New Zealand Palliative care Maddie Fangman, N4

Objectives Use evidence-based practices, health care technology, and effective communication strategies to guide the essential public health interventions across the lifespan. Use data from population assessments to identify the influences of the determinants of health (environmental, social, political, legal-ethical, economic, behavioral, and cultural) on delivery of care to diverse populations. Assess the health status, health care access, and emergency preparedness needs of the defined population. Participate with healthcare providers and community leaders in the planning, implementation, and evaluation of health interventions. Collaborate with healthcare providers and community partners to promote clinical prevention and population-focused health. Apply knowledge from nursing and related arts and sciences to the care of selected community based aggregates.

History of New Zealand New Zealand was first settled by the ancestors of Maori between 1200 and 1300 AD. These first settlers arrived from Polynesia as they explored the pacific, navigating by ocean currents and the winds and stars via there Canoes. The first European to arrive in New Zealand was a Dutch explorer Abel Tasman in 1642 (New Zealand Now, 2017). British captain James Cook made three voyages to the islands in 1769. In 1840 the Treaty of Waitangi was established between British and several Maori tribes pledges protection of Maori land and establishes British law in New Zealand. In 1947 New Zealand gained full independence from Britain (BBC, 2017).

MAJOR CAUSES OF DEATH

Auckland, New Zealand New Zealand is a wealthy pacific nation dominated by two cultural groups; New Zealanders of Europe and the Maori people. It is made up of two main islands and numerous smaller ones. Auckland City Population: 1.6 million 1/3 of total New Zealand Population

Palliative Care Palliative care is the total care of people who are dying from active, progressive diseases or other conditions when curative or disease-modifying treatment has come to an end. Palliative care is globally recognized as a legitimate component of health care. Evidence shows that palliative care is effective in improving the quality of life for people who are dying, and that it should be a central feature of all good clinical practice (WHO 1990; NCHSPCS 1994; Bruera et al 1999; Higginson et al 2000)

Mercy Hospice Auckland Mercy Hospice Auckland provides a range of specialist community palliative care and hospice services for people facing life limiting illnesses All services are offered free to patients and their families, regardless of age, ethnicity, means or religion, thanks to the generosity of the community. Services: 13 bed inpatient unit Specialist care in the community Counseling & education Family/ spiritual/ cultural support

Palliative Care in New Zealand Aims to… optimize an individual’s quality of life until death by addressing the person’s physical, psychosocial, spiritual and cultural needs support the individual’s family, whānau and other caregivers where needed into bereavement. New Zealand is the third best place in the world to die – just behind the United Kingdom and Australia. (Economist Intelligence Unit). This is a reflection of the level of public awareness about death, the quality of care available for people at the end of life and cost and availability of that care. Over 720 doctors, nurses and allied health professionals provide palliative care services in New Zealand. Palliative care is globally recognized as a legitimate component of health care. Evidence shows that palliative care is effective in improving the quality of life for people who are dying, and that it should be a central feature of all good clinical practice (WHO 1990; NCHSPCS 1994; Bruera et al 1999; Higginson et al 2000)

At a Glance 13% of all healthcare costs in the United States are spent on the last year of life Last year, Medicare paid $50 billion just for doctor and hospital bills during the last two months of patients' lives - that's more than the budget of the Department of Homeland Security or the Department of Education. Approximately 60% percent of Americans die in acute care hospitals, with 20% spending their last days in the ICU. The New Zealand government spends approximately $50 million a year on palliative care. $22 million is raised through charitable donations to fund palliative care services. 7,000 volunteers, working 480,000 hours a year help deliver hospice services. In New Zealand, patients with chronic, terminal illnesses are rarely admitted to intensive care units.

Palliative Care Interventions Individual: Timely referrals to palliative care services Many times palliative care is given alongside therapies with advanced cancer patients in order to improve their quality and length of life. The New Zealand Palliative Care strategy recommends that palliative care should generally be available to people whose death from progressive disease is likely within 12 months. System: Ensure access to essential palliative care services For for people to have the option of dying at home there must be access to a range of services provided in the community. Community: Educate the public about palliative care services Most people do not understand the difference between palliative care and hospice care and this can lead to a negative stigma Education on the many holistic services available through palliative care could greatly improve community involvement.

Clinical Experience Through my clinical at Mercy Hospice I was able to experience holistic patient and family centered care. On my first day at the inpatient hospice a patient who had been with Mercy services for a while passed away surrounded by the amazing interproffesional care team at mercy hospice. On my final day I was able to visit the home of the deceased and continue the emotional and spiritual care support of his grieving family. This was just one of many touching experiences I had with the compassionate team at Mercy Hospice.

Cultural Experience Experienced the amazing and adventures KIWI culture by exploring some of its most beautiful cities with other travelers. Rotorua Coromandel Queenstown Piahia Bay of Islands & Waitangi treaty grounds Waiheke Island

NEW ZEALAND NOW. A Brief History. Newzealand. govt. nz NEW ZEALAND NOW. A Brief History. Newzealand.govt.nz. New Zealand Now, (2017) NZ. https://www.newzealandnow.govt.nz/living-in-nz/history-government/a-brief-history BBC. New Zealand country profile .BBC (2017). http://www.bbc.com/news/world-asia-pacific-15357770 Williams-Grut, Oscar. The 11 best school systems in the world. Independent. (2016). http://www.independent.co.uk/news/education/11-best-school-systems-in-the-world- a7425391.html Commonwealth Health Online. Current health issues and progress in New Zealand. Nexus Partnerships Limited. (2017). http://www.commonwealthhealth.org/pacific/new_zealand/current_health_issues_an d_progress_in_new-zealand/