Access to global health

july 13 volume 21 number 1

anj

AUSTRALIAN NURSING JOURNAL

Access to global health

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Health policy in the daily newspapers is about elusive to me as the clincher to the super-crossword.

editorial

By lee thomas anf FEDERAL secretary

So it was, the final sitting fortnight of the 43rd Parliament, at the end of last month, before the federal election and Australians head to the polls on 14 September. Perhaps it just is that we are getting closer to this election, but right now it feels that we are on a precipice for which way we want the future of this country to take but without a firm footing. Carbon tax and ‘boat people’ we hear almost daily about from the Coalition on one hand. ‘Gonski’ and the National Disability Insurance Scheme from federal Labor. All issues close to the heart of Australians, but where is health? Where are the health policies for us to analyse to make an informed vote on? Where are the policies on health workforce, health system funding, privatisation of public hospitals and the social determinants of health? Health policy in the daily newspapers is about elusive to me as the clincher to the super-crossword. The ANF has put its election platform to our politicians. Next month we will share those responses from political parties with you in an analysis prior to the federal election. We also hope to have preliminary results from the employment and workplace survey about the conditions and issues you face. If you haven’t yet done so, go online and fill out the survey. It will take you no longer than 15 minutes. www. surveymonkey.com/s/nursesmidwiveswork placestudy We are heading into the time for several ANF state and territory branches holding their delegates’ conferences around the country. Where many issues are raised, resolutions put forward and debated. Resolutions that are passed set the priorities and form the bedrock

for the work of the ANF. The ANF also holds its national biennial delegates’ conference in October this year which we look forward to, particularly following the federal election. As the ANJ went to print, we waited with baited breath on the passage of the five aged care bills being debated through the Senate late last month. The passing of the federal government’s Living Longer, Living Better aged care package of five aged care bills is crucial so the reforms can start as planned on 1 July. The bills include the Workforce Supplement, which is the $1.2 billion investment which will go towards closing the wages gap for aged care workers in Australia. For the first time this will give older Australians choice and control over what kinds of services they receive, when and from whom. On another Parliamentary note, the ANF has commended MPs and Senators after the passing of motions which condemn ongoing human rights violations in Bahrain. Since February 2011, mass pro-democracy protests in Bahrain have been met with fierce military repression. According to the Bahrain Centre for Human Rights, there have been at least 87 deaths and more than 1,800 arrests of prodemocracy protestors. More than 90 medical staff, including nurses have been targeted, in some cases arrested and tortured for treating injured protesters. It is unacceptable that nursing professionals and other health workers have been detained by the authorities for treating the victims of the anti-government uprisings. It is understood there are still seven medics who are being held in Bahraini prisons, including Ibrahim al Demistani, General Secretary of the Bahrain Nursing Society. We hope these motions will raise the awareness of human rights violations in Bahrain and the need for action.

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JULY 13 volume 21 number 1 Australian Nursing Journal 1

contents

26 ANFdirectory feature ACCESS TO GLOBAL HEALTH Kathryn Anderson reports

03 MAIL 05 NEWS 17 lee 17 yvonne 19 reflections 21 industrial 21 Immigration q&a 22 education 23 professional 23 volunteering 24 books

Editorial Level 1, 365 Queen Street Melbourne, Victoria 3000 Phone (03) 9602 8500 Fax (03) 9602 8567 Email [email protected]

AUSTRALIAN NURSING FEDERATION NATIONAL OFFICE

Advertising THE MEDIA COMPANY, Jana gungor Ph: 02 9909 5800 Fax: 02 9909 5810 Mobile: 0437 426 574 Email: [email protected]

canberra 3/28 Eyre Street, Kingston, ACT 2604 Phone (02) 6232 6533 Fax (02) 6232 6610 melbourne & ANJ Level 1, 365 Queen Street, Melbourne, VIC 3000 Phone (03) 9602 8500 Fax (03) 9602 8567

www.anf.org.au

25 ethics 30 legal 31 issues 32 viewpoint 33 working life 34 Clinical update 38 clinical issues 39 focus 46 calendar 47 network 48 sally

FEDERAL Secretary Lee Thomas

Assistant FEDERAL Secretary Yvonne Chaperon

ANF STATE AND TERRITORY BRANCHES

The Australian Nursing Journal is published monthly by Lee THOMAS, Australian Nursing Federation FEDERAL Secretary. Editor Natalie Dragon journalist kathryn anderson PRODUCTION MANAGER Cathy Fasciale Design and Production Mary Callahan design pty ltd Printing AIW printing distribution d&D mailing services

AUSTRALIAN CAPITAL TERRITORY Branch Secretary Jenny Miragaya Office address Unit 3, 36 Botany Street, Phillip ACT 2606 Postal address PO Box 1995, Woden ACT 2606 Phone (02) 6282 9455 Fax (02) 6282 8447 Email [email protected]

NEW SOUTH WALES Branch Secretary Brett Holmes Office address 50 O’Dea Avenue, Waterloo NSW 2017 Phone 1300 367 962 Fax (02) 9662 1414 Email [email protected]

NORTHERN TERRITORY Branch Secretary Yvonne Falckh Office address 16 Caryota Court, Coconut Grove NT 0810 Postal address PO Box 42533, Casuarina, NT 0810 Phone (08) 8920 0700 Fax (08) 8985 5930 Email [email protected]

QUEENSLAND Branch Secretary Beth Mohle Office address 106 Victoria Street, West End QLD 4101 Phone (07) 3840 1444 Tollfree 1800 177 273 Fax (07) 3844 9387 Email [email protected]

SOUTH AUSTRALIA Branch Secretary Elizabeth Dabars Office address 191 Torrens Road, Ridleyton SA 5008 Postal address PO Box 861, Regency Park BC SA 5942 Phone (08) 8334 1900 Fax (08) 8334 1901 Email [email protected]

TASMANIA Branch Secretary Neroli Ellis Office address 182 Macquarie Street, Hobart TAS 7000 Phone (03) 6223 6777 Fax (03) 6224 0229 Direct information 1800 001 241 (toll free) Email [email protected]

2 Australian Nursing Journal JULY 13 volume 21 number 1

VICTORIA Branch Secretary Lisa Fitzpatrick Office address ANF House, 540 Elizabeth Street, Melbourne VIC 3000 Phone (03) 9275 9333 Fax (03) 9275 9344 Information hotline 1800 133 353 (toll free) Email [email protected]

WESTERN AUSTRALIA Branch Secretary Mark Olson Office address 260 Pier Street, Perth WA 6000 Phone (08) 6218 9444 1800 199 145 (toll free) Fax (08) 9218 9455 Email [email protected]

The Australian Nursing Journal is delivered free monthly to members of ANF Branches other than New South Wales, Queensland and Western Australia. Subscription rates are available on (03) 9602 8500.Nurses who wish to join the ANF should contact their state branch. The statements or opinions expressed in the journal reflect the views of the authors and do not represent the official policy of the Australian Nursing Federation unless this is so stated. Although all accepted advertising material is expected to conform to the ANF’s ethical standards, such acceptance does not imply endorsement. All rights reserved. Material in the Australian Nursing Journal is copyright and may be reprinted only by arrangement with the Australian Nursing Federation Federal Office. Note: ANJ is indexed in the CUMULATIVE INDEX to NURSING AND ALLIED HEALTH LITERATURE and the INTERNATIONAL NURSING INDEX. ISSN 1320-3185

Moving State? Transfer your ANF membership If you are a financial member of the ANF, QNU or NSWNA, you can transfer your membership by phoning your union branch. Don’t take risks with your ANF membership – transfer to the appropriate branch for total union cover. It is important for members to consider that nurses who do not transfer their membership are probably not covered by professional indemnity insurance. Telephone your branch membership section using the numbers above.

Circulation 92,315 Source: BCA verified audit, March 2013

june 13 volume 20 number 11

anj union

Health System FUNDING

reform

Re-assess clinical traini ng

AUSTRALIAN NURSING JOURNAL

mail

NATIONAL REGISTRATION

Social Justice

PUBLIC HOSPITALS Public hands

2013

Assistants in nursing

Federal Election

DETERMINANTS OF HEALTH

equity

Nurses

midwives

CARE

CLIMATE CHANGE

INDUSTRIAL DICARE RELATIONS ME SOCIAL

ORCE WORKF AGED Access

PRIVATE HEALTH Insurance Rebate

MENTAL HEALTH Nurse Incentive Scheme

HealtH

ANJJune13_3.indd 1

I am a second semester EN student currently on placement. I agree with the letters written by experienced RNs who are observing that the curren t system of teaching and training nursing students needs some changing. I am a part time student and as such only go on a thr ee week placement every 12 months, with only 20 hou rs of practical training at TAFE. When I was placed at my facility I was informe d that I would be in a ward environment, however wh en I arrived on my first day of placement for orienta Simple Answers tion I was informed, along wit h seven other students, tha Reading this month’s Clinical t we were going to be in the emergency department Update (“The Vitamin D Dilemma”, (ED). I have encountered many RNs during my tim June ANJ, p38-41), reminded me e in the ED, some are hap py to have students, som of how in nursing the most simple e are not and I was informe d by a particular RN tha of explanations can be forgotten, t in her opinion an “EN should not be in ED, EN studen whether it be because we are too ts should never be in ED and EN students should nev busy with our caseloads, we are er ever be in paediatric ED ”, therefore, three strikes thinking of more complicated I was unwelcome. In hindsi ght I wish she would hav causes for illness or the mae spoken to my facilitator and expressed her disple chines we use are not calibrated asure and asked that I be assigned to a different correctly. We must remember department and a differe nt RN for the shift. I was Occam’s Razor, “The simplest anextremely excited and wa s eagerly anticipating my swer is usually correct” and take placement but on arriva l I felt totally unprepared for a step back from the machines, a real hospital environme nt; two years sitting in a the busy caseloads and compliclassroom cannot compar e to “on the job” experie cated answers and look at the nce and the reality of what a nurse deals with on a dai simple answers. Such as UTIs, ly basis. I would like ‘the pow ers that be’ to continue machines not calibrated corto reassess and re-work the way that we are taught, rectly and how some nutritional either going back to hos pital based training, or spl supplements can cause diaritting our training week wit h some days theory, som rhoea. Also how some vitamin e days practical instead of it being in a block. This ma deficiencies such as vitamin B y also help with the issue of making up time missed and vitamin D have been linked on practical placement due to public holidays. As the to mental health problems. By Queen’s Birthday holida y fell during my placement looking at the simple answers and the facilitator was not ava ilable the students we can hope to rule these out were not allowed to atte nd. We are now required by first, and aim to decrease hosTAFE to do another five day block to make up the pital admission times which one day missed, the rati onale is that they are una is a good thing for hospitals ble to place us for one day and must book a five day and patients, as we all know block; when this will hap pen is unknown. My big the consequences of a longer gest concern was that the unfi nished hours would imp hospital stay are increased ede me from continuing on to semester three as some risk of pressure areas, subjects have semester two prerequisites, and I decreased conditioning of pahad not met all my semester two requirements with the tients and a stronger chance unfinished time. Much to my relief I have been adof acquiring a hospital based vised that so long as I am marked competent for my infection. skills I can continue on to sem ester three and make Jacqui up the time prior to gradua tion. I would also like for facilities to be aware of which RNs are happy to accommodate students and which are not and take this The winners of into consideration when placing students. The pla the Miranda series cement experience is already a stressful, exhausting, 3 DVD giveaway: feet aching, head spinni ng time for a student wit hout the extra stress of having Tania Cilliers, ACT an RN who does not wa nt you in their work environ Anita Yeung, NSW ment. Sec ond Semester EN Studen Heather Lees, Tas t Hayley Murrells, Vic The winner of the ANJ best letter Ingrid Cother, SA competition receives a $50 Coles Myer vouche r

24/5/13 4:50:30 PM

Bullied and leaving I am concerned that in this day and age bullying in nursing is rife. I am more concerned now since I believe it is actually on the increase, despite the policies and procedures of hospitals to the contrary. I personally have been bullied under the heading of micromanagement. It appears to me that micromanagement is used by those in so called leadership positions to hide what their intent actually is. Bullying is an insipid attack that once having been commenced the bully is encouraged by the response they get from the person they have bullied. The person being bullied suffers from an anxiety that varies so greatly from other stressors that they have difficulty carrying out their functions in a reasonable fashion. The attack may be a personal one. It is sadder still to be bullied by someone you have known for many years, someone for whom you had great admiration and respect. Is this what we really want to do to nurses considering there will be fewer nurses available in the future? Yet we have people in powerful positions bullying experienced and senior nurses until they have had enough, can no longer deal with the stress and leave not only the organisation but also the profession. I plan to work for Bunning’s now. Clinical Educator, Victoria

VE debate Whilst I understand Coral’s own belief about voluntary euthanasia (VE) (Coral, June ANJ, p56) I can’t see why she considers it to be a surprise that a number of nurses were against it. She is obviously not up to date with what is happening in society. I believe that her opinion should be considered but her job is to be neutral, not to be pushing in any one direction. And yes I have read the ANF statement on VE. E.M Mazzei


ANTI-POVERTY WEEK 13-19 OCTOBER 2013

This is a week when we can all do something about poverty For information and ideas, visit the website

www.antipovertyweek.org.au

NURSING & MIDWIFERY SCHOLARSHIPS

An Australian Government initiative supporting nurses and midwives. ACN, Australia’s professional organisation for all nurses is proud to work with the Department of Health and Ageing as the fund administrator of this program.

Open 22 July 2013 – Close 13 September 2013 Scholarships are available in the following areas: > continuing professional development for nurses and midwives > postgraduate for nurses and midwives > nurses and midwives in an Aboriginal Medical Service > nurse re-entry > emergency department nursing > non clinical support staff in an emergency department, continuing professional development.


Apply online www.acn.edu.au freecall 1800 117 262

An Australian Government initiative supporting nurses and midwives. ACN, Australia’s professional organisation for all nurses is proud to work with the Department of Health and Ageing as the fund administrator of this program.

Low-paid authorisation rejection a blow In a disappointing blow, the Fair Work Commission has rejected an application by the ANF for low-paid bargaining authorisation on behalf of nurses working in medical practice in Victoria, New South Wales and Tasmania. ANF Acting Federal Secretary Yvonne Chaperon said the decision would ensure nurses in general practice remained amongst the most poorly paid nurses in Australia. The application for a low-paid authorisation would have compelled employers covered by it to bargain in good faith with their employees and the ANF to reach collective agreements covering wages and conditions of practice nurses. Ms Chaperon said tribunal member Vice President Graeme Watson in handing down the decision, appeared to acknowledge that ANF had been unsuccessful pursuing enterprise agreements for many years with general practice employers; enterprise agreements in the sector were virtually nonexistent; and nurses in general practice were remunerated well below their colleagues in other sectors. Despite this, the tribunal rejected the application instead finding that some nurses in general practice were paid above the award. The ANF’s view that general practice nurse wages and conditions should be raised to levels comparable with the hospitals sector was a factor in the rejection of the application. “All this decision appears to do is to leave nurses in general practice to languish at the whims of their employers and send a strong signal that refusing to bargain is acceptable, if not promoted,” Ms Chaperon said. The ANF was examining the decision and looking at all options available at the time the ANJ went to print.

Mandate safety against needlestick injuries A campaign calling for the mandating of safety devices to help prevent needlestick injuries has gained momentum following the International Council of Nurses (ICN) Congress held in Melbourne. A Private Members Bill was introduced to Parliament last month by WA Federal MP Mal Washer to have the use of Safety-Engineered Medical Devices (SMEDs) mandated throughout Australian hospitals. The Alliance for Sharps Safety and Needlestick Prevention in Healthcare which includes the ANF, has led the call for mandating safety devices. One in nine Australian nurses suffered at least one needlestick injury in the previous 12 months, Office of Australian Safety and Compensation Council data has found. It is mandatory for health care facilities in the United States to use safety engineered sharps devices in health care settings. The United Kingdom and the European Union have regulations covering the use of safer technologies to prevent needlestick injuries. CoDirector of Sterilisation and Infection Control at Monash Health Elizabeth Gillespie wants to see a program similar to that of Monash’s rolled out nationwide. Monash Health has seen a reduction in needlestick injuries due to the introduction of safety devices. “Basically in 2008 we had a huge increase in numbers of needlestick injuries

from insulin pens. Insulin pens had become popular in the community and patients would recap their needles. We had nurses going into patients’ sponge bags just to find soap and being stuck with an insulin pen.” Monash Health has introduced a safety device for insulin pens for all patients admitted to its facilities. “Once used, it automatically retracts and cannot be recapped. It’s effectively made redundant and you cannot get a needlestick injury,” Ms Gillespie said. However diabetic patients’ needles are funded through a federal government scheme and the non-safety pens are still used in the community, Ms Gillespie said. The safety devices are four times the expense and not subsidised. However, the cost of follow-up after a needlestick injury, on average was $500 for testing, counselling and time off work, she said. ANF Federal Secretary Lee Thomas said the health sector should align its safety protocols with legislation that requires the use of engineering controls to eliminate foreseeable workplace hazards. “Hospitals and the health sector need to take up the challenge to be proactive in protecting their staff,” she said, calling for safety-engineered devices to be made available “sooner rather than later”.

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NEWS

An injured female survivor of the Christmas Island boat wreck arrives at Perth Airport on December 16, 2010 in Perth, Australia.

