with most engagements are the standard 15 minute appointment.

The most important phase of engagement is ‘Whakawhanaungatanga’.

Listening and capturing their story at its rawest must be given respect.

NAVIGATOR/KAIAWHINAThere are whanau who identify their needs as ‘small’ or ‘one-off’ - but we have learnt that the smallest of need can have a huge impact on whanau. My child has no shoes to wear to school My child is always sick, always in hospital. I have been kicked out of home. I am sleeping in my car - I have no money - I have no food I DNA my appointments because I have no transport or I have a car but I can

not afford the registration / w.o.f / petrol. I have come to see my doctor today because I have a sore knee but what

actually pains me is I was raped as a child and now my 7yr old moko tells me she is being touched by a known person.

PathwayPhone calls (network) – i.e. Salvation Army, Winz, Budget advice, CYFPhone calls to TDHB – OPD, RadiologyOutcomeFollow up – on-going aspirations

Patient 1

Lives alone – ex wife and their 17yr old daughter live in NP Friends picked up his medication from the pharmacy – they are all

users Friends took his eftpos card and emptied his account weekly Friend was his signatory at the bank He has short term memory loss Cannot walk 2 flights of stairs – awaiting surgery for hip replacement Has Multi outstanding bills Has seizures – ambulance callouts numerous times, has an

outstanding account Unopened mail

WHANAU ORA PLAN

Patient 1 Pathway

• Kaiawhina – support and advocate to Winz, set up redirection of the benefit to support his outstanding accounts

• Access Ability – home support – PC, house cleaning, shopping• Navigator – transport and support to medical appointments• Conversation with pharmacy – weekly courier pick up & selected people to pick up• Continence nurse support• Medlab home visits 

Outcome

• Medication oversight • Joined St John Ambulance membership group• Bills / mortgage / insurance are being paid• Cupboards are stocked weekly & meals are prepared• Daily care support• Transported to medical appointments• Incontinent products available• Communication with ex wife now active

WHANAU ORA PLAN

Patient 2

• Moved home with whanau to Taranaki from Australia after 10yrs, staying with uncle

• Has Klippel-Feil Syndrome – can not lie in an ordinary bed• Constant seizures• Menorrhagia• Profoundly deaf• Signs • Mother transports patient to a friend’s house 1.5 km away daily

for a shower – hygiene, therapeutic • Bathroom tiny, separate toilet.

WHANAU ORA PLAN

Patient 2 Pathway • Access Ability – to support with PC & outings • Deaf foundation – interpreter• TDHB OT – assess bathroom Outcome • Care support for outings in the event of seizures.• Medical alarm • Interpreter available when necessary• Given a hospital bed• Has a new wet-floor bathroom thanks to local tradesmen and businesses

that provided free materials and time – now showers whenever she feels the need

• Volunteers for 2 hrs a week at the SPCA – she never ever thought in her wildest dream that this would be possible.

WHANAU ORA PLAN