Worldwide, the numbers of people living with chronic conditions are rapidly on the rise. Chronic illnesses are enduring and often cannot be cured, requiring a strategy for long term management and intervention to prevent further exacerbation. Globally, there has been an increase in interventions using telecommunications technologies to aid patients in their home setting to manage chronic illnesses. Such interventions have often been delivered by nurses. The purpose of this research was to assess whether a particular intervention that had been successfully implemented in the United Kingdom could also be implemented in Canterbury. In particular, this research assessed the perspectives of Canterbury based practice nurses and district nurses. The findings suggest that a majority of both district and practice nurses did not view the service as compatible with their current work situation. Existing workload and concerns over funding of the proposed service were identified as potential barriers. However, the service was perceived as potentially beneficial for some, with the elderly based in rural areas, or patients with chronic mental health needs identified as more likely to benefit than others. Practice nurses expressed strong views on who should deliver such services. Given that it was identified that practice nurses already have in-depth knowledge of their patients’ health, while valuing the strong relationships established with their communities, it was suggested that patients would most benefit from locally based nurses to deliver any community based health services in the future. It was also found that teletriaging is currently widely used by practice nurses across Canterbury to meet a range of health needs, including chronic mental health needs. This suggests that the scope of teletriaging in community health and its potential and full implications are currently not well understood in New Zealand. Significant events, such as the Christchurch earthquakes indicate the potential role of teletriaging in addressing mental health issues, thereby reducing the chronic health burden in the community.
Christchurch has experienced a series of over 13,500 earthquakes between September 2010 and January 2012. Some children who have been exposed to earthquakes may experience post-traumatic stress disorder symptoms (PTSD) including difficulty concentrating, feeling anxious, restlessness and confusion. Other children may be resilient to the effects of disaster. Western models of resilience relate to a child’s social support and their capacity to cope. The Māori model of wellbeing relates to whanau (family), wairua (spiritual connections), tinana (the physical body) and hinengaro (the mind and emotions). Children’s concepts of helping, caring and learning may provide insight into resilience without introducing the topic of earthquakes into the conversation, which in itself may provoke an episode of stress. Many researchers have studied the effects of earthquakes on children. However, few studies have examined positive outcomes and resilience or listened to the children’s voices. The objective of this study was to listen to the voices of children who experienced the Canterbury earthquake period in order to gain a deeper understanding of the ideas associated resilience. Individual interviews were conducted with 17 five-year-old participants during their first term of primary school. After the interviews, the teacher shared demographic information and reports on the children’s stress and coping. Six children were identified as New Zealand European and eleven children identified as New Zealand Māori. Children had different views of helping, caring and learning. Themes of resilience from Western and Kaupapa Māori models were identified in transcripts of the children's voices and drawings. Māori children voiced more themes of resilience associated with the Western model, and in the Tapa Whā model, Māori children's transcripts were more likely to be inclusive of all four components of well-being. How five-year-old children, having experienced an earthquake disaster during their preschool years, talk or draw pictures about helping, caring and learning can provide insight into resilience, especially in situations where it is not advisable to re-traumatise children by discussing the disaster event. Future research should interview parents/caregivers and whānau to gain further insights. Considering information from both a Western and a Tapa Whā perspective can also provide new insights into resilience in young children. A limitation of this study is that qualitative studies are not always free from a researcher’s interpretation and are, therefore, subjective.
Background: Up to 6 years after the 2011 Christchurch earthquakes, approximately one-third of parents in the Christchurch region reported difficulties managing the continuously high levels of distress their children were experiencing. In response, an app named Kākano was co-designed with parents to help them better support their children’s mental health. Objective: The objective of this study was to evaluate the acceptability, feasibility, and effectiveness of Kākano, a mobile parenting app to increase parental confidence in supporting children struggling with their mental health. Methods: A cluster-randomized delayed access controlled trial was carried out in the Christchurch region between July 2019 and January 2020. Parents were recruited through schools and block randomized to receive immediate or delayed access to Kākano. Participants were given access to the Kākano app for 4 weeks and encouraged to use it weekly. Web-based pre- and postintervention measurements were undertaken. Results: A total of 231 participants enrolled in the Kākano trial, with 205 (88.7%) participants completing baseline measures and being randomized (101 in the intervention group and 104 in the delayed access control group). Of these, 41 (20%) provided full outcome data, of which 19 (18.2%) were for delayed access and 21 (20.8%) were for the immediate Kākano intervention. Among those retained in the trial, there was a significant difference in the mean change between groups favoring Kākano in the brief parenting assessment (F1,39=7, P=.012) but not in the Short Warwick-Edinburgh Mental Well-being Scale (F1,39=2.9, P=.099), parenting self-efficacy (F1,39=0.1, P=.805), family cohesion (F1,39=0.4, P=.538), or parenting sense of confidence (F1,40=0.6, P=.457). Waitlisted participants who completed the app after the waitlist period showed similar trends for the outcome measures with significant changes in the brief assessment of parenting and the Short Warwick-Edinburgh Mental Well-being Scale. No relationship between the level of app usage and outcome was found. Although the app was designed with parents, the low rate of completion of the trial was disappointing. Conclusions: Kākano is an app co-designed with parents to help manage their children’s mental health. There was a high rate of attrition, as is often seen in digital health interventions. However, for those who did complete the intervention, there was some indication of improved parental well-being and self-assessed parenting. Preliminary indications from this trial show that Kākano has promising acceptability, feasibility, and effectiveness, but further investigation is warranted. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12619001040156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377824&isReview=true
The 22nd February 2011, Mw 6.3 Christchurch earthquake in New Zealand caused major damage to critical infrastructure, including the healthcare system. The Natural Hazard Platform of NZ funded a short-term project called “Hospital Functions and Services” to support the Canterbury District Health Board’s (CDHB) efforts in capturing standardized data that describe the effects of the earthquake on the Canterbury region’s main hospital system. The project utilised a survey tool originally developed by researchers at Johns Hopkins University (JHU) to assess the loss of function of hospitals in the Maule and Bío-Bío regions following the 27th February 2010, Mw 8.8 Maule earthquake in Chile. This paper describes the application of the JHU tool for surveying the impact of Christchurch earthquake on the CDHB Hospital System, including the system’s residual capacity to deliver emergency response and health care. A short summary of the impact of the Christchurch earthquake on other CDHB public and private hospitals is also provided. This study demonstrates that, as was observed in other earthquakes around the world, the effects of damage to non-structural building components, equipment, utility lifelines, and transportation were far more disruptive than the minor structural damage observed in buildings (FEMA 2007). Earthquake related complications with re-supply and other organizational aspects also impacted the emergency response and the healthcare facilities’ residual capacity to deliver services in the short and long terms.
For 150,000 Christchurch school students, the 12.51 pm earthquake of 22 February 2011 shattered their normal lunch time activities and thrust their teachers into the role of emergency first responders. Whether helping students (children) escape immediate danger, or identifying and managing the best strategies for keeping children safe, including provision of extended caregiving when parents were unable to return to school to retrieve their children, teachers had to manage their own fears and trauma reactions in order to appear calm and prevent further distress for the children in their care. Only then did teachers return to their families. Eighteen months later, twenty teachers from across Christchurch, were interviewed. At 12.51pm, the teachers were essentially first responders. Using their usual methods for presenting a calm and professional image, the teachers’ emotion regulation (ER) strategies for managing their immediate fears were similar to those of professional first responders, with similar potential for subsequent burnout and negative emotional effects. Teachers’ higher emotional exhaustion and burnout 18 months later, were associated with school relocation. Lower burnout was associated with more emotional awareness, ER and perceived support. Consistent with international research, teachers’ use of cognitive reappraisal (re-thinking a situation) was an effective ER strategy, but this may not prevent teachers’ emotional resources from eventually becoming depleted. Teachers fulfill an important role in supporting children’s psychosocial adjustment following a natural disaster. However, as also acknowledged in international research, we need to also focus on supporting the teachers themselves.
Interagency Emergency Response Teams (IERTs) play acrucial role in times of disasters. Therefore it is crucial to understand more thoroughly the communication roles and responsibilities of interagency team members and to examine how individual members communicate within a complex, evolving, and unstable environment. It is also important to understand how different organisational identities and their spatial geographies contribute to the interactional dynamics. Earthquakes hit the Canterbury region on September, 2010 and then on February 2011 a more devastating shallow earthquake struck resulting in severe damage to the Aged Residential Care (ARC) sector. Over 600 ARC beds were lost and 500 elderly and disabled people were displaced. Canterbury District Health Board (CDHB) set up an interagency emergency response team to address the issues of vulnerable people with significant health and disability needs who were unable to access their normal supports due to the effects of the earthquake. The purpose of this qualitative interpretive study is to focus on the case study of the response and evacuation of vulnerable people by interagencies responding to the event. Staff within these agencies were interviewed with a focus on the critical incidents that either stabilised or negatively influenced the outcome of the response. The findings included the complexity of navigating multiple agencies communication channels; understanding the different hierarchies and communication methods within each agency; data communication challenges when infrastructures were severely damaged; the importance of having the right skills, personal attributes and understanding of the organisations in the response; and the significance of having a liaison in situ representing and communicating through to agencies geographically dispersed from Canterbury. It is hoped that this research will assist in determining a future framework for interagency communication best practice and policy.
Fine grained sediment deposition in urban environments during natural hazard events can impact critical infrastructure and properties (urban terrain) leading to reduced social and economic function and potentially adverse public health effects. Therefore, clean-up of the sediments is required to minimise impacts and restore social and economic functionality as soon as possible. The strategies employed to manage and coordinate the clean-up significantly influence the speed, cost and quality of the clean-up operation. Additionally, the physical properties of the fine grained sediment affects the clean-up, transport, storage and future usage of the sediment. The goals of the research are to assess the resources, time and cost required for fine grained sediment clean-up in an urban environment following a disaster and to determine how the geotechnical properties of sediment will affect urban clean-up strategies. The thesis focuses on the impact of fine grained sediment (<1 mm) deposition from three liquefaction events during the Canterbury earthquake sequence (2010-2011) on residential suburbs and transport networks in Christchurch. It also presents how geotechnical properties of the material may affect clean-up strategies and methods by presenting geotechnical analysis of tephra material from the North Island of New Zealand. Finally, lessons for disaster response planning and decision making for clean-up of sediment in urban environments are presented. A series of semi-structured interviews of key stakeholders supported by relevant academic literature and media reports were used to record the clean-up operation coordination and management and to make a preliminary qualification of the Christchurch liquefaction ejecta clean-up (costs breakdown, time, volume, resources, coordination, planning and priorities). Further analysis of the costs and resources involved for better accuracy was required and so the analysis of Christchurch City Council road management database (RAMM) was done. In order to make a transition from general fine sediment clean-up to specific types of fine disaster sediment clean-up, adequate information about the material properties is required as they will define how the material will be handled, transported and stored. Laboratory analysis of young volcanic tephra from the New Zealand’s North Island was performed to identify their geotechnical properties (density, granulometry, plasticity, composition and angle of repose). The major findings of this research were that emergency planning and the use of the coordinated incident management system (CIMS) system during the emergency were important to facilitate rapid clean-up tasking, management of resources and ultimately recovery from widespread and voluminous liquefaction ejecta deposition in eastern Christchurch. A total estimated cost of approximately $NZ 40 million was calculated for the Christchurch City clean-up following the 2010-2011 Canterbury earthquake sequence with a partial cost of $NZ 12 million for the Southern part of the city, where up to 33% (418 km) of the road network was impacted by liquefaction ejecta and required clearing of the material following the 22 February 2011 earthquake. Over 500,000 tonnes of ejecta has been stockpiled at Burwood landfill for all three liquefaction inducing earthquake events. The average cost per kilometre for the event clean-up was $NZ 5,500/km (4 September 2010), $NZ 11,650/km (22 February 2011) and $NZ 11,185/km (13 June 2011). The duration of clean-up time of residential properties and the road network was approximately two to three months for each of the three liquefaction ejecta events; despite events volumes and spatial distribution of ejecta. Interviews and quantitative analysis of RAMM data revealed that the experience and knowledge gained from the Darfield earthquake (4 September 2010) clean-up increased the efficiency of the following Christchurch earthquake induced liquefaction ejecta clean-up events. Density, particle size, particle shape, clay content and moisture content, are the important geotechnical properties that need to be considered when planning for a clean-up method that incorporates collection, transport and disposal or storage. The geotechnical properties for the tephra samples were analysed to increase preparedness and reaction response of potentially affected North Island cities from possible product from the active volcanoes in their region. The geotechnical results from this study show that volcanic tephra could be used in road or construction material but the properties would have to be further investigated for a New Zealand context. Using fresh volcanic material in road, building or flood control construction requires good understanding of the material properties and precaution during design and construction to extra care, but if well planned, it can be economically beneficial.