Humanitarian policy for immigrant women Refugee and asylum seeker women take desperate measures to get to Australia, with many exploited and abused when they arrive and left with no other choice than deportation, says a leading women’s health expert. Immigrant Women’s Health Service (IWHS) Manager Dr Eman Sharobeem told delegates at the 7th Australian Women’s Health Conference held in Sydney recently of the barriers to life these women who take great risks to come to Australia face. For many women, the cost is exorbitant to even make the journey, Dr Sharobeem said. “For women to come to Australia, they have to pay a lot of money when they come through the normal application process and get here. It is at least $50,000 for any woman or anyone to come to Australia. So they try to take shortcuts [by boat] and maybe pay half that and need $25,000. These people are fleeing from a warzone, rape and torture.” The financial barriers were obvious, such as inadequate Centrelink benefits to live, the

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inability to work, and low paid work when employment was possible, Dr Sharobeem said. “People are suffering from poverty. Migrant workers accept employment wherever they can find it, usually cleaning or in the home care industry. They are willing to accept whatever job they can.” Many also face domestic violence and abuse, Dr Sharobeem said. A recent woman who came to the IWHS for help had been on a spouse visa living in the garage of a man working as his slave. “She was a widow back home; that man came from the ‘promised land’. He said to her: ‘Come, I give you life.’ She came and he gave her death. It was the neighbours who opened the garage door and got her out. He cancelled her spouse visa.” Her future lies in the hands of the Immigration Department. Many women in similar circumstances face deportation, Dr Sharobeem said. “Often the current system doesn’t assist much. Women lose entitlements under the spouse visa.” Dr Sharobeen said with continual changes to policy under successive governments, there was uncertainty for migrant, refugee and asylum seeker women. She has called on political parties for clearer policy to help improve the health of these women in the lead up to the federal election.


New online research repository A new international online nursing research repository, freely available to all, will be launched this month. The Honor Society of Nursing Sigma Theta Tau International’s (STTI) Virginia Henderson International Nursing library is launching the online nursing research repository. The service is focused on reviewing, organising, preserving and freely disseminating nursing research materials authored or co-authored by nurses. “The repository is dedicated to bringing the latest research on nursing knowledge to people around the world,” STTI Director, Education and Leadership Cynthia Vlasich said. The research in the repository covered all aspects of nursing, including best practice and models of care and clinical competence competencies, Ms Vlasich said. The material is authored and submitted by nursing students, nursing faculty, nurse researchers and nurse clinicians. “All the material is peer reviewed to ensure credible standards and copyright remains with the author.” Nurses are encouraged to submit their work to the repository. Benefits include increased visibility of the work via open access worldwide and the online resource is also backed by Sigma Theta Tau International. The repository will consider pre and post print journal articles, technical reports and conference papers/presentations. Nurses do not need to be members of STTI to access or submit materials. For more information go to www.nursinglibrary.org

New website on Medicare Locals A new government website has gone live which provides information on all Medicare Locals and health services provided. Anyone can go online and find out which of the 61 regional Medicare Locals they are located in. By clicking on a region, patients are taken to a page which shows health services provided and a list of frontline health workers employed by the service, including staffing numbers. www.medicarelocals.gov.au/

Break away from glass. Paracetamol IV from Pfizer, the individually foil wrapped packaging solution for intravenous paracetamol infusion.

PBS Information: This product is not listed on the PBS

Before prescribing, please review full Product Information available at www.pfizer.com.au PARACETAMOL IV PFIZER® (PARACETAMOL, 10 MG/ML) SOLUTION FOR INFUSION. Indications: For the relief of mild to moderate pain and the reduction of fever, where intravenous route is considered clinically necessary. Contraindications: Hypersensitivity to paracetamol or excipients, hepatocellular insufficiency, patients with hepatic failure or decompensated active liver disease. Precautions: Use with caution in cases of hepatocellular insufficiency, severe renal insufficiency, Glucose 6 Phosphate Dehyrogenase (G6PD) deficiency, chronic alcoholism, Anorexia, bulimia or cachexia; chronic malnutrition, Dehydration, hypovolemia. Pregnancy Category A: Use after a careful benefit-risk assessment. Interactions with other Medicines: Probenecid causes an almost 2-fold reduction in clearance of paracetamol by inhibiting its conjugation with glucuronic acid. Caution should be paid to the concomitant intake of enzyme-inducing agents. Concomitant use of paracetamol (4 g per day for at least 4 days) with oral anticoagulants may lead to slight variations of INR values. Phenytoin administered concomitantly may result in decreased paracetamol effectiveness and an increased risk of hepatotoxicity. Busulfan - busulfan is eliminated from the body via conjugation with glutathione. Concomitant use with paracetamol may result in reduced busulfan clearance. Diflunisal - concomitant diflunisal increases paracetamol plasma concentrations and this may increase hepatotoxicity. Adverse Effects: Neurological, GI, Haematological, Hepatobiliary, Psychiatric, Skin and Appendage, Respiratory, Endocrine/Metabolic. Very rare cases of hypersensitivity reactions from skin rash or urticaria to anaphylactic shock, isolated reports of thrombocytopenia. Dosage and Administration: Dosing is based on patient weight. For >50 kg, 1 g up to 4 times/day. For >33 kg to ≤ 50 kg, 15 mg/kg up to 4 times/day. For >10 kg to ≤ 33 kg, 15 mg/kg up to 4 times/day. For ≤ 10 kg, 7.5 mg/kg up to 4 times/day. Overdosage: May be fatal. Refer to full Product Information for details. Pfizer Australia Pty Ltd, ABN 50 008 422 348, 38-42 Wharf Road, West Ryde, NSW 2114. Medical Information 1800 675 229. Based on TGA approved Product Information of 11 January 2013. ®Registered trademark. P7192 Feb 2013. V11012/AM4479/ANJ.

4479E Pfizer Paracetamol BreakAway_ANJ_FP_FA.indd 1

14/02/13 12:00 PM

NEWS

Pregnant women drinking alcohol Many Australian pregnant women continue to drink alcohol throughout pregnancy despite current guidelines which recommend abstinence, research shows. The latest data from the Australian Longitudinal Study on Women’s Health (ALSWH) was presented at the recent 7th Australian Women’s Health Conference in Sydney. This latest data was collated on the 1973-1978 cohort, those now in their mid to late 30s, recruited to the study when aged 18-23 years. Australian guidelines on drinking during pregnancy have varied since 1992; however since 2009 it has been recommended not drinking during pregnancy is the safest option, ALSWH researcher Amy Anderson said. However, most women continued to drink during pregnancy, the data showed. “Seventy two per cent are still drinking during pregnancy and are not compliant with current guidelines,” Ms Anderson said. Women who drank alcohol pre-conception were 1.6 times more likely to drink throughout pregnancy. The study found that lifestyle preconception had a huge impact on women during pregnancy, Ms Anderson said. “Women who used to binge drink were more likely to continue to drink during pregnancy.” The reasons why women continued to drink alcohol despite current guidelines were unclear. “We need a more systematic process to ensure all women have information on alcohol recommendations and encourage women to abstain,” Ms Anderson said. The Australian Longitudinal Study on Women’s Health also found a prior history

Nurses needed for study on self-injurers

of depression and anxiety increased the risk of developing postnatal depression. Women with postnatal depression were also likely to describe a history of dissatisfaction with health services which had implications for targeting those at risk to seek help, the researchers said.

Trial for flexible child care starts A federal government trial for more flexible child care arrangements for nurse and paramedic shift workers starts in Queensland this month. The federal government funded trial for more flexible childcare arrangements for nurses and paramedics is part of a broader $5.5 million package for increased flexibility for shift workers across Australia. The Queensland nurses, midwives and paramedics flexibility trial arm will run in partnership with the Queensland Nurses’ Union, United Voice Queensland and Family Day Care Australia. The new flexible child care arrangements will trial in Brisbane, Toowoomba and Townsville for around 50 families.

8 8 Australian Nursing Journal JULY 13 volume 21 number 1

Nurses are being encouraged to participate in a study on their attitudes towards selfinjuring individuals who present to health services. Mental health nurse of 28 years and ANF Victorian member Julie Vine is currently in her third year of a PhD candidature. Her thesis is exploring nurses’ attitudes, knowledge and beliefs towards individuals who engage in non-suicidal deliberate self-injury. “Little research has been completed on nurse’s attitudes towards self-injuring individuals who present to our services, and no research has explored nurses’ attitudes in mental health and emergency facilities towards the selfinjurer in Australia.” “I acknowledge that this is often a bewildering and perplexing if not frustrating behaviour. I would appreciate to hear from nurses through this anonymous online survey of how you feel towards self-injurers presenting to your facility.” Ms Vine has worked in clinical, middle management as nurse unit manager and as a psychiatric clinical nurse specialist. “I have a passion for the phenomenon of non-suicidal deliberate self-injury and mental health.” The anonymous online survey takes five to 10 minutes. Those interested, are invited to participate in a follow up face to face or telephone survey in their own time to further explore nurses’ attitudes towards self-injury. The questionnaire takes about 20-30 minutes. “This research will fill a gap in the research body and inform further nurse educators whether there needs to be any specific debriefing or support for nurses who deal frequently with this behaviour, or if there should be any additional education at undergraduate or postgraduate levels,” Ms Vine said. To participate in the survey, visit: https://rmit.asia.qualtrics.com/ SE/?SID=SV_cABn5RxsNx6ONP7

Children’s Panadol. Suitable from 1 month of age. ®

Children’s Panadol is gentle enough for tiny tummies and can be used from one month of age. It can start to reduce a fever in just 15 minutes.1,2

Children’s Panadol contains paracetamol. For the temporary relief of pain and fever. References: 1. Wong A et al. Clin Pediatr (Phila) 2001;40(6):313−324. 2. Mahar AF et al. Clin Pediatr (Phila) 1994; 33(4):227–231. Panadol® is a registered trade mark of the GlaxoSmithKline group of companies. GlaxoSmithKline Consumer Healthcare, 82 Hughes Avenue, Ermington NSW 2115 Australia. 09/12 GSK0657/UC/ANJ

Calvary Health Care, ACT Clare Holland House Registered Nurses Various Levels Registered Nurses Clare Holland House provides specialist Palliative Care service to the ACT and the Palliative Care surrounding district. The service includes a 19 bed Inpatient Unit, and Home Based Clare Holland House Palliative Care. Clare Holland House provides high quality, skilled and compassionate care to patients withthat and advancing illness who are no longer responding to curative Do you want to be part of a team makes treatment. a real difference? It is located in beautiful parkland setting on the shores of Lake Burley Griffin, with the surrounding Brindabella Mountains. Calvary Health Care ACTviews – Clareto Holland House is

seeking highly experienced Palliative Care Registered Clare Holland House is looking for several experienced Palliative Care Registered Nurses Nurses to fill various positions within the hospice. to fillHouse in various positions at Registered Nurse Level 1 and 2 depending upon their skills and n support, Clare Holland will provide ongoing learning opportunities, competitive wages and expertise. If you are employed as a Registered Nurse Level 2 you will undertake the role salaries and family friendly, flexible working hours of team leader and provide relief to CNC position as required. In this role you will be able to: and conditions.

• Directly provide comprehensive and coordinated patient focussed care (acknowledging processes of

For further information regarding these roles, the patient and7300 their significant others as the unit of care) utilising contact Jane Etchells (02) 6264 or visit our website continuous www.calvary-act.com.au assessment, negotiated support and evaluation.

• Act as a professional role model and resource person in the provision of active, compassionate patient centred care as a member of the interdisciplinary team. • Actively promote an atmosphere that is conducive to learning for both staff and patients. • Actively participate in clinical projects involving quality improvement, policy development, risk management and the development of knowledge and evidence to inform processes of continuous development in the provision of quality palliative care. • Clare Holland House supports staff with ongoing education including post graduate studies and participation in local and nation palliative care conference and seminar If you are interested in applying for this role please feel free to contact:

Jane Etchells Ph: (02)62647300 Email: [email protected] Website: www.calvary-act.com.au

Fund shingles vaccine for over 60s Immunisation experts have called on the government to introduce a ‘whole of life’ immunisation approach. The federal government is currently considering a national immunisation program for those aged 60 years and older to help prevent shingles and associated pain. International immunisation experts in a forum at the recent International Council of Nurses Congress agreed a preventative herpes zoster vaccine funded by the Pharmaceutical Benefits Scheme would prevent shingles and its complications for Australians most at risk, the elderly and immune compromised. The Australian and New Zealand Society for Geriatric Medicine’s recently revised position statement recommends a single vaccination with the herpes zoster vaccine for those over 60 who have not previously received zoster vaccine, whether or not they report a prior episode of shingles. Victorian registered nurse Maria Kilvern has retired due to ongoing soft tissue and muscle pain and reduced mobility following two episodes of shingles in 2008 and 2010. The 65-year-old who until recently was spending $100 a month on treatment not subsidised by the PBS said a national immunisation program would help prevent cases like herself. “I have wanted to get back to work but couldn’t. I can walk short journeys but no great distance. I know there are lots of people that are worse off than I am, it’s just debilitating.” Shingles affects 20-30% of adults and more than half occur in those over 60 years. Complications which occur in up to 40% of cases are more common with increasing age and include post herpetic neuralgia (PHN) and muscle paralysis. There is currently no cure for shingles or PHN. Antiviral therapy can reduce the severity and duration of shingles, but does not prevent the development of PHN.

AGED CARE NURSING SCHOLARSHIPS Open 1 July 2013 – Close 30 August 2013 Aged Care Nursing Scholarships are available for: Undergraduate > For those with a demonstrated commitment to aged care wanting to become a registered nurse.

Postgraduate > For registered nurses working in aged care wishing to further their studies.

Nurse Practitioner > For registered nurses working in aged care

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prevent shingles in those 60 years and older, based on the Shingles Prevention Study. The study of more than 38,000 adults 60 years and older found a live attenuated vaccine containing 15 times as much antigen as the current childhood varicella vaccine, reduced shingles by 51% and post herpetic neuralgia by 55.5%. It reduced acute and chronic herpes zoster-associated pain by 61%. “The vaccine is registered and has begun to be distributed in several countries around the world,” Dr Pearce said. “A global trial added to the evidence base for the 50-59 population in 2011.” Immunisation experts argue that shingles and PHN cost the Australian health care system $32.8 million per year for those aged over 50 years, including 4,058 hospitalisations and 139,000 GP consultations per year.

the integration of new technologies and the expanding area of travel health. Australian Practice Nurses Association Board Member Jane Butcher will be on this year’s judging panel. Entries close 5pm 30 August 2013. For more information or to submit an entry, visit: www.vaxigrants.com.au

Immunisation grants on offer Educational grants worth up to $20,000 are on offer for immunisation providers, including South Australian GP and immunisation nurses who have an original and sustainable expert Dr Rodney Pearce AM said a live atimmunisation idea. There are seven categotenuated varicella-zoster vaccine was first ries open in the Sanofi Pasteur Vaxigrants licensed in the United States in 2006 to ANJ-June-Magazine-Horiztonal_Medicines.pdf 1 15/05/13 4:03 PM categories for program, including two new

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cuffs from all three clinical areas, those from operating theatres were significantly less compared to other areas. Although MRSA and VRE were infrequently isolated, current disinfection and infection control protocols need to be improved, according to the researchers at Westmead Hospital, NSW. “Although a direct correlation between blood pressure cuff contamination rates and risks of multi-resistant organism transmission cannot be made, increased contamination of cuffs is likely to increase the risk of nosocomial infections,” Westmead Hospital emergency physician Dr Amith Shetty said. “It is likely that these same results would be found in health care facilities around the world, which means that extra care should be taken in cleaning BP cuffs.”

BP cuffs harbor bugs despite cleaning Extra vigilance is needed in the cleaning of blood pressure cuffs, with multi-resistant organisms present despite routine cleaning, research shows. The study, published in the latest issue of Emergency Medicine Australasia, found high

bacterial colonisation rates in blood pressure (BP) cuffs in the emergency department, high dependency unit and operating theatres after routine disinfection procedures. Swabs were collected from the inner and outer surfaces of BP cuffs between patients and investigated for multi-resistant organisms such as Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). While there were high colonisation rates in

New book examines Alzheimers portrayal in euthanasia debate The ‘Alzheimerisation’ of the euthanasia debate is examined in a new book by a leading Australian nursing ethics academic. Author, Deakin University Professor of Nursing Megan-Jane Johnstone argues that Alzheimer’s is placed as a soft target in the

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for or against euthanasia and does not take a position either way. “My hope is that the book will open people’s eyes to the ‘Alzheimersation’ of the euthanasia debate and encourage them to critically evaluate the messages they are receiving from all sides of the debate,” Professor Johnstone said.

Stress link to arthritis Stress may be more of a predictor of developing arthritis than obesity. Research presented at the 7th Australian euthanasia debate as it plays to people’s Women’s Health Conference in Sydney fears of developing the disease and what it recently showed women who had experienced symbolises. “It positions Alzheimer’s as somestress were 1.7 times more likely to develop thing that requires a remedy; that remedy arthritis compared to women who reported increasingly being pre-emptive and beneficent no stress. Women who reported moderate euthanasia.” to high levels of stress were 2.4 times more ‘Alzheimer’s disease, media represenlikely to develop arthritis. tations and the politics of euthanasia: The Australian Longitudinal Study on constructing risk and selling death in an Women’s Health (ALSWH) collated data on ageing society’ is based on research into 12,202 women born 1946-1951. The results media representations of Alzheimer’s and showed stress was a greater risk than obesity the shift in public attitudes towards euthanafor developing arthritis, ALSHW researcher sia. Professor Johnstone considers the way Ellie Gresham said. Alzheimer’s disease is portrayed by advoStress by women studied was defined as cacy groups and the media is having undue specific anxiety, being under pressure, worry influence on the euthanasia debate, through etc. Many women were reluctant to call it highly publicised individual cases. stress, Gresham said. ANJ-June-Magazine-Horiztonal_On-the-Go.pdf 1 Ms 15/05/13 4:03 A PMlarge amount of The book is not a treatise on the arguments

stress had a powerful effect on mental health which influenced the physical domain, she said. “Many women dismiss aches and pains just as a sign of the body run down, ageing. Many women with arthritis cope with a stoic attitude.” Public health education strategies were required to dispel myths associated with joint symptoms and ageing, Ms Gresham said. “Mental health needs to be included as part of a national chronic disease strategy.”

ANJ index now available The ANJ index for reference for the 20122013 year is now available on request. For a copy, email [email protected]

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Deloitte’s reviews are also being implemented in this budget. This means $77 million reduction in the health service budget.” Adj Assoc Professor Elizabeth Dabars said the state budget also expected hospitals to treat more patients, including more acutely unwell patients as a result of increased complexity of care. “On our reading [of the budget] health professionals are being asked to do more with less; to deliver more services with less staff and less funding. It is unclear how health services and the health professionals seeking to provide care are expected to achieve this outcome.” The ANMF (SA Branch) has sought an urgent briefing on the issue.

STATE AND TERRITORY QLD Centaur Memorial Fund for Nurses marks 70 By Dr Deborah Prior

On 14 May 2013, Centaur Memorial Fund for Nurses convened a service to commemorate the 70th anniversary of the sinking of Australian Hospital Ship Centaur. The service was held at St John’s Cathedral, Brisbane in the presence of Her Excellency, Governor of Queensland, Ms Penelope Wensley AO, and Archbishop of Brisbane, the Most Reverend Dr Phillip Aspinall. The congregation included several family members, friends and even a former work colleague of those who had served on board AHS Centaur. At 4.10 am on 14 May 1943 despite having clear identification as a hospital ship AHS Centaur was attacked by a Japanese submarine and sunk almost immediately taking 268 lives. The 64 survivors clung to makeshift rafts with virtually no food or water for 36 hours before they were rescued by the crew of an American destroyer USS Mugford. Dr Outridge and Sister Ellen Savage, the only doctor and nurse to survive, suffered extensive injuries, yet still provided professional care to others during their 36 hour ordeal, waiting to be rescued. The loss of nurses and doctors with the sinking of the AHS Centaur in such a barbaric and senseless manner shocked all Australians. The tragedy and plight of the victims touched Queenslanders perhaps more deeply because the attack occurred in Queensland waters and the survivors were initially admitted to Brisbane hospitals, Greenslopes and Brisbane General. About a year after the tragedy of AHS Centaur, Queensland nurses initiated a fund raising appeal to establish a permanent war

memorial for nurses and formalised the Centaur Memorial Fund for Nurses in 1948. The Brisbane Telegraph newspaper backed the nurses’ fundraising efforts and launched and sponsored the appeal. The response from the public was overwhelming and the appeal raised sufficient funds to actually buy a building that was named Centaur House at 337 Queens Street, Brisbane. For many years Centaur House was a central meeting place for nurses and also accommodated visiting nurses from other regions. Centaur House become known as ‘the emotional heartbeat of nursing’ (Milligan and Foley 1993). The funds realised from the final sale of Centaur House in 1979, were prudently invested by the management committee of the day. The investment with other funds raised over the years has enabled the Centaur Memorial Fund for Nurses to support nursing research and scholarship. The fund awards an annual scholarship to a Queensland nurse undertaking higher degree studies leading to professional Doctorate or Doctor of Philosophy (PhD). Application details can be found at www. centaurnursesfund.org.au Dr Deborah Prior RN PhD. FACN Centaur Fellow, is President, Centaur Memorial Fund for Nurses

SA Access to health care at risk The quality and availability of South Australian health care services is under risk following the delivery of the state’s budget last month. Australian Nursing and Midwifery Federation (ANMF SA Branch) CEO Adj Assoc Professor Elizabeth Dabars said the budget raised concerns due to significant cuts to staffing numbers in health of around 400 to 900 positions. “Additionally, the significant cuts announced last year in the KPMG and

VIC Prison nurses stop work Victorian prison nurses held stop work rallies and implemented bans on administrative work last month in an effort to secure improved wages and working conditions. The ANF Victorian Branch and GEO Care Australia, which manages the prisons, reached a stalemate last month over a 2.5% wage increase and the introduction of entitlements that are standard for all other Victorian nurses. About 60 nurses employed in medical clinics in 11 prisons across Australia took protected industrial action which included bans on filing, collecting data, taking general phone calls, and working any extra hours or in higher duties. The nurses held two hour stop work rallies at Barwon Prison, Dame Phyllis Frost Centre, Hopkins Correctional Centre and Loddon Prison on 18 June. Entitlements for nurses employed by GEO Care Australia were significantly below health industry standard, ANF Victorian Branch Secretary Lisa Fitzpatrick said. This included prison nurses not paid health industry standard penalty rates for public holidays. “Nurses only ever take industrial action as a last resort and nurses employed by GEO Care Australia believe that they’ve exhausted all other avenues to negotiate reasonable wages and conditions that reflect health industry standards,” Ms Fitzpatrick said. The current nurses’ agreement expired in July 2012. Prison nurses’ last wage increase was in January 2011. The ANF Victorian Branch has sought agreement from GEO Care Australia to pay nurses the increase from July 2012.

15


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Lee

By lee thomas anf FEDERAL secretary

ANF Federal Secretary Lee Thomas (L) with NSWNMA Assistant General Secretary Judith Kiejda (second L) and QNU Branch Secretary Beth Mohle (back R) at the Golden Gate Bridge for the NNU Conference, rallying for nurse to patient ratios

As I write this late June, I am in sunny but windy San Francisco attending the National Nurses United’s (NNU) Staff Assembly. NNU is the largest union and professional association of RNs in the United States, representing 185,000 RNs in all 50 states. The Staff Assembly is NNU’s annual conference that brings together 1,000 registered nurses from across the United States. This year the NNU ANF attended the Age Well “End the Aged Care Lottery” breakfast at Parliament House in Canberra in mid-June to relaunch the Age Well campaign. I was one of three who sat on an expert panel at the breakfast answering questions from the audience about access to aged care and workforce issues. The breakfast was attended by 20 politicians and over 100 aged care providers, consumer and union groups. The message delivered to all political parties was that access to aged care is a lottery as the current aged care system is rationed on an arbitrary numbers game, rather than a system based on the need for care. Aged care packages are allocated by area and if one area uses some of their care packages and has some care packages unused, these unused care packages cannot be relocated or transferred to an area that has used all its aged care packages. It is not rocket science - the allocation of aged care packages should be based on the need of the consumer. All too often we hear of stressful situations where an elderly person wishes to stay in their home and be cared for. They may have to wait up to 18 months to access home care packages. This is just not good enough. More often than not, some of these elderly citizens may end up presenting at our

made a special effort to bring nurse union leaders from around the world to participate and focus on the global effort to achieve nurse to patient ratios and building the global nurses’ movement. From Australia it is great to have Beth Mohle from Queensland Nurses’ Union (QNU, ANF Queensland), Judith Kiejda from NSW Nurses and Midwives’ Association (NSWNMA, ANF NSW Branch) and Paul Gilbert

from ANF Victorian Branch representing Australian nurses and midwives. Over the past two decades there has been a growing body of evidence that adequate nurse to patient ratios affects quality care and patient outcomes. Studies have shown adverse outcomes where there are insufficient nurse staffing levels. To date, in the United States, California has the only legislated system requiring hospitals to adhere to set nurse to patient ratios. However in April this year, proposed legislation was introduced by Californian Democrat Senator Barbara Boxer that would require hospitals to maintain a minimum nurse to patient ratio at all times and allow the government to audit and penalise hospitals that fail to comply. If only we could achieve something similar in our own country. The Bill is modelled on the historic Californian law that since its implementation nine years ago has saved thousands of patient lives, improved quality of care and helped retain its most experienced nurses. Nurses across the US have rallied for the proposed legislation to be passed to ensure adequate nurse staffing levels for safe patient care. It’s not just in the United States. Nursing unions around the world, including the Royal College of Nursing (UK), the Canadian Federation of Nurses Unions and the ANF have been lobbying governments and health authorities to implement adequate nurse to patient ratios or nursing hours of care per patient day. The evidence is clear: it is time for governments to act and legislate for safe patient care. We must fight on we must succeed.

By yvonne chaperon assistant federal secretary

Yvonne

state and territory public hospital emergency departments. And we are all too familiar with bed blocking and ambulance ramping due to the ever increasing numbers of presentations. These elderly people deserve to be treated in a timely manner in the appropriate setting. This is not necessarily an acute emergency department. What the political parties need to support is a level of resources for eligible individuals, determined by a needs based assessment to meet their needs however chosen by that individual - in their own home or a residential aged care facility. At the time of writing this column, we are eagerly awaiting the expeditious passage through the Senate of the government’s Living Longer Living Better aged care reforms. The package of five aged care

bills is scheduled for debate in the Senate and needs to be dealt with promptly so the reforms can start as planned on 1 July. The bills include the Workforce Supplement, which is the $1.2 billion investment which will go towards closing the wages gap for aged care workers in Australia. This legislation is critical to improving the lives of older Australians who need aged care and miss out now. Over the next decade reform will deliver services to hundreds of thousands of extra people in their own homes, which is where most people prefer to be as they age. For the first time this aged care reform, Living Longer, Living Better will give people choice and control over what kinds of services they receive, when and from whom.


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reflections Overcoming disability By Rasa Kabaila When I was 13 years old, our primary school was lucky enough to be taken to the Paralympic Games. The most mesmerising event at the games for me was ‘Goalball’. This sport was invented in 1946 in an effort to help in the rehabilitation of blind war veterans. In Goalball, participants compete in teams of three, and try to throw a ball that has bells embedded in it into the opponent’s goal. Teams alternate throwing or rolling the ball from one end of the playing area to the other, and players remain in the area of their own goal in both defence and attack. Players must use the sound of the bell to judge the position and movement of the ball. Blindfolds allow partially sighted players to compete on an equal footing with blind players. I could never imagine trying to do anything blindfolded, so watching this game captivated me. After my exposure to the Paralympic Games, I took a huge interest in and developed an admiration for seeing the achievements of people who live with a disability. As a nurse, every day I see people with disabilities making the most of what they have, including a blind patient who plays the piano beautifully, and a paraplegic man who can move himself around the room on his own with the use of his superior upper body strength. As an ‘able bodied person’ I have been playing basketball for many years and have always enjoyed watching wheelchair basketball. I remember seeing a poster at the basketball stadium asking if able bodied people would like to have a go at playing wheelchair basketball. I was interested in playing, but the opportunity never really arose. Years later, a friend of mine came to watch one of my basketball games, however he got the time wrong and arrived after my game had finished. I suggested we should casually shoot some hoops but there were no courts available.

Whilst searching for a court we came on some people playing wheelchair basketball and decided to watch. I soon discovered the manager of the wheelchair basketball team, Jez, used to be my basketball manager in a previous team and he invited us to join the wheelchair basketball game. I felt pretty nervous, for a few reasons. Firstly, I was afraid to embarrass myself. I was also afraid that Ed and I were at an advantage because we had complete use of our legs and I was concerned that this could possibly make the game unfair. I was also fearful that because I was ‘able bodied’, it could be seen as an insult to the players who had lower bodied disabilities. Regardless, we were encouraged to play, so we did. My preconception that I may have been at an ‘advantage’ because of being able bodied was quickly dismissed. The technique and coordination involved in wheelchair basketball was certainly not reflected in my many years of playing able bodied basketball. Everything about it was a mixture of excitement and difficulty. The amount of times that I had the urge to leap out the chair and shoot were endless and my upper body strength was really being pushed. I had the ball intercepted from me numerous times as it was taking me too long to figure out how to dribble the ball and move at the same time. It was like mimicking the movement of patting your head with one hand and rubbing your stomach with the other. By the time I managed to get myself to one end of the court, it had been a turnover and I was puffed. Not to mention that I never realised how inconvenient it is when the ball heads out of the court when you have to try and chase it in a wheelchair! Clearly struggling, a nice woman approached us, as well as Jez, and taught us the difference in ball skills in a wheelchair compared to playing able bodied basketball. I asked this woman how she was involved in wheelchair basketball. She explained to me that her son, limbless from the thigh down, loved playing. They were from the country town of Cooma and drove to the Canberra basketball stadium every Tuesday so that he

could play. Currently, they are hoping to get a team together so they can play in a tournament in Sydney. I spoke to another young woman on the court, a happy go lucky girl who plays wheelchair basketball; she has spina bifida. Michaela is studying at Merici College and is also a representative wheelchair athlete in track and field. Michaela was explaining to me how happy the other players were to have people participating in wheelchair basketball, regardless if they were able bodied or not. She further explained that the people playing wheelchair basketball were just keen to play; they didn’t want to be treated differently from anyone else. Michaela told me, that for people who have disabilities, being able to play sport helped them to feel more ‘normal’. For a few days after the game, I felt a lot of pain in my hands and arms, in places where I never thought I had muscles. Ed had black marks and cuts on his hands caused by turning the wheels which also lasted for days. Emotionally and physically, wheelchair basketball was a fantastic and insightful out of body experience and I would recommend it to anyone. Email: [email protected] Rasa Kabaila is a Registered Nurse working in Canberra and an ANF ACT Member

19


2013

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ANTI-POVERTY WEEK 13-19 OCTOBER 2013

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www.aucklandhealthjobs.co.nz 20 Australian Nursing Journal JULY 13 volume 21 number 1

Australian Nurses & Midwives Workplace Survey 2013 This survey is being jointly conducted by Monash University and the Australian Nursing Federation about contemporary employment and workplace issues facing nurses and midwives. The survey should take no more than 15 minutes to complete. Your participation in this survey is entirely voluntary. You may decline to answer individual questions. Please be assured that this survey is completely confidential and anonymous. If you wish to obtain a copy of aggregated results of this survey please email your request to Associate Professor Peter Holland at Monash University at: [email protected] and a copy of the report will be sent to you. Please take the time to complete the survey. Your responses are confidential. Your participation is highly valued as it will provide essential information to assist in the retention of nurses and midwives in the healthcare sector. http://www.surveymonkey.com/s/ nursesmidwivesworkplacesurvey

By NICK BLAKE FEDERAL senior industrial officer

industrial

Government announces changes to workplace laws In June 2013, the federal government was successful in securing significant changes to the Fair Work Act through the federal parliament despite strong opposition from the conservative parties. The amendments provide important workplace changes including: • expanding the right of pregnant women to transfer to a safe job; • providing greater flexibility in relation to the unpaid parental leave; • ensuring that any special maternal leave taken does not reduce an employee’s entitlement to unpaid parental leave; • expanding access to the right to request flexible working arrangements; • requiring employers to consult with

Employing legal workers I am the nurse manager at a private hospital in Victoria and oversee the personnel functions of the business. I recently heard that if we don’t check the work rights of all our employees, we may face fines if found to be hiring illegal workers. This could mean a lot of paperwork. Also, I don’t understand the visa labels that our overseas nurses sometimes produce. I know some local staff won’t be happy about this either, as a few don’t have passports or evidence of their citizenship. Can you please suggest some easier options? New laws from 1 June 2013 mean that businesses employing, referring or contracting non-citizens who do not have valid visas allowing them to work, could be issued with an infringement notice or be liable for civil penalties. The new penalties range from $3,060 to $76,500 per illegal worker and complement existing criminal penalties that have existed since 2007. While businesses can now be held responsible whether or not they knew a worker was allowed to work, the department’s focus is to respond effectively to the few businesses that wilfully take part in illegal work – not to penalise the majority of employers who act in good

employees about the impact of changes to regular rosters for hours of work, particular in relation to family and caring responsibilities; • requiring the Fair Work Commission to take into account the need to provide additional payment for employees working overtime, unsocial, irregular or unpredictable hours, working on weekends, public holidays or shifts; • improving the rights of union representatives to visit the workplace; and • allowing the employee who has been bullied at work to seek redress through the Fair Work commission. The ANF campaigned strongly in support of the amendments as it considered that the changes would improve the working lives of nurses. The ANF supported the proposed amendments in relation to special maternity

leave considering it was appropriate that nurses who need to take special maternity leave do not have their 12 months of unpaid maternity leave reduced by reason ie. illness during pregnancy. The ANF also supported changes to extend a period of parental leave that may be taken concurrently by parents. As rostering arrangements in nursing have significant ramifications to hours and entitlements ANF supported changes that would require modern awards to contain requirements for employers to consult with employees about changes to the regular roster or ordinary hours of work. We welcomed new regulations that require the industrial tribunal to have particular regard for the need to provide additional payment for employers working overtime, shifts and weekends. Most nurses and midwives work at least some of their shifts outside regular business hours of 9am-5pm, Monday to Friday and frequently work overtime. Accordingly it is essential they receive penalty rates for working these unsociable hours. The amendments go some way to making it more difficult to remove such provisions. Further detail on the changes and the ANF response can be viewed at: http://anf.org.au/documents/submissions/House_Inquiry_into_the_Fair_Work_ Amendment_Bill_2013_Submission.pdf

By Amanda Dansie DIAC Outreach Officer

Q&A

immigration

faith by taking reasonable steps at reasonable times to verify a worker’s status. In implementing the new laws, the Department of Immigration and Citizenship aims to raise awareness of the changes and to support continued voluntary compliance. The department has published a new video and a set of practical examples and guidelines on how employers can quickly and easily deal with their checking obligations. This includes managing situations where Australian citizens and permanent residents do not have formal evidence of their status. The government provides a free, 24-hour service - Visa Entitlement Verification Online (VEVO) - to confirm if a non-citizen is allowed to work, or if there are any work limitations associated with their visa. It is no longer necessary for you to sight visa labels in passports but, if you do need assistance, contact the Employers’ Immigration Hotline on 1800 040 070.

New VEVO email functionality enables visa holders to send any employer their visa details and entitlements directly from VEVO. This means employers do not need to register to use VEVO to confirm if someone has permission to work. Sighting appropriate evidence of Australian citizenship, permanent residence or New Zealand citizenship is confirmation that a person can work. In most cases, this is straightforward as most people have some form of government issued photo identification. More information about hiring legal workers and additional examples of steps employers can take to check existing workers can be found at: www.immi.gov.au/legalworkers

The ANF works in partnership with the Department of Immigration and Citizenship (DIAC) to assist in providing members with immigration assistance and guidance in the event that it may be required. If you are an ANF member and have a question for Amanda, she can be contacted via the ANF website – www.anf.org.au/html/topics_international_nurses.html


ANF Continuing Professional Education online The ANF’s CPE website has grown immensely since it first went live in 2008. We now have 35 topics available with another 20 in various stages of completion. These include arterial blood gases, communicating with psychotic patients, personality disorders, antipsychotic medication, seizure recognition in nursing practice, the decision making framework, quality use of medications and paediatric oncology. We have three of the new telehealth tutorials online with another six to follow. These tutorials are free to all nurses and midwives as is the hand hygiene tutorial. Manual handling and infection control tutes, both recently updated, are free to members only. The tutorials are all now iPhone/iPad compatible to allow you to access anywhere. Your CPE record is FREE and printable at any time. There is even provision for you to add in CPD you have attended outside of the CPE website so you can keep all your CPD safely on one document. CPE is the ANF’s solution for your professional education needs to allow you to fulfil the NMBA’s standard for continued professional development. Your CPD couldn’t be in better hands. Interested in writing education material for the ANF? • It counts towards your CPD. • Helps other nurses and midwives to undertake their CPD. • Share your expertise and passion with other nurses and midwives. Get started on your 2013-2014 CPD registration requirements now to avoid the rush next May! www.anf.org.au/cpe For any enquiries regarding Continuing Professional Education please contact: Jodie Davis, ANF Federal Education Officer. Email: [email protected]

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By ELIZABETH FOLEY federal professional officer

professional

By whose standard?

Recently I’ve had people ask me what right the ANF has to develop national professional standards. This has prompted me to respond by writing on professional practice standards in this column. There are two forms of regulation under which we practice as nurses and midwives: statutory regulation and self-regulation. The Nursing and Midwifery Board of Australia (NMBA) regulates nurses and midwives under the Health Practitioner Regulation National Law (2009) – this is statutory regulation. Under statutory regulation aspects of our professional practice are set in legislation, such as: title protection, requirements for registration – minimum education and competence standards for entry to practice, and continued fitness to practice standards.

National minimum standards of competence are prescribed in the National Law 2009 for registered nurses, enrolled nurses, registered midwives and nurse practitioners. The NMBA uses these standards to determine the eligibility of people applying for a licence to practice as a nurse or midwife, in Australia. In contrast, self-regulation, where the profession itself develops standards, is an essential mark of a professional group. Nurses and midwives in Australia have worked hard, over many years, to gain the professional status we enjoy today. This means that within our professions – nursing and midwifery – we have the ability to determine the standards for our own professional practice beyond beginning/entry to practice level. Self-regulated standards are not set in legislation and do not have a legally binding force. They may, however, be used in a court of law as ‘soft law’, as

a measure by which to judge the actions or behaviour of a nurse or midwife in a particular situation, in conjunction with statutory regulation criteria. The nursing and midwifery professions use standards of practice in a peer review context, as a framework against which to measure their own performance, and, to set goals for maintaining or enhancing practice (ANF 2005). Specific professional practice (competency) standards have been developed by specialty nursing organisations: critical care, operating rooms, palliative care, mental health, gastroenterology, and diabetes education, to name a few. As the largest professional and industrial body in Australia for nurses and midwives, the ANF takes seriously its professional leadership role. Accordingly, we led the formulation of professional practice standards for: the advanced registered nurse, the advanced enrolled nurse, nurses in general practice, and most recently, informatics (in publication) and school nurses. The ANF will continue to ensure that the professions maintain ownership of the self-regulatory standards by which we describe safe and competent nursing and midwifery practice. Reference

Australian Nursing Federation. 2005. Competency Standards for nurses in general practice. Available at: http://anf.org.au/pages/competency-standards

volunteering Panacea for the Ageing Nurse As we get older it is easy to start doubting our ability to be as effective as younger nurses, not quite as efficient and generally slowing down a bit. Despite many years of practice and loving the profession it was difficult to start thinking about the transition to retirement. The process of letting go of a career in a profession that I had enjoyed and had allowed me to work in such diverse and interesting work places was challenging. In 2009 I started to hit a brick wall and needed to make some changes. Being “the nurse” in a six member volunteer team in a Vanuatu prevention of blindness project, working in remote villages in 2009, helped me put my negative thinking into perspective. It was a matter of adapting to local conditions with a supportive team: to enjoy a laugh as we fumbled and bumbled around with mosquito nets at night, lived in traditional thatched dwellings, slept on the ground and dealt with the horrid ‘long drops’ and lack of running

By Wendy Flahive

water for a shower. Having electricity and running water was a luxury, even at the local hospitals and health centres, but we met the challenge as best we could as a small team of volunteers, two optometrists, one doctor, one spectacle dispenser (my husband Peter), our team leader plus three local Ni-Van health workers as our local Indigenous contacts and guides for the project. Over the two and a half week project my thinking started to change. You know you are doing good work when you arrive at the remote island of Malekula and dispense antibiotics in remote villages to a local subsistence living woman who has had a urinary tract infection for three months, another reportedly for two years. Or sitting under a banyan tree, talking to the local women about their health and the culture of family violence they experience. Having the ability to help assist women to deal with their health in ways that are second nature to us in a wealthy

country helps put everything in perspective. Now, looking back, I find that this project work, along with many others, has helped me appreciate nursing as a career that has taken me along so many interesting paths and this can continue into retirement as long as I keep my skills and knowledge up to date. By sharing this information I hope to encourage other nurses to see their careers continue beyond retirement by offering their volunteer skills to their own communities locally, Aboriginal communities or volunteer work overseas, some fabulous opportunities out there. We don’t stop using nursing skills just because we are no longer in paid employment. I now do a bit of casual work some paid, some unpaid, not only in Victoria but in Vanuatu, Kiribati, Malaysia, Indonesia and Scotland. What a wonderfully flexible career nursing can be! Wendy Flahive is a Maternal and Child Health Nurse, Bairnsdale, Victoria


The Happiness Trap Pocketbook

By Dr Russ Harris & Bev Aisbett RRP: $29.99 Publisher: Exisle Publishing ISBN: 9781921966187 www.exislepublishing.com.au

The Happiness Trap Pocketbook is an illustrated pocketbook version of author Dr Russ Harris’ original international bestseller The Happiness Trap. He describes how popular myths about happiness are directly contributing to an epidemic of stress, anxiety and depression. The book uses the mindfulness-based approach called Acceptance and Commitment Therapy (ACT) as an effective means to deal with life’s struggles. Techniques explained include how to: reduce stress; rise above fear, doubt and insecurity; handle painful thoughts and feelings more effectively; break self-defeating habits; and develop selfacceptance and self-compassion. Whether you’re lacking confidence, suffering illness, stressed at work, struggling with low selfesteem or trying to lose weight or quit smoking, this book may be for you. An easy to read, highly illustrated book full of tidbits of info and techniques.

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A Road Less Travelled: A Guide To Children, Emotions and Disasters By Brett McDermott and Vanessa Cobham RRP: FREE Publisher: TFD Publishing ISBN: 9780646581118 www.beyondblue.org.au

beyondblue is offering free copies of A Road Less Travelled: A Guide To Children, Emotions and Disasters to health professionals, teachers and community workers in disaster-affected areas. Authors, beyondlblue Board Member and psychiatrist at Brisbane’s Mater Hospital Professor Brett McDermott and Clinical Psychologist at Mater Hospital and University of Queensland Associate Professor Vanessa Cobham are two of Australia’s leading experts in child and adolescent mental health following trauma and disaster. The book is based on their work following several natural disasters in Australia, including the Canberra bushfires in 2003, Cyclone Larry in 2005 and the Queensland floods in 2011. This resource is specifically aimed to understand the child and youth responses to emotional trauma and child and adolescent postdisaster presentations. To order a free copy, email your name, job title and postal address to: childrenanddisasters@hotmail. com


Communication and Professional Relationships in Healthcare Practice

the Greek Book Translations for Aged Care

By Sally Candlin and Peter Roger

By Kiri James

RRP: $45.00 Publisher: Equinox ISBN: 9781908049971 www.equinoxpub.com

RRP: $39.95 Publisher: Sheridan House Australia ISBN: 97809752218464 www.sheridanhouse.com.au

Anyone working in the health care sector understands the crucial importance of effective communication in practice. Communication and Professional Relationships in Healthcare Practice draws on scenarios based in settings of clinical experience. During everyday conversations we often find ourselves in situations where we have to ‘correct’ what we have said, ‘search for the right word’ or feel the need to provide an explanation. The book presents a range of interactions, including consultations, team meetings, dialogues and casual conversations between health professionals, their colleagues and their patients in a variety of settings. The authors introduce readers to a number of approaches that can be used to analyse these interactions. This book is designed specifically for medical, nursing and allied health practitioners with an interest in communication.

This handy resource will help care providers in a range of settings communicate more effectively with elderly Greekspeaking people. The Greek Book - Translations for Aged Care provides carers with a range of useful words and phrases in Greek and English, with illustrations to further clarify their meaning. The vocabulary follows the daily routine in a health care setting from washing, dressing and eating, to physical assessment and routine tests. It’s a user-friendly book designed for nurses and other health workers who need to communicate effectively with their Greek-speaking clients and don’t always have an interpreter available. “Elderly clients will have a more positive experience when carers can offer them choices in Greek, and staff will rapidly build a rapport with their clients. Staff can even try saying the words in Greek as the book provides a guide to pronunciation”, says Kiri James, the book’s author.

By megan-jane johnstone

Moral distress

ethics

During the course of their day to day practice, nurses will invariably encounter situations in which they may be required to make a moral decision. In some instances, despite deciding what they believe is the ‘right thing to do’, nurses may nonetheless feel constrained in acting on their moral judgments and, in the end, either do nothing or do what they believe is the wrong thing to do. This situation has been hypothesised as giving rise to what has been controversially termed ‘moral distress’. The notion of moral distress dates back to the foundational work of United States philosopher Andrew Jameton and may take one of two forms: • initial moral distress, which is characterised by feelings of frustration, anger, anxiety and guilt when faced with perceived institutional obstacles and interpersonal conflict about values; and • reactive moral distress (also called moral residue), which occurs when an individual fails to act on their initial moral distress and is left with ‘residue’ or lingering distress (Epstein and Hamric 2009). The ‘root cause’ of moral distress in nursing has been attributed to three key domains: clinical situations (eg. controversial end of life decisions; inadequate informed consent; working with incompetent practitioners); internal constraints (eg. nurses’ lack of moral competencies; perceived lack of autonomy and powerlessness to act; lack of knowledge and understanding of the full situation); and external constraints (eg. hierarchies within the health care system; inadequate communication among team members; hospital policies and priorities that conflict with patient care needs (Hamric et al 2012). Of these domains, clinical situations involving ‘prolonged, aggressive treatment that the professional believes is unlikely to have a positive outcome’ are regarded as being the most common cause of moral distress in nurses (Epstein and Hamric 2009). A question of nursing ethics Moral distress has been characterised in the nursing literature as a ‘major problem in the nursing profession, affecting nurses in all health care systems’ (Corley 2002). It

is portrayed as threatening the integrity of nurses and, in turn, the quality of patient care. It has also been implicated in the problem of nurse retention, with scholars suggesting unresolved moral distress can lead to nurses experiencing job dissatisfaction, burnout, and ultimately abandoning their positions and even their profession altogether. Even so, the notion of moral distress is not without controversy and may even be misguided. Moreover, without further inquiry into the psychological underpinnings and ethical components of nurses’ responses to moral issues in the workplace, there is a risk that continuing nursing narratives on ‘moral distress’ might serve more to confuse rather than clarify the ethical dimensions and challenges of nursing work.

Clarifying nurses’ moral judgments Linchpin to the theory of moral distress is the idea that ‘nurses know what is the right thing to do, but are unable to carry it out’. This idea is highly questionable, however, since it assumes without supporting evidence the unequivocal correctness of nurses’ moral judgments in given situations. It also underestimates the capacity of nurses to take remedial action even in difficult environments. Research has shown that different people can make quite different yet equally valid moral judgments about the same situation. Even when presented with ‘the facts’, decision makers rarely change their minds. Instead they will search for and only accept information that reaffirms their initial intuitions (Sonenshein 2007). One reason for this is that people approach situations with their own individual system of ethics and a predetermined stance on what they value and believe is right and wrong. In keeping with their own ‘bounded personal ethics’ individuals will construct, interpret, and respond to issues ‘based on their own personal motivations and expectations’ (Sonenshein 2007). Nurses are no exception in this regard. Even in contexts plagued by uncertainty and complexity (of which clinical environments are a prime example) nurses are just as vulnerable as are others to constructing idiosyncratic ‘subjective interpretations of issues beyond their objective features’ (Sonenshein 2007). It is inevitable they will encounter moral disagreements in the workplace and some of these disagreements might engender an

intense emotional reaction. Essential to the theory of moral distress is the assumption that such a state in fact exists. Much of what has been written about moral distress, however, involves little more than an appropriation of ‘ordinary’ psychological and emotional reactions (eg. frustration, anger) that nurses may justifiably feel when encountering moral issues and disagreements in the workplace. Whether these reactions necessarily constitute ‘moral distress’, however, is another matter. Research ostensibly identifying nurses’ moral distress and exploring its incidence and impact in the workplace is also problematic. First, the scenarios used in survey research instruments (Corley 2002) tend to depict situations that lack the equivocality and uncertainty that is likely in the clinical settings in which nurses’ work. These instruments minimise the role of ‘issues construction’ by nurses and erroneously frame the scenarios as involving a clear choice between right and wrong (Jones 1991). Second, the very presentation of given issues in the moral distress scales used by researchers already pre-code and interpret the situations presented as involving ‘moral distress’ thus priming respondents to accept both the existence and incidence of moral distress as a ‘reality’ in their practice. In order to better understand the foundations of moral disagreements in the workplace and nurses’ reactions to them, more needs to be known about nurses’ taxonomy of ethical ideologies ie. what their personal ethical standpoints are, the extent to which their personal views frame their ethical decision making and behaviours in professional contexts, and the bases on which they justify their conduct. Until further inquiries are made, the assumed credibility of ‘moral distress’ as a bona fide problem in nursing will remain dubious. References

Corley, M. 2002. “Nurse moral distress: a proposed theory and research agenda,” Nursing Ethics, 9(6):636650. Epstein, E. and Hamric, A. 2009. “Moral distress, moral residue, and the crescendo effect,” Journal of Clinical Ethics, 20(4):330-342. Hanna, D. 2004. “Moral distress: the state of the science,” Research and Theory for Nursing Practice: an International Journal, 18(1):73-93. Jones, T. 1991. “Ethical decision making by individuals in organisations: an issue-contingent model,” Academy of Management, 16(2):366-395. Sonenshein, S. 2007. “The role of construction, intuition, and justification in responding to ethical issues at work: the sensemaking-intuitive model,” Academy of Management Review, 32(4):1022-1040.

MEGAN-JANE JOHNSTONE IS PROFESSOR OF NURSING IN THE SCHOOL OF NURSING AND MIDWIFERY AT DEAKIN UNIVERSITY IN VICTORIA. PROFESSOR JOHNSTONE HAS EXTENSIVE INTEREST AND EXPERTISE IN THE AREA OF PROFESSIONAL ETHICS IN NURSING.


Access to global Millions of people around the globe are denied access to health care, according to United Nations Special Envoy for HIV/AIDS in Eastern Europe and Central Asia, Dr Michel Kazatchkine. “We live in a time of extraordinary inequity in health. One million people are living on less than a dollar a day.” Dr Kazatchkine argues that poverty and inequity remain the world’s greatest killers. “Over 360 million people have died from hunger and preventable diseases in just 20 years.” He says economic inequities between the rich and the poor have doubled over the past 25 years and are continuing to increase. “As we all know inequities in health are the most evident as there are huge gaps when it comes to global health expenditure. For example in 2005 Africa spent just 5% of the amount rich countries spend each year on health. At the same time the developing world is seeing an extraordinary spread of infectious diseases.”

Access to health care is considered by most a fundamental necessity, yet millions of people around the world are denied this basic human right. To tackle this issue and other concerns relating to poverty, the United Nations developed eight Millennium Development Goals (MDGs), which are being worked on across the globe. With MDG targets due to be met in three years’ time, internationally renowned speakers at the recent International Council of Nurses 25th Quadrennial Congress discussed the current state of global health as well as the impact nurses and midwives have in achieving the MDGs. Kathryn Anderson reports. 26 Australian Nursing Journal JULY 13 volume 21 number 1

Millennium Development Goals – impact and progress In order to improve global wellbeing the United Nations during 2000 created eight Millennium Development Goals (MDGs) to combat poverty, hunger, disease, literacy, environmental degradation and discrimination against women. Each of the MDGs has targets set for 2015. While some countries have made impressive gains in achieving these targets, others have fallen behind. Some of the gains in achieving the health related targets can be attributed to activism and social organisation against the inequity of access to care, Dr Kazatchkine says. “Activism has breathed life into the human right to access care. Through activism pressure has been put on governments to fulfill their most fundamental responsibilities.” Other key factors in improving access to care include a global political commitment to fund health, Dr Kazatchkine says. “During the 2000 G8 summit, political leaders came together and committed to an ambitious plan to tackle HIV, malaria and TB. This commitment was a great force through key Dr Michael Kazatchkine instruments such as the declarations of the heads of state in Africa where 15% of their budgets were committed to health care.” Countries that have made progress in lifting its people out of poverty include Brazil, Russia, South Africa, China and India,

health according to Human Rights Lawyer and Professor at the University of Nigeria Dr Joy Ngozi Ezeilo. “However if you look at countries like Africa, you will notice progress is uneven and also questionable.” Some of the inroads made to better health include a decline in child mortality rates, Dr Ngozi Ezeilo says. “Deaths of children under five worldwide have declined from 12.4 million to 6.9 million deaths in 2011. This translates to about 14,000 fewer deaths every year.” Despite this progress a large proportion of child deaths are still occurring in Sub-Saharan Africa. “This is related to a lack of health care, water, sanitation and education,” says Dr Ngozi Ezeilo. Other advances include improving access to drugs, such as medication for HIV/AIDS which has resulted in a significant number of people living with HIV rather than developing AIDS, Dr Ngozi Ezeilo says. “With access to drugs for malaria incidence of the disease has decreased 17% since 2000 and the mortality rates related to malaria have declined by 25%. In addition countries with access to improved malaria control interventions including bed netting have seen child mortality rates fall by at least 20%.” However in order for countries to reach MDG targets by 2015, more strategies need to be put in place, Dr

ANF Federal Secretary Lee Thomas and Australian College of Nursing CEO Debra Thoms

Ngozi Ezeilo says. “Many countries need better access to community based services. People also need to become mobilised to take control of their lives and improve their health patterns through participation of empowerment. This has proved to be successful so far in combating childhood diseases such as polio.” Dr Ngozi Ezeilo advises that more professional health care workers are required to work where they are most needed. “Nurses and the nursing profession can impact the MDGs; so we need to build on a nursing workforce by addressing nurse migration from developed countries to the developing world through better pay and even better living environments.” Women’s health impacts community wellbeing Dr Leslie Mancuso President and CEO of Jhipiego, an international not for profit health organisation, says to improve global wellbeing, women must have better access to health care. Women are some of the most marginalised people in the world resulting in poor health outcomes and premature death, she says. “In the context of women’s health today, one women every two minutes will die due to pregnancy related causes and 99% of those women live in the developing world. “Two hundred and seventy thousand women will also

Dr Joy Ngozi Ezeilo

Dr Leslie Mancuso

die from cervical cancer, a very preventable cancer, while over half a million women will die from TB.” Women and girls make up 60% of all HIV cases in Africa and 50% around the world. While women’s deaths have a profound impact on the wellbeing of families, their deaths can also affect communities and society at large, Dr Mancuso says. “When a woman dies the likelihood of their child dying under the age of two is 10 times greater. When a woman lives the family stays intact, the community is stronger, the country is stronger and the world at large is stronger.


“What we know is when a mother lives that child is likely to get more nutrition, is more likely to get immunised, to get educated, will hold a job and be a productive citizen.” Dr Mancuso says saving women’s lives would insure developing and fragile countries have educated human capita. “When a mother dies we lose paid and unpaid labour. That country no longer benefits for the contribution for social and economic development.” Nurses and Midwives making a difference To prevent premature deaths of women, access to care and education is imperative. Key to this access is nurses and midwives, Dr Mancuso stresses. “Nurses and midwives are often the first point of call for women accessing health care. What I have seen around the world are nurses and midwives making an impact through encouraging access to health for women. Often they do this through their critical position as advocates for women. They can be the voice of women when women don’t have a voice.” Nurses also have firsthand knowledge about what works and what doesn’t, Dr Mancuso says. “In the countries I have visited nurses will often understand the barriers to access; they understand the inequities in

gender and they understand social stigma.” Dr Mancuso says nurses and midwives are also finding innovative ways to bring health care to women in the most disadvantaged areas, including strategies and interventions even when there is a lack of facilities. Importantly, the care, dignity and respect nurses and midwives give is encouraging women to seek out care. “We see this around the world,” Dr Mancuso says. “For example in Cambodia, women far and wide come to see a nurse called Jennifer because they say she cares. We see in the slums of India women are accessing care more than ever because they heard there is a nurse/ midwife there that will treat them well and help them to learn.” As a result of the impact nurses and midwives have in improving access to health care, Dr Mancuso argues they should be taking up more leadership positions internationally. “We need to recognise our value and stand up for nurses and midwives of the world and women of the world. I want to see nurses and midwives fill up leadership positions in the business of dealing with health care internationally. If we make up 87% of the health workforce, we need to be in those leadership positions.

Outgoing ICN President Rosemary Bryant talks to the ANJ about access to health care and roles nurses play: How important has it been for you as president of the ICN to improve access to health? As ICN is a membership organisation, its main sphere of influence is through its members and how they can increase access to health care. ICN can assist this process by providing programs to assist nurses to be more influential at country level especially lobbying for improved health care. ICN has several programs which can be loosely grouped around leadership. ICN’s three leadership programs: Leadership for Change, Leadership in Negotiation and the ICN Global Nursing Leadership Institute have helped to prepare nurses for leadership, improving their knowledge and skills to lead in an era of reform. ICN does have some specific health programs in Africa such as the wellness centres which provide health care for health professionals. These centres began in the acute phase of the AIDS epidemic when access to drugs was limited. The aim was to ensure nurses had adequate access to these drugs for both themselves and their families. By so doing, nurses were able to keep working and providing care for their populations. Nowadays the remit has been broadened to include all health professionals and to deliver generic health care.

28

How do nurses and midwives create better access to health care? Nurses are central to the delivery of health care globally. In developed countries nurses are the largest component of the health workforce and deliver care in all health settings. In developing countries, nurses are the main providers of primary health care and for many people, a nurse is the only health professional they may see for the majority of their lives. Without nurses, there would be no functioning health systems so they are critical to the success of health care delivery. How important is nursing leadership in creating better global health outcomes? Nursing leadership is critical to the success of the health system. Nursing by its very nature, needs to be organised and delivered in a coordinated and safe manner. Nursing leaders are essential at all levels of the health team to motivate and lead nursing teams. Many public health programs are designed and delivered by nurses. Examples include immunisation programs, programs designed to stem the increase of non-communicable diseases and programs to combat the rising level of infectious diseases in communities. Of course in acute care, nurses are the only


health professional with the patient for the 24 hour cycle and so are critical to the patient’s recovery. What needs to be done to continue better health outcomes globally? Eradication of potentially fatal diseases is the first step but of course the overall goal must be to prevent disease both infectious and noncommunicable and this needs an integrated approach encompassing both public health and health education. More broadly the social determinants of health such as housing, literacy and education are critical to building a healthy society. Other specific initiatives such as reduction of road traffic accidents, safe motherhood and reduction in tobacco use are just some of the successful programs in recent times.

Foreign aid has impact Philanthropist Bill Gates lobbied the Australian government to increase its commitment to foreign aid, when he visited the country last month. Speaking at the National Press Club, Mr Gates acknowledged Australia’s tight fiscal budget, but also stressed aid of 0.5% of the gross national budget was imperative to global health outcomes. “Australia has been very generous so far in its commitment to giving to the poor, even though economic conditions have been tough.” Currently Australian foreign aid currently stands at 0.37%. The Australian government has delayed reaching its 0.5% target of aid until at least 2017-18. “If we could get people to see the impact of these [aid] programs, they would be committed with their own resources and government resources for aid to continue,” Mr Gates stressed. According to Mr Gates the quality of aid has improved dramatically over the last 20 years. “It has become focused on measurable humanitarian outcomes so that the aid makes sense.” Smart aid had made a real difference to humanitarian outcomes, he said. “Poor countries are nothing like they were 15 or even 20 years ago. Childhood deaths have significantly improved over the past 50 years because of the generosity of aid and the access to vaccines.” Globally, poverty, literacy and maternal deaths had improved across all measures, Mr Gates said. “Smart aid is about good for the world at large, for world stability, security and stronger economic markets. China for example was a recipient of aid and has now become self sufficient.” The Bill and Melinda Gates Foundation is the largest private foundation in the world. The primary aims of the foundation are to improve health care outcomes and reduce extreme poverty in developing countries. The foundation invests heavily in vaccines to prevent infectious diseases, including HIV, polio, and malaria. It also supports the development of integrated health solutions for family planning, nutrition, and maternal and child health.

adequate delivery facilities and low levels of trust in public services. Much of Australia’s foreign aid goes to Papua New Guinea and surrounding pacific countries to improve poverty, mortality and health outcomes. The work Professor Homer does has been around building a maternal workforce, nurses and community health workers. “We need to have properly trained midwives with a functional health system so we can improve maternal and child care.” Family planning access is also essential Professor Homer says. “By implementing family planning fewer women will get pregnant and therefore be at less risk of dying. It also means women go into pregnancy in better shape because they won’t be having babies close together.” Currently there are approximately only 200 midwives working in PNG, Professor Homer says. To increase the number of midwives and health care workers so as to increase access to maternal services, Professor Homer’s project aims to strengthen midwifery by supporting education, regulation and association. “Education is crucial and regulation is important for quality and sustainability.”

“I suggest that all nurses need to take on the challenge to be leaders in the world so as to make the change we want to see, which is to see women surviving and in turn create a safe, educated and economically sound world.” Maternal mortality in neighbouring countries University of Technology Sydney’s Professor of Midwifery Caroline Homer says more needs to be done to improve maternal health rates in countries such as Papua New Guinea (PNG). Professor Homer, who is also the project director for a midwife education project in PNG, says while maternal deaths have decreased as a whole, countries with high rates of poverty such as PNG have seen an increase in the maternal death rate. According to Professor Homer, the number of maternal deaths in PNG ranged somewhere between 360 per 1,000 live births to possibly 733 per 1,000 live births. “That’s pretty horrendous. In Australia the maternal rate is less than 10 and in many countries it is similarly low.” These rates can be attributed to the low amount of skilled attendants at birth, which is mainly due to a shortage of midwives, poor accessibility, lack of

Professor Caroline Homer


By jayr teng

legal The Coroner’s Court and nursing practice The mention of the Coroner’s Court and the thought of appearing before it may make some registered nurses nervous. Whilst not a pleasant experience to give evidence in any court in relation to any matter, it is not a jurisdiction as threatening as an Australian Health Practitioner Regulation Agency disciplinary hearing or appearing as a named defendant in civil proceedings. For the purposes of this article, the references are to the processes of the Coroners Court of Victoria although the processes and observations in the Victorian jurisdiction will likely be relevant to all other states and territories. The Coroners Court of Victoria The Coroner’s Court is a specialist jurisdiction, the aim of which is to independently investigate deaths and contribute to a reduction in the number of preventable deaths. The Coroner’s Court can be distinguished from other state and federal courts through its inquisitorial powers. Ordinarily, the function of a court is to act as an independent adjudicator of disputes. In the case of civil litigation, such as in negligence matters for example, a court would hear and make a determination based on the submissions and arguments of the parties to the proceeding. In the Coroner’s Court the process is different in that the coroner actively participates in the investigative process. The coroner may call witnesses, ask questions and determine what issues the court will hear at inquest. In this way, when a coroner decides to investigate a death it is effectively being investigated by the state with the aim of preventing similar deaths from occurring. What matters are investigated? The start of the coronial process is when the death is reported to the Coroner’s Court. Deaths which are reportable deaths or reviewable deaths are required to be notified to the court. In general terms, a reportable death is a death which occurred in Victoria and is a death which: • appears to be unexpected, unnatural or violent or have resulted, directly or indirectly,

are finalised after the investigation stage. If a matter progresses to inquest, registered nurses may be called to provide oral evidence in relation to any statements provided.

from an accident or injury; • occurs during or following a medical procedure where the death is or may be causally related to the medical procedure and a registered medical practitioner would not have reasonably expected the death; • the death is of a person who immediately before death was placed in custody or care; • the person was a patient within the meaning of the Mental Health Act 1986 immediately before death; • the deceased person’s identity is unknown; or • the cause of death is not certified and is not likely to be certified by a person who is authorised to do so. Death of a second or subsequent child is a reviewable death. The child must have died in Victoria. Deaths of a child which occur in a hospital and are not reportable deaths are generally not reviewable deaths. After a reportable or reviewable death has been reported to the Coroner’s Court one of two things may happen: • the coroner reviews the death and it is determined the death is due to natural causes; or • an investigation is commenced and statements and further information is requested to assist the coroner make a finding around the circumstances regarding the death. Where an investigation has commenced, registered nurses may be required to provide factual statements regarding matters specified by the coroner. It is the police who assist the coroner in compiling the required evidence so it may be the police who request statements from individual registered nurses. When drafting or reviewing a statement proposed to be submitted it is important to: • explain the matters described in a factual manner; • avoid exaggerating matters or using emotive language; • explain any inconsistencies between the statement prepared and the medical record; and • explain any medical terminology used in plain language. After the evidence gathered as part of the investigation has been reviewed, the coroner may find it necessary to hold an inquest regarding the matter. Almost 95% of cases in Victoria do not proceed to inquest and


What happens after an investigation or after an inquest? The end result of the coronial process is that there is generally a finding regarding: • identity of the deceased person; • cause of death; • circumstances in which the death occurred; and • any particulars required for the Registry of Births, Deaths and Marriages. It is not for the Coroner’s Court to determine guilt, apportion liability or decide whether a registered nurse has engaged in professional misconduct. These matters are dealt with through other processes. However the coroner may make public findings regarding the practice of a registered nurse and whether the practice in question was appropriate in the circumstances. The coroner can refer their findings to AHPRA for investigation of individual RNs, ENs or midwives. In more serious matters the coroner may make a recommendation to the Director of Public Prosecutions that a person is or may be guilty of an offence. Practical tips While the coronial process starts from notification of the matter to the court, in reality the process may start before an incident or reportable death even occurs. Systems and processes in place at a health service that may have contributed to death are of most interest to the coroner. For registered nurses, ensure you adhere to best practice even if this is above the standard expected of you by your employer. While a call from the in house legal department may be confronting, remember they are there to assist you. If applicable, you should assist your legal counsel by engaging in open and honest conversations from the outset. From a practice perspective, maintain accurate documentation, as ultimately this is what will be relied on if there are ever questions asked about your individual nursing practice. Also be aware and conversant with your health service’s policies and procedures as this is the standard you will be tested against. This is especially pertinent for nurse unit managers who may be asked about the health service processes before and after a reportable or reviewable death has occurred. Jayr Teng is a Registered Nurse and Legal Counsel at Western Health in Victoria

Editor’s note: ANF recommends if you are requested to submit a statement or be interviewed by the police or employer in relation to a coronor’s inquest, the member should firstly speak to their ANF organiser.

By Natasha Franklin and Sharlene Chadwick

Identify any workplace issues early

issues

Build relationships to foster social cohesion

The impact of workplace bullying in nursing

Case study Vanessa is a nurse with a diverse background in clinical, education and managerial roles and regarded in high esteem amongst her colleagues for being approachable, hard-working and an innovative and a valued team member. Vanessa however, resigned from her position when her role became untenable due her employment responsibilities being reduced below the level of her knowledge, skills and experience. She experienced being excluded from meetings and the day to day operational activities within the department, unable to move forward with existing or new projects due to her manager failing to respond to such requests and being exposed to intimidating and threatening behaviour from her manager. Despite Vanessa’s attempts to resolve the situation by raising her concerns with her manager, then the Director of Nursing followed by the Human Resource Manager, Vanessa left her position experiencing feelings of fear, anxiety, self-doubts regarding her professional capability, worthlessness as a person and feelings of depression. Regardless of Vanessa’s professional background, she did not recognise this situation as workplace bullying and left the organisation blaming herself by asking “what did I do wrong and what could I have done differently?” Workplace bullying Workplace bullying in nursing, also known as horizontal violence, is the second most common form of bullying that nurses face (Queensland Nurses’ Union (QNU) 2012). Workplace bullying in nursing is often considered in graduate nurses, however is not isolated to graduate nurses. All nurses regardless of level experience or position are at risk of workplace bullying as a result of lateral violence. Despite clear workplace health and safety guidelines and organisational policies and procedures relating to protecting, reporting and managing workplace bullying, bullying remains largely under-reported due to people not

Manage conflict early before bullying becomes an issue

Figure 1: Three step bullying management model using IBM: Identify issues; build relationships; manage conflict (Chadwick & Franklin 2013)

recognising bullying behaviours, fear of retribution and fear they will not be protected especially if they perceive the bully is part of a protected group or if people with bullying behaviours have been promoted into higher levels of power (Human Rights Commission 2011). The impact of workplace bullying may cause financial losses to the nurse being bullied but also impacts their physiological, psychological and psychosocial health and wellbeing. Workplace bullying can also have a significant impact on the organisation’s level of employee engagement (including nurses being bullied, bystander/s and the bully/ies); social cohesion, leadership and finances all directly affect the productivity of the workplace and patient care. Within the workplace, bullying must become everyone’s issue and nurses, nurse managers and organisational managers must adopt and model professional and ethical behaviours to improve the socialisation and social cohesion of nurses (see figure 1). A key component to preventing and managing workplace bullying is education. Educating all levels of employees about what workplace bullying is, how to identify bullying behaviours and how to respond and report and manage bullying. Education of workplace bullying is ineffective without protecting and

safeguarding nurses who report bullying, and this also applies to those accused of bullying. Promoting a culture of safety through open and respectful communication is imperative and providing counselling for all parties involved in workplace bullying should be actively encouraged. Nursing is regarded as a ‘caring’ profession and nurses have a responsibility under the Code of Professional Conduct to “promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care” (Australian Nursing and Midwifery Council 2008). Nurses must apply this code of practice amongst themselves not only to look after each other but so they are physically and emotionally well enough to care for their patients. The main steps to providing a healthy and safe workplace are: • modelling empathy and compassion; • educating all levels of nurses’ social and emotional intelligence; • fostering positive and healthy relationships amongst nurses; • encouraging reporting; • providing a safe reporting environment for the person being bullied and bystanders; • educating nurses how to deal and manage bullying behaviours; and • offering support, education and counselling to any nurse exhibiting bullying behaviours. Natasha Franklin is a Lecturer (Nursing), Faculty of Health, University of Technology Sydney Sharlene Chadwick is Manager, Health Internship Program, Australasian College of Health Service Management

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What does the culture of the client tell you? Shoes left in the doorway, objects on mantle pieces and walls and windowsills tell us about our clients. A Moslem student confided in me that when she graduated she wanted to work among her ‘own’ people. Recently she was used by the community nurse as an interpreter with clients who spoke Arabic. This thrilled the student as she was empowered by taking on this role. Sometimes we can break cultural barriers with a smile or by going the second mile with our patients. The student found due to a common language, doors were opened to her and she was able to identify and work more closely with the clients.

What was the moment that you heard something that corrected a previous misunderstanding?

Debriefing to make a difference: a nursing lecturer’s experience By Wayne Bradshaw

As a lecturer in nursing, I like to know that after I have engaged with my students they will become nurses who will make a difference. I have had students tell me that they are planning to work in a particular area because of the influence I have had. While it’s nice to hear, it is nicer however to know that something has happened within the student that has motivated them to make a difference and it is time for me to move aside. I debrief students after community practice. I work hard to engage them in a session designed to help them make sense of their clinical experiences. In an hour a week, we debrief and I feel it is hardly enough time. The level of analysis continues to improve. By listening carefully to the students my questions have evolved to challenge the students to reflect on what is really happening in their experience. Three such questions are discussed.

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What has come out of left field? A couple of weeks ago my students came back for a debrief session. I asked the question: “What has come out of left field and has really amazed you?” “Well”, one of the students said. “Today we went into the home of a man who was really obese. He was 45 years old and over 300kgs. We can’t move him. He just sits there. He can’t go up the stairs because the stairs start to buckle under his weight. He can walk with a walker but they can’t get a walker strong enough to hold him up. His last walker buckled. We are dressing an ulcer on his leg. He has more ulcers on the back of his leg but we can’t get to them because we can’t lift his leg up and he has told us to leave them alone”. While distressing for the student it was an opportunity to let the students deal with issues they hadn’t discussed in the classroom but nevertheless something that nurses deal with in the community. What are the ethics of not dressing the wound and the long term consequences of this? The registered nurse was aware of all the issues and had talked with the client, the medical practitioner and her supervisors. With a little pulling and stretching and much nursing ingenuity they were able to see the state of the ulcers on the back of the client’s legs and note that they were healing.


Recently students came back with stories of the health effects of cigarette smoking. Student Steph said she was doing clinical practice in a lower socioeconomic area of Sydney. “You must talk to the new students about the links between socioeconomic status and disease”. A number of their clients were dying from the effects of cigarette smoking. Some of them were in their thirties. One had a mass growing on the side of his neck. The nurse said it was expected the cancer would eat through the carotid artery at some stage and result in death. It was positive to see that while witnessing something unfortunate, the clinical practice not only enhanced their learning but also their understanding. A strong link between socioeconomic status and health was made. Steph reported that she had not previously recognised the links between lower socioeconomic status and ill health. From my own experience and the sage experiences of students working with registered nurses, students’ learning does not stand still. With a little prodding and poking and a little intuition, each student’s unique experience contain jewels of learning that will considerably enhance their practice as future registered nurses. Wayne Bradshaw is a Lecturer in Nursing, Avondale College of Higher Education,nsw.

Susanne Lampitt Mental Health Promotion Officer and Mental Health Education & Training Consultant

workinglife

When asked why I chose mental health nursing as a career, I have to admit that I didn’t; as the phrase goes, it chose me. I fell into nursing in the early 80’s; my intention after leaving school was to enter the police force, however being female meant a minimum age of 21 years. While I waited, I explored a career that would end up changing my life forever and on reflection, wonder where the past 30 years have gone. Working in the field for three decades has given me an insight that has enriched my life enormously, allowed me to experience the good, bad and ugly of an ever changing health system, but most of all, allowed me the privileged position of working with and for one of the most marginalised groups in our community. Every day is different bringing new people, challenges and opportunities. It’s been a natural progression that my work now focuses on mental health promotion, education and training in the field. We have come a long way with regard to the community’s knowledge and understanding of mental health and mental illness, but we still have a way to go. The two terms are often used interchangeably, when in fact we need to be reminded that mental health is not just the absence of mental illness. We should all strive towards optimal health and wellbeing: it’s important for us to realise that there can be no true health without mental health, the two are intrinsically entwined. Mental Health Promotion Officers were introduced in Victoria in 1997 as one of a number of mental health promotion and suicide

prevention strategies. Originally working specifically to target improvements in the mental health needs of children and adolescents, increasingly the focus is shifting to a whole of life approach. My role is very broad and incredibly diverse, but only working three days per week has meant setting a few boundaries. Primarily, I endorse and facilitate training and education in mental health literacy, early intervention and self care such as youth mental health first aid www.mhfa.com.au and partners in depression www.partnersindepression.com. au courses and presentations around service availability and access and awareness of mental health issues. I promote opportunities for prevention and early intervention and collaborate with primary care, education and community services sectors to enhance their capacity to recognise and respond to the mental health needs of young people. I participate in collaborative partnerships such as the KidsMatter mental health promotion initiative for primary schools www.kidsmatter.edu.au I’m involved in resource development, secondary consultation and sit on a variety of committees to ensure that mental health and wellbeing stays firmly on the agenda. We know that the largest source of disease burden for Australian youth are mental disorders, that one in four young people will experience a mental illness in a given year, and that the total annual cost of mental illness in Australia is $20 billion. It’s a no brainer that as a society we need to put our energy into

Promoting mental health is everyone’s business; I’m just someone who is lucky enough to get paid to spruik my passion.

building the capacity of families, groups, communities and individuals to consider risk and protective factors, and influence the social determinants of health, build emotional resilience from a young age and develop a greater awareness of the mental health issues facing our population. Promoting mental health is everyone’s business; I’m just someone who is lucky enough to get paid to spruik my passion. As a community we must take action to maximise health and wellbeing now and for future generations. Mindful of practising what I preach, I’ve managed to find a good work/life balance by combining my part time role as a Mental Health Promotion Officer for a public mental health service with being a founding partner in the mental health training and education business Minding Mental Health www.mindingmentalhealth.com.au I manage to have the best of both worlds, which can only be good for my mental health!

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CLINICAL UPDATE july 2013

Magnesium sulphate for the prevention of cerebral palsy in Australia and New Zealand

By Emily Bain, Louise Goodchild, Ros Lontis, Sarah McIntyre, Pat Ashwood, Tanya Bubner, Philippa Middleton and Caroline Crowther Introduction In 2010, the Australian National Health and Medical Research Council (NHMRC) endorsed Australian and New Zealand clinical practice guidelines that recommend magnesium sulphate to be given to women at risk of imminent, very early preterm birth (at less than 30 weeks gestation) for the prevention of death and cerebral palsy in their infants (The Antenatal Magnesium Sulphate for Neuroprotection Guideline Development Panel 2010). Now, the WISH Project (Working to Improve Survival and Health of babies born preterm), supported by the Cerebral Palsy Alliance, is working to bring Australian and New Zealand clinical practice in line with the recommendations from these guidelines (ARCH 2013).

Preterm birth and cerebral palsy: the burden of disease Cerebral palsy is an umbrella term which “describes a group of disorders of the development of movement and posture, causing activity limitations, which are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain” (Bax et al 2005). It is the most common physical disability in childhood, and the most severe physical disability within the spectrum of developmental delay. Cerebral palsy is a complex neurological condition, with the motor and/or postural dysfunction often found alongside cognitive,

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communication, sight and hearing impairments, or epilepsy, pain, behaviour and sleep disorders (Novak et al 2012). Understandably cerebral palsy has considerable emotional, social and economic costs to individuals, their families and communities. In 2007, the cost of cerebral palsy to the Australian community was estimated at $A3.87 billion (including financial cost and lost wellbeing) (Access Economics 2008). The overall incidence of cerebral palsy in developing countries remains static at 2.1 per 1,000 live births (Oskoui et al 2013). In Australia, over 600 children are diagnosed with cerebral palsy each year; and it has been estimated that approximately 40% of these cases are related to preterm birth (ACPR Group 2013). The prevalence of cerebral palsy increases significantly with decreasing gestational age; infants born very preterm are at a substantially higher risk than infants born at term (Saigal and Doyle 2008). The most recent Australian Cerebral Palsy Register report suggests that while the rate of cerebral palsy in infants born most preterm is starting to decrease, survival (with associated morbidities) is continuing to increase (ACPR Group 2013). The identification of primary preventive measures has therefore been identified as a key priority by consumers, clinicians and researchers (McIntyre et al 2010); prevention for infants born very preterm is of high interest, due to their increased risk of developing cerebral palsy, and also their apparent ability to respond to interventions.


Magnesium sulphate and prevention of cerebral palsy: the evidence base Nearly 20 years ago, a case control study first described the association between antenatal magnesium and a reduction in cerebral palsy. Nelson and colleagues observed that in infants born with a birthweight of less than 1,500 grams, their risk of cerebral palsy was reduced if their mother had received magnesium sulphate in labour (whether received as a tocolytic to suppress preterm labour, or for severe pre-eclampsia) (Nelson and Grether 1995). In order to establish more reliable evidence, a number of randomised controlled trials were undertaken to assess the effects of in utero exposure to magnesium for preventing cerebral palsy. Of the five trials conducted, the primary aim of four (two from the United States (Mittendorf et al 2002; Rouse et al 2008), one from France (Marret et al 2007) and one from Australia and New Zealand (Crowther et al 2003)) was to assess the use of magnesium sulphate for neuroprotection of the fetus. The primary aim of the fifth (conducted worldwide (Magpie Trial Follow-Up Collaborative Group 2007)) was assessing use for the prevention of eclampsia, however longer term outcomes were reported for the infants. These five trials were included in a Cochrane systematic review meta-analysis (Doyle et al 2009) and a number of other systematic reviews, which each supported a neuroprotective role for antenatal magnesium sulphate. Specifically in the Cochrane review, magne-

sium sulphate given to the mother prior to preterm birth was shown to reduce the risk of cerebral palsy or death for the infant (risk ratio (RR) 0.85; 95% confidence interval (CI) 0.74 to 0.94; four trials, 4,446 infants), and to reduce the risk of cerebral palsy alone (RR 0.68; 95% CI 0.54 to 0.87; five trials, 6,145 infants) (Doyle et al 2009). The Cochrane review showed that 63 mothers need to be given antenatal magnesium sulphate for one baby to avoid cerebral palsy. The corresponding number needed to treat to prevent one baby dying or developing cerebral palsy was 42 (Doyle et al 2009).

Clinical practice guidelines for the use of antenatal magnesium sulphate for the prevention of cerebral palsy In 2010, in response to the findings from the randomised trials and Cochrane review, the Antenatal Magnesium Sulphate for Neuroprotection Guideline Development Panel prepared and published NHMRC endorsed Australian and New Zealand clinical practice guidelines. These clinical practice guidelines ‘Antenatal magnesium sulphate prior to preterm birth for neuroprotection of the fetus, infant and child’ provide detailed guidance in the form of nine evidence based recommendations (Table 1) and six practice points on how and when to use antenatal magnesium sulphate for fetal neuroprotection (The Antenatal Magnesium Sulphate for Neuroprotection Guideline Development Panel 2010).

What do the guidelines recommend? – The Australian and New Zealand algorithm (see Figure 1) Who should receive magnesium sulphate for fetal neuroprotection and when? The guidelines recommend antenatal magnesium sulphate to be administered to women at risk of very early preterm (where gestational age is less than 30 weeks), imminent birth (when early preterm birth is planned or definitely expected within 24 hours; and when birth is planned, as close as possible to four hours before birth). The guidelines recommend administration regardless of the woman’s plurality and parity, the reason she is at risk of preterm birth (ie. spontaneous preterm labour; medically indicated preterm delivery), her planned/expected mode of birth, and whether or not she has received antenatal corticosteroids for fetal lung maturation. The trials included in the Cochrane review mainly enrolled women at gestational ages less than 30 weeks, however some trials did include women at later gestations. In order to minimise the number of women exposed to treatment and to accordingly limit resource implications, the Guideline Development Panel made the pragmatic decision to restrict the recommended upper gestational age limit to 30 weeks gestation. A new trial, the MAGENTA trial, is currently underway assessing whether significant beneficial effects are present beyond the gestational age currently recommended in these guidelines (Crowther et al 2013).

How should magnesium sulphate for fetal neuroprotection be given? To women at risk of very early preterm, imminent birth, the guidelines recommend that a 4gram loading dose of magnesium sulphate be administered slowly over 20 to 30 minutes followed by a 1gram per hour maintenance infusion until birth or for 24 hours, whichever comes first. This recommendation was made based on the lowest loading and maintenance doses used in the randomised trials, and is identical to the loading and maintenance doses commonly used throughout Australia and

New Zealand to treat women with pre-eclampsia or eclampsia.

‘Good practice points’ from the guidelines To address some of the common dilemmas arising in clinical practice, the guidelines also provide a number of ‘practice points’, addressing the questions below (and see Figure 1 for the more detailed treatment algorithm):

What if birth is expected sooner than four hours? The guidelines recommend administering magnesium sulphate to women at risk of very early preterm birth even when birth is expected sooner than four hours as there are still likely benefits for the fetus/ infant.

What do I do in the case where urgent delivery is necessary? When there is actual or imminent maternal or fetal compromise, the guidelines recommend that birth should not be delayed to administer magnesium sulphate.

What should I do if birth does not occur after giving magnesium sulphate, and birth again appears imminent at less than 30 weeks gestation? The guidelines recommend that if birth (at less than 30 weeks) again appears imminent (planned/ expected within 24 hours), after magnesium sulphate has already been given (and stopped), that a repeat dose may be considered at the attending clinician’s discretion.

How should I monitor a woman receiving magnesium sulphate for fetal neuroprotection? During administration of magnesium sulphate, the guidelines recommend that women be assessed regularly as detailed in individual obstetric unit protocols, including minimum assessments during both the loading and maintenance doses (see Figure 1 for the more detailed treatment algorithm).

Implementation into clinical practice Even with up to date, relevant guidelines, it was not anticipated that all health professionals (obstetricians and midwives) caring for women at risk of an early preterm birth would immediately begin using antenatal magnesium sulphate for the prevention of

death and cerebral palsy, without some form of implementation strategy. Acknowledging that changing practice and implementing the best available evidence is often challenging, an implementation project WISH (Working to Improve Survival and Health of babies born preterm) was designed with the specific aims of monitoring and improving the uptake of the use of antenatal magnesium sulphate as a neuroprotective therapy, in line with the clinical practice guideline recommendations, to reduce the risk of preterm babies dying or having cerebral palsy (ARCH 2013). The WISH Project has been funded by a Cerebral Palsy Alliance Innovative Research Grant, and comprises a package of implementation strategies to guide the introduction and local adaptation of these NHMRC endorsed guidelines throughout the 25 Australian and New Zealand tertiary maternity units where magnesium sulphate is now recommended.

Australian and New Zealand progress and the need for ongoing support for implementation Throughout 2011 to 2013 the WISH Project has been monitoring progress in implementation of the Antenatal Magnesium Sulphate Clinical Practice Guidelines across Australia and New Zealand. While in 2011 approximately 76%, and in late 2012 to early 2013, close to all tertiary maternity centres were reportedly using this beneficial treatment, few hospitals were undertaking formal audits of uptake. Estimates of uptake across these sites varied greatly, from approximately 50% to almost 90% (Bain et al 2012; Middleton et al 2013). Ongoing education for health professionals about the use of antenatal magnesium sulphate for fetal neuroprotection and its benefits is needed, as is support for implementation including strategies to overcome barriers and enhance facilitators (Bubner et al 2013). In addition, improved processes to monitor uptake across Australia and New Zealand are needed to facilitate high quality audit of practice and feedback to the relevant sites. The most important measures to assess implementation success, however, will be health outcomes, such as

CLINICAL UPDATE Magnesium sulphate for the prevention of cerebral palsy in Australia and New Zealand

2

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CLINICAL UPDATE Magnesium sulphate for the prevention of cerebral palsy in Australia and New Zealand

3

survival free of cerebral palsy and major neurosensory disability for the infants. Efforts are underway to ensure that data is collected about these important health outcomes. The nurses of the WISH team greatly appreciate the benefits of a collaborative approach to implementing such guidelines. In addition to assisting with the administration of antenatal magnesium sulphate to the eligible mothers (a role of midwives), an important role for nurses is to act as advocates for the infants’ quality of life – through prompting and reminding our colleagues of the recommendations surrounding this therapy (see ‘Links’ below for access to the Health Professional Information Brochure), and through providing women at risk of very preterm birth the relevant information to enable them to make informed decisions regarding this treatment (see ‘Links’ below, for access to the Consumer Information Brochure).

Conclusion There is now strong evidence that antenatal magnesium sulphate

Table 1: Summary of clinical recommendations from the NHMRC endorsed Australian and New Zealand clinical practice guidelines Clinical Recommendations

Grade^

Guideline Chapter

In women at risk of early preterm* imminent# birth, use magnesium sulphate for neuroprotection of the fetus, infant and child: *when gestational age is less than 30 weeks. #when early preterm birth is planned or definitely expected within 24 hours. (When birth is planned, commence magnesium sulphate as close to four hours before birth as possible).

A

4-7

B

8

A

9

• intravenously with a 4 gram loading dose (slowly over 20-30 minutes) and 1 gram per hour maintenance dose via intravenous route, with no immediate repeat doses. Continue regimen until birth or for 24 hours, whichever comes first.

C

• regardless of plurality (number of babies in utero).

B

11

• regardless of the reason women (at less than 30 weeks gestation) are considered to be at risk of preterm birth.

B

12

• regardless of parity (number of previous births for the woman).

B

13

• regardless of anticipated mode of birth.

B

14

• regardless of whether or not antenatal corticosteroids have been given.

B

15

10

given to women prior to imminent, early birth significantly increases the chances of the babies surviving free of cerebral palsy (Doyle et al 2009). The Australian and New Zealand Antenatal Magnesium Sulphate for Neuroprotection Clinical Practice Guidelines provide a summary of the research thus far and evidence based clinical practice recommendations to assist health professionals with implementation. It is anticipated that the successful adoption into clinical practice of this research could lead to 40 per 1,000 fewer babies born early in Australia dying or suffering the long term consequences of cerebral palsy. Broad implementation of the guidelines will accordingly reduce the burden of this illness on babies born preterm, their families and the community.

Links Clinical Practice Guidelines on Magnesium Sulphate Prior to Preterm Birth for Neuroprotection of the Fetus, Infant and Child: www.nhmrc.gov.au/guidelines/ publications/cp128 Health Professional Information Brochure: www.adelaide.edu. au/arch/research/translational_ health/wish/Information_Sheet_ for_Health_Professionals_270411. pdf Consumer Information Brochure: www.adelaide.edu.au/arch/ Consumer_Info-_Mg_Sulphate_ Oct_2011.pdf WISH Project website: www.adelaide.edu.au/arch/ research/translational_health/ wish/ Cerebral Palsy Alliance website: www.cerebralpalsy.org.au/ References

^These grades are based on the NHMRC’s standards for grading recommendations for developers of guidelines

Access Economics. 2008. The Economic Impact of Cerebral Palsy in Australia in 2007. Access Economics Pty Limited for Cerebral Palsy Australia: Sydney. Australian Research Centre for the Health of Women and Babies (ARCH). The WISH Project. www.adelaide.edu. au/arch/research/translational_health/ wish/ [Accessed 22 May 2013] Bain, E., Bubner, T., Ashwood, P., Crowther, C. and Middleton, P., for The WISH Project Team. 2012. “Implementation of a clinical practice guideline for antenatal magnesium sulphate for neuroprotection in Australia and New Zealand,” Australian and New Zealand Journal of Obstetrics and Gynaecology, 53(1):86-9. Bax, M., Goldstein, M., Rosenbaum,


P., Leviton, A., Paneth, N., Dan, B., Jasobsoon, B. and Damiano, D. 2005. “Proposed definition and classification of cerebral palsy,” Developmental Medicine and Child Neurology, 47:571-6. Blair, E. and Watson, L. 2006. “The epidemiology of cerebral palsy,” Seminars in Fetal and Neonatal Medicine, 11:117–25. Bubner, T., Bain, E., Middleton, P., Ashwood, P., Heatley, E., Reid, S. and Crowther, C. 2013. “Changing knowledge, use and views of antenatal magnesium sulphate for neuroprotection of the fetus (2011-12),” Journal of Paediatric and Child Health, 49(suppl 2):P371. Crowther, CA., Hiller, JE., Doyle, LW. and Haslam, RR. 2003. “Effect of magnesium sulfate given for neuroprotection before preterm birth: a randomised controlled trial,” Journal of the American Medical Association, 290(20):2669-76. Crowther, C., Middleton, P., Wilkinson, D., Ashwood, P., Haslam, R. and the MAGENTA Study Group. 2013. “Magnesium sulphate at 30 to 34 weeks’ gestational age: neuroprotection trial (MAGENTA) – study protocol,” BMC Pregnancy and Childbirth, 13:91. Doyle, L., Crowther, C., Middleton, P. and Marret, S. 2009. “Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus,” Cochrane Database of Systematic Reviews, Issue 3:CD004661. Magpie Trial Follow-Up Study Collaborative Group. 2007. “The Magpie Trial: a randomised trial comparing magnesium sulphate with placebo for pre-eclampsia. Outcome for children at 18 months,” British Journal of Obstetrics and Gynaecology, 114(3):289-99. Marret, S., Marpeau, L., Zupan-Simunek, V., Eurin, D., Lévêque, C., Hellot, M. and Benichou J., on behalf of the PREMAG trial group. 2007. “Magnesium sulphate given before very-preterm birth to protect infant brain: the randomised controlled PREMAG trial,” British Journal of Obstetrics and Gynaecology, 114(3):310-8. McIntyre, S., Novak, I. and Cusick, A. 2010. “Consensus research priorities for cerebral palsy: a Delphi survey of consumers, researchers, and clinicians,” Developmental Medicine and Child Neurology, 52(3):270-5. Middleton, P., Bain, E., Ashwood, P., Bubner, T., Reid, S., McIntyre, S., Morris, J., Flenady, V. and Crowther, C. 2013. “Implementation progress of a clinical practice guideline for antenatal magnesium sulphate for neuroprotection in Australia and New Zealand,” Journal of Paediatric and Child Health, 49(suppl 2):A117. Mittendorf, R., Dambrosia, J., Pryde, P., Lee, K-S., Gianopoulos, J., Besinger, R. and Tomich, P. 2002. “Association between the use of antenatal magnesium sulfate in preterm labor and adverse health outcomes in infants, “American Journal of Obstetrics and Gynaecology, 186(6):1111-8. Nelson, K. and Grether, J. 1995. “Can magnesium sulphate reduce the risk of cerebral palsy in very low birthweight infants?” Paediatrics, 95(2):263-9. Novak, I., Hines, M., Goldsmith, S. and

CLINICAL UPDATE

Barclay, R. 2012. “Clinical prognostic messages from a systematic review of cerebral palsy,” Paediatrics, 130(5):e1285-312. Oskoui, M., Coutinho, F., Dykeman, J., Jette, N. and Pringsheim, T. 2013. “An update on the prevalence of cerebral palsy: a systematic review and metaanalysis,” Developmental Medicine and Child Neurology, 55(6):509-19.

Antenatal magnesium sulphate prior to preterm birth for neuroprotection of the fetus, infant and child

Rouse, D., Hirtz, D., Thom, E., Varner, M., Spong, C. and Mercer, B., for the Eunice Kennedy Shriver NICHD Maternal–Fetal Medicine Units Network. 2008. “A randomised controlled trial of magnesium sulfate for the prevention of cerebral palsy,” New England Journal of Medicine, 359(9):895-905. Saigal, S. and Doyle, L. 2008. “An overview of mortality and sequelae of preterm birth from infancy to adulthood,” Lancet, 371:261–9. The Antenatal Magnesium Sulphate for Neuroprotection Guideline Development Panel. 2010. Antenatal magnesium sulphate prior to preterm birth for neuroprotection of the fetus, infant and child: national clinical practice guidelines. The University of Adelaide: Adelaide. The Australian Cerebral Palsy Register (ACPR) Group. 2013. Report of the Australian Cerebral Palsy Register, Birth Years 1993–2006. ACPR Group: Sydney. www.cpregister.com/pubs/pdf/ACPRReport_Web_2013.pdf EMILY BAIN IS A RESEARCH ASSOCIATE AT THE AUSTRALIAN RESEARCH CENTRE FOR HEALTH OF WOMEN AND BABIES (ARCH), AT THE ROBINSON INSTITUTE, THE UNIVERSITY OF ADELAIDE, AND IS A MEMBER OF THE WISH TRANSLATIONAL HEALTH PROJECT TEAM. LOUISE GOODCHILD AND ROS LONTIS ARE CLINICAL practice CONSULTANTS WORKING AS RESEARCH NURSES IN THE NEONATAL NURSERIES AT THE WOMEN’S AND CHILDREN’S HOSPITAL, ADELAIDE, SOUTH AUSTRALIA. SARAH MCINTYRE IS THE STAR SCIENTIFIC SENIOR RESEARCH FELLOW AT THE RESEARCH INSTITUTE OF THE CEREBRAL PALSY ALLIANCE, AND IS A MEMBER OF THE WISH PROJECT STEERING GROUP. PAT ASHWOOD IS A CLINICAL TRIALS MANAGER AT ARCH, AND TANYA BUBNER IS THE MANAGER OF ARCH; BOTH ARE MEMBERS OF THE WISH PROJECT TEAM. PHILIPPA MIDDLETON IS THE EXECUTIVE DIRECTOR OF ARCH, AND IS A MEMBER OF THE WISH PROJECT STEERING GROUP. CAROLINE CROWTHER IS A PROFESSOR OF MATERNAL AND PERINATAL HEALTH, LIGGINS INSTITUTE, AUCKLAND, NEW ZEALAND. SHE IS THE CLINICAL DIRECTOR OF ARCH, AND IS THE CHIEF INVESTIGATOR OF THE WISH PROJECT.

When to give magnesium sulphate?

R Gestational age < 30 weeks R Birth planned or definitely expected within 24 hours

Give magnesium sulphate regardless of: R plurality; R reason at risk of preterm birth; R anticipated mode of birth; R parity; R whether antenatal corticosteroids have been given or not

When/what to administer? Magnesium sulphate using a dedicated intravenous line: R Loading: 4 g (slowly over 20 to 30 minutes) R Maintenance: 1 g/hour for up to 24 hours or until birth (whichever comes first)

When urgent delivery/birth is required: R Do not delay delivery to administer magnesium sulphate

What if birth does not occur within 24 hours? R A repeat dose may be considered at the discretion of the attending health professional if birth again appears imminent

How to monitor women? R Monitoring is essential for both loading and maintenance doses R Monitor: pulse, blood pressure, respiratory rate and patellar reflexes: (a) before loading infusion (b) 10 minutes after starting infusion (c) after loading infusion is complete (d) every 4 hours during the maintenance infusion R Resuscitation and ventilator support should be available during and after administration of magnesium sulphate (and calcium gluconate) When to stop administration? urine output < 100 mL in 4 hours; absent patellar reflexes; respiratory depression (< 12 breaths/minute); hypotension (diastolic blood pressure < 15 mm Hg below baseline) If magnesium toxicity occurs: stop the infusion and administer antidote of calcium gluconate (10 mL of 10% solution slowly, intravenously over 10 minutes) Potential interactions between magnesium sulphate and nifedipine may result in hypotension and neuromuscular blockade effects. If such interactions occur, cease both therapies and seek medical review

Figure 1: Treatment algorithm for antenatal magnesium sulphate prior to preterm birth for neuroprotection of the fetus, infant and child

37


By name

clinicalissues ‘Precovery’: a proactive version of recovery in perinatal mental health

By Paul McNamara and Dr Kay McCauley

In Australia, one in 10 pregnant women and one in six new mothers will experience depression, anxiety or both (Austin et al 2011). Can we combine ideas borrowed from psychiatry and physiotherapy to assist midwives and nurses to incorporate perinatal mental health into everyday practice?

Recovery In recent years mental health services have been encouraged to adopt ‘the recovery model’. This is a move away from seeking to ‘fix’ the individual experiencing mental health difficulties. Instead, recovery supports the individual on their journey, with an emphasis on hope and autonomy. The individual is supported to engage in an active life, one with purpose and meaning, and thereby acquire and sustain a more positive sense of self. The recovery model assumes existing psychiatric disability and/ or psychopathology, whereas in perinatal mental health the focus is on early intervention. We want to avoid the level of acuity or chronicity that the recovery model caters for, but keep the core values of recovery, especially respect for the individual’s dignity and uniqueness.

Prehab ‘Prehab’ (aka ’prehabilitation’) is a model used in physiotherapy. Prehab is where the patient is taught and practises the skills and exercises required for postoperative recovery before the operation. Practising exercises and the use of mobility aids is easier if there are no wound drains, dressings and other postoperative impediments. By using the preoperative phase to learn skills required in the postoperative phase, prehab aims to prevent problems developing and/ or fast-track recovery.

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Precovery

‘Precovery’ combines the ideas of mental health recovery and physiotherapy prehab as a model to articulate an empowering, early intervention/prevention approach to perinatal mental health. Precovery aims to promote the acquisition of information, supports and skills for all women in the perinatal period before symptoms of depression and anxiety arise, thereby building the individual’s resilience and help-giving capacity.

Precovery principles Create or reinforce support networks Antenatal and parenting classes are often more valued for the relationships/contacts made with other parents than the content of the classes. Playgroups offer a further opportunity to develop connections. Ideally these will be spaces where parents are not feeling insecure and/or competitive, but are supportive, non-judgemental and welcoming of each other. Targeted supports in the perinatal period create a deeper sense of connectedness through sharing of similar experiences eg. teenage parents may feel much more comfortable, better supported, if they get to meet with other young people who are pregnant/ have new babies. Informed and supportive significant others Postnatal depression prevalence and severity falls when the woman has a supportive partner. Where there is no supportive partner, other significant relationships drawn from family and friends can also decrease the impact and likelihood of postnatal depression. Symptom awareness/monitoring Symptom awareness and monitoring will happen to some degree with the routine, universal screening as recommended by the National Perinatal Depression Initiative (NPDI) and Australian perinatal mental health guidelines. Precovery encourages people who have experienced depression, anxiety or other mental health difficulties in the past to have a good awareness of their early warning signs and potential for relapse. This selfawareness/self-monitoring fits nicely with the empowering aspects of recovery, so certainly fits with the concept of precovery.


Easy access to appropriate information and support Often the supports that help the most are not specialist mental health supports. An approachable midwife or a friendly, relaxed child health nurse may do more to decrease anxiety in a pregnant woman or new mother than weeks of ‘talk therapy’ could ever achieve. Specialist perinatal mental health support (often provided by nurses) is currently available in most Australian health districts. Telephone helplines, GPs and mainstream mental health services/clinicians are other avenues of information and support. Recognition of the uniqueness of the individual and informed choice The values and the goals of the individual woman will determine what, if any, support is required; clinicians can guide and promote realistic expectations. While clinicians may make suggestions and recommendations these are not always followed. However, advocating for real, informed choices puts the clinician on a more realistic footing too. The aim is not for perfection, but to minimise harm. A non-judgemental, non-coercive approach fits with the dignity and respect found within the recovery model, and is a key precovery principle. Partnership and communication An essential part of precovery is to provide the individual with opportunities to ask questions and ventilate concerns, and to be supported by the clinician to explore solutions together. The quality and style of the partnership between the clinician and the women can serve as a parallel process to the mother-child relationship: one that nurtures, encourages exploration, and builds resilience and trust. Parents will be made aware that babies are born with a brain primed for experience, a mind that is ready to socialise and learn from day one. Education about infant communication and attachment in antenatal classes will allow parents to more fully prepare themselves for the baby. Precovery is a new concept which requires further discussion and exploration. Perhaps by combining two approaches of existing practices (ie. preparatory rehabilitation and mental health recovery) perinatal mental health promotion can be embedded in clinical services. Paul McNamara is a Clinical Nurse Consultant, Perinatal Mental Health, Cairns and Hinterland Hospital and Health Service Dr Kay McCauley is a Senior Lecturer, School of Nursing and Midwifery, Monash University

primary and community care part 2

An innovative at-home treatment model… is enabling patients to return home sooner, while contributing to reduced hospital costs and demand for beds.

Head of Infectious Diseases Dr John Dyer with HITH A/Clinical Nurse Consultant Lynda Smith

Team effort to provide more convenient care By Anni Fordham

An innovative at-home treatment model for patients requiring intravenous antibiotics is enabling patients to return home sooner, while contributing to reduced hospital costs and demand for beds. Treatment of serious infections has traditionally involved administering intravenous antimicrobial agents to patients in hospital,

with many patients remaining in hospital for lengthy periods of time. Over the last decade, Fremantle Hospital and Health Service’s Infectious Diseases (ID) Department and Hospital in the Home (HITH) have joined forces to provide intravenous antimicrobial therapy to patients in their own homes, an alternative to hospitalisation for patients with conditions such as cellulitis, as

well as a range of more complex conditions requiring long courses of high dose antibiotics. At any one time there may be up to 40 patients receiving care from the ID HITH team across Fremantle and Rockingham hospital sites, with more than 500 cases managed each year. This has enabled around 14 more beds available at Fremantle Hospital each day for elective and emergency admissions. The accessibility of at-home intravenous treatment has been made possible by the development of both long term peripherally inserted intravenous access devices (PICCs) and easy to use continuous infusion drug delivery systems, as well as new antimicrobial agents requiring less frequent dosage. To qualify for HITH care, patients must be clinically stable and suitable for discharge apart from their need for antimicrobial therapy. Suitable patients are identified by their treating medical or surgical team before being assessed for suitability by both the ID and HITH teams. Anni Fordham is the Public Relations Officer at Fremantle Hospital and Health Service in Western Australia

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Primary and community care

Victorian awarded for setting up mental health nurse ‘army’ A Victorian who set up his own small ‘army’ of mental health nurses throughout eastern Melbourne has won the individual Distinction Award at the 2013 HESTA Primary Health Care Awards announced last month. Eastern Melbourne Medicare Local Director of Health Services Craig Maloney (pictured below) won the award for demonstrating progress on achieving a vision for Australian health care that is innovative and will lead to better community health care. A new regional service model was created to identify individuals and groups failing to access mental health services and took action to bring services into areas of need. The Mental Health Nurse Service brought trained nurses into GP practices, secondary schools, drug and alcohol services, maternal and child health services, youth services and psychiatric disability rehabilitation services leading to improved patient outcomes. The service also established a mental health nurse and wellbeing program at Worowa Aboriginal College, a Healesvillebased boarding school for Aboriginal girls from all across Australia. Mr Maloney said the mental health nursing team integrated service delivery across three national programs, to ensure patients didn’t ‘fall through gaps’ and came up with new protocols and management procedures to optimise opportunities for clients’ sustained recovery.

Left to right: Community nurses, Moya Collins (foot care) Gai Downes (audiometry), Laurenn Wallace (diabetes resource nurse). All are part of the ‘team’ at Singleton Community Health

Introducing hearing assessment into diabetes care By Gai Downes

The Singleton Community Health adult audiometry clinic is an innovative project which was set up for the purpose of introducing hearing assessments into diabetes care at a local level. Established in August 2011, original funding was sourced through the Innovation Scholarship program as a nurse-led initiative to provide hearing evaluation for diabetes clients. This new model of care focused on increased awareness, early detection and interventions for hearing issues in a rural community health centre. The Singleton Diabetes Support Group identified an unmet need within the local community for a more readily assessable adult hearing service. This prompted further investigation of the issues related to diabetes and hearing loss. These findings then became the focus for the provision of an improved service for diabetes clients. Data suggests hearing impairment may be a common, under-recognised complication of diabetes. Studies in the United States


(Bainbridge et al 2008) and Australia (Mitchell et al 2009) indicate an association between diabetes and increased incidence of hearing impairment. People with diabetes are twice as likely to suffer a hearing loss which has an earlier onset, increased degree of loss and faster decline of hearing thresholds. A further study has suggested that diabetes may impair recovery from noise exposure (Wu et al 2009). Funding allowed for expansion of the existing children’s audiometry service to include adult assessment. The clinic is staffed by two audiometry nurses and receives referrals from other nurses and allied health services at the centre. This includes the diabetes resource nurse, dieticians and foot care nurse who encourage clients to use the new service. Due to public demand, the clinic was expanded to include all adults who wished to have their hearing checked. Baseline hearing levels were established using the diagnostic audiometry method. During the initial funding period the clinic assessed 148 adults aged from 18-87 years. This included 69 clients with diabetes.

Primary and community care Results while surprising, were not intended as a study however do reflect suggested outcomes. Of the diabetes clients (aged 29-83 years) overall 100% had some degree of hearing loss compared to 80% of the non-diabetes group (aged 18-87 years). Further evaluation and comparison of the under-65 year age groups again highlights the increased incidence of hearing loss in the diabetes group (100%) compared to 69% of non-diabetes clients. This group also had a greater involvement of various frequencies and increased degree of loss that required further GP investigation. At present no formal recommendation exists for the provision of hearing assessments in the diabetes care pathway although it is generally recognised any ‘at risk group’ have early baseline assessment. The clinic has demonstrated the value of hearing assessments in diabetes care and has been proactive in ‘hearing’ education for both diabetes and non-diabetes clients. Hearing related issues will continue to rise due to expected increases in new diabetes diagnosis, noise injury due to lifestyle activities (Australian Hearing 2010) and an ageing population. Hearing loss has been termed ‘the invisible handicap’. At Singleton Community Health, we have increased awareness of this problem and continue to address identified needs within the community. Further information on clinical outcomes can be accessed in the Australian Diabetes Educators Association November 2012 journal.

References

Australian Hearing. 2010. Binge Listening; is exposure to leisure noise causing hearing loss in young Australians? www.nal.gov.au/pdf/Binge%20Listening. pdf [Accessed 1 May 2013] Bainbridge, K., Hoffman, H. and Cowie, C.2008. “Diabetes and hearing impairment in the United States: audiometric evidence from the National Health and Nutrition Examination Surveys 1999 to 2004,” Annals of Internal Medicine, 149(1):1-10. Mitchell, P., Gopinath, B., McMahon, C., Rochtchina, E., Wang, J., Boyages, S. and Leeder, S. 2009. “Relationship of Type 2 diabetes to the prevalence, incidence and progression of age related hearing loss,” Diabetic Medicine 26(5):483-8. Wu, H., Cheng, T., Tan, C., Guo, Y., Hsu, C.2009. “Diabetes impairs recovery from noise induced temporary hearing loss,” Laryngoscope 119(6):1190-4. Gai Downes is a Nurse Audiometrist in the Community Health Centre at Singleton District Hospital in NSW.

Telehealth tackles elderly health care

RDNS demonstrated its project with a videolink between Singapore’s Senior Minister of State, Mr Chan Chun Sing and nurse Amanda Murray who was more than 6,000 kilometres away at the RDNS call-centre in Melbourne. Ms Murray took the Minister through a conversation as though he was a real patient, monitoring his ‘medication’ (lollies for this occasion) and hypothetically taking his blood pressure.

The RDNS (Royal District Nursing Service) telehealth project, which allows a nurse to make a ‘virtual visit’ to a patient at home, has taken out an international innovation award. The telehealth project, Healthy, Happy and at Home, which has been in operation for the past two years in Australia, won the Outstanding ‘ICT’ Innovation award in the Asia Pacific Eldercare Innovation Awards 2013 in Singapore recently. The project is being pioneered with the help of the Victorian Government under its Broadband Enabled Innovation Program (BEIP). The objective is to potentially enable earlier hospital discharge, prevent medicine mismanagement and maximise nursing resources. The RDNS’ move into delivering care using high-speed broadband technology is designed specifically to help address the challenges associated with caring for an ageing population. At RDNS’ call centre in Camberwell, Melbourne, a team of nurses make ‘virtual visits’ to clients at home using broadband technology. Video-based medication management services are provided in using high speed internet connections. Client

monitoring involves the use of a videoconferencing unit. Each client has a special monitor at home with an inbuilt camera, allowing nurses at the RDNS call centre to conduct two-way video calls with clients in their home. The videoconferencing unit is enabled by a broadband connection, installed in the client’s home under the supervision of an RDNS project team member to ensure that the system is set up properly. The effectiveness of the solution has been tested over the past 24 months in Australia with a sample size of over 50 clients. RDNS client Nancy Latham, who has Alzheimer’s said the system she calls “Pill TV” offers new freedom. “I didn’t like having to wait around for the nurse visits every day. I can get out and about now,” the active 94-year-old says. “I like talking to the nurses by TV and it’s good to know someone is keeping an eye on me when I take my tablets. I’m not computer-minded but I think people should try new technology.”

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My role as a chronic illness management nurse By Tabeth Chimbwanda

My role as a Chronic Illness Management Nurse (CIMN) involves identifying clients referred to Mt Druitt Community Health’s chronic aged and complex care services. Most commonly these clients have chronic and complex illnesses such as chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, heart failure and diabetes, and who are at risk of multiple hospital admissions or presenting to the emergency department (ED) frequently in a crisis state due to exacerbation of their chronic illness. I am actively involved in the development and implementation of strategies to reduce presentation to the ED and avoidable admissions; reduction in length of hospital stay; improvement in the quality of life of clients and carers; reduction of anxiety and depression; and other desired outcomes. In my role as a chronic illness management nurse, I collaborate with other CIMNs, community nurses, GPs, GP liaison nurses, discharge planners, and other health care providers. Involving the client and family, I develop a comprehensive care plan to address any health related issue. I provide advice to community nurses and other allied health professionals in the management of clients with chronic illness, including timely referral to

self-management programs such as pulmonary and cardiac rehabilitation and programs for people with diabetes. In my role I was involved in the development and implementation of a quality improvement project The respiratory program for community nurses to improve the knowledge and skills of community nurses case managing clients with chronic and complex conditions such as COPD. This program was developed as a result of identification of lack of adequate knowledge and skills in managing these clients. This led to the development of the respiratory program which was coordinated by the community health education coordinator in partnership with the respiratory clinical nurse consultants and chronic illness management nurses. The respiratory program for community nurses comprised of five online respiratory modules, including development of respiratory assessment tools. I conducted multiple in-services and one to one coaching for community nurses to introduce the program, including: respiratory symptom assessment tools; chest auscultation; correct inhaler device techniques using placebo inhalers and spacers; and the use of respiratory devices, such as oxygen therapy, CPAP and nebulisers. During this I identified a lack of resources such as education resources

for nurses and essential equipment such as pulse oximeters, sphygmomanometers, stethoscopes, glucometers, and patient and carer education resources. To resolve this, I negotiated with nursing management to ensure adequate resources were provided to the Mt Druitt community nursing team to provide high quality care to our clients. I have also introduced the use of the hospital anxiety and depression tool to assess clients with chronic conditions such as COPD. This has led to early identification of clients with high levels of anxiety and depression and initiation of early treatment. A COPD action plan and symptom diary to promote early interventions in acute exacerbations of COPD has also been introduced. The final component of the respiratory program was the respiratory competency assessment I conducted for Mt Druitt CACC community nurses. I have successfully completed respiratory competency assessment for 12 CACC community nurses. Due to the development and implementation of this program, there have been a number of identified improvements in patient outcomes, such as reduction in hospital admissions and length of hospital stay; reduction in ED presentation; and improvements in clients with the COPD action plan who are now well informed on how to use it. There have also been improvements with clients using their inhalers correctly and adhering. Another improvement noted was the increase in numbers of clients referred to pulmonary rehabilitation; and identification of clients with severe chronic illnesses who require palliative/end of life care. Tabeth Chimbwanda is a Chronic Illness Management Nurse (CNS 2) at the Mt Druitt Community Health Centre in Mt Druitt, NSW

The S.O.N.S (Society of Neuromuscular Sciences) 39th Annual Winter Meeting is to be held at the Thredbo Alpine Hotel August 12th – 16th, 2013 and boasts a very good lecture and social programme.

Are You a Nurse and a Skier/Boarder? Do You Wish to Enrich Your Clinical Knowledge?

SOCIETY OF NEUROMUSCULAR SCIENCES INC. 39TH ANNUAL CONFERENCE IN THREDBO For membership and registration information contact: The Secretary 441 Bangerang Rd, Echuca Village, VIC 3564 Phone: 03 54807206 Fax: 03 54826724 Email: s.o.n.s @bigpond.com Web site www.sons.net.au

Despite its historic name the Society welcomes presentations in all aspects of clinical practice. A diverse range of topics from all areas of Medicine will be presented and these will appeal to Specialists, Registrars, RMOs, General Practitioners, Nurses and Allied Health Professionals. Nurses and Allied Health Professionals are welcome to join as Associate Members and the annual subscription is quite modest. We also conduct a conference in Niseko, Japan each year. The dates for 2014 are from Monday 13th to Friday 17th January, 2014. We would love to see some new faces in Thredbo in August. Present a lecture/talk and receive a discount on your registration fee.

BRUSH UP ON YOUR CLINICAL KNOWLEDGE (AND YOUR SKIING)! JOIN SONS NOW! 42 Australian Nursing Journal JULY 13 volume 21 number 1


Dr Lea Budden

Aboriginal and Torres Strait Islanders Tobacco Smoking: tackling the challenge By Dr Lea Budden

Aboriginal and Torres Strait Islanders are almost four times more likely to die from respiratory diseases than other non-Indigenous Australians (Australian Bureau of Statistics 2010). Tobacco smoking is a major cause leading to these diseases. The rates of tobacco smoking of Aboriginal and Torres Strait Islanders in the population (including pregnant women) aged 15 and over are more than double compared to non-Indigenous Australians (Gray and Wilkes 2010). Smoking cessation is a preventative measure to reduce the chronic illness and mortality in Aboriginal and Torres Strait Islanders. Nurses are well placed in working with Aboriginal and Torres Strait Islanders to identify, develop and deliver culturally suitable anti-tobacco programs. Currently there is little evidence about the best interventions and education methods to use in these programs. There are many smoking cessation methods and programs which have been found to be effective for non-Indigenous Australians, however purely adopting these may not necessarily be the answer. Available evidence

indicates that health professionals providing brief interventions with nicotine replacement is effective for aiding smoking cessation for Aboriginal and Torres Strait Islander peoples (Ivers 2011). The Australian government has recognised the importance of tackling tobacco smoking with the introduction of the ‘Closing The Gap’ (Department of Health and Ageing 2013) initiative, including for anti-tobacco programs for Aboriginal and Torres Strait Islanders. Nurses can deliver brief interventions for cessation of smoking for Aboriginal and Torres Strait Islander Australians. Brief interventions are short interactions by health professions which are designed to screen, provide education and support to help people change an unhealthy behaviour, such as smoking (Centre for Excellence in Indigenous Tobacco Control 2011). Brief intervention in the SmokeCheck program in Queensland provides specifically culturally designed information and referral based on a person’s stage of change namely pre-contemplation, contemplation, preparation, action and maintenance (Queensland Health 2007).

The Australian government has recognised the importance of tackling tobacco smoking with the introduction of the ‘Closing The Gap’ (Department of Health and Ageing 2013) initiative

Most states in Australian now have programs based on the SmokeCheck model to assist Aboriginal and Torres Strait Islander people to quit smoking. References

Australian Bureau of Statistics. 2010. The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples. Australian Government: Canberra. Centre for Excellence in Indigenous Tobacco Control. 2011. Fact Sheet: What do we know about brief interventions. Centre for Excellence in Indigenous Tobacco Control: Melbourne. Department of Health and Ageing. 2013. Closing the Gap. www.health.gov.au/internet/main/publishing. nsf/Content/currentissue-P10000005 [Accessed 10 April 2013] Gray, D. and Wilkes, E. 2010. Reducing alcohol and other drug related harm. Resource sheet no.3. Closing the Gap Clearinghouse. Australian Government: Canberra. Ivers, R. 2011. Anti-tobacco programs for Aboriginal and Torres Strait Islander people. Resource sheet no.4. Closing the Gap Clearning House. Australian Government: Canberra. Dr Lea Budden is a Senior Lecturer in the School of Nursing, Midwifery & Nutrition at James Cook University in Townsville, QLD.

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WA Aboriginal service wins HESTA team award An innovative ante/postnatal service for young Aboriginal women in Western Australia has seen a reduction in smoking and alcohol rates during pregnancy and better outcomes for babies at birth. Moort boodjari mia, a health service for Indigenous families in the north metropolitan area of Perth, Western Australia (WA), won the Team Excellence Award at the 2013 HESTA Primary Health Care Awards last month. Moort boodjari mia provides free antenatal and postnatal clinical care, guidance, support, and education to pregnant Indigenous women and their families. A team of health professionals works with each client during pregnancy and for four weeks after birth, to provide clinical, cultural, social, and emotional care and support. The service’s Coordinator Alison Gibson said the service focussed on providing ante/ postnatal assistance to young women under 20, but also worked with their partners,

Team Excellence representative Alison Gibson and midwife Jodie.

grandparents and other significant people in their lives. A multidisciplinary team works together to deliver patient care which includes a mixture of home visits, clinic visits and transport to hospital appointments. “The service has a unique complement of staff, with each case managed by a midwife, Aboriginal Health Officer and Aboriginal Liaison Grandmother.” “The program has been successful in

reducing incidences of smoking and drinking alcohol during pregnancy, and increasing the average birth weight to a healthy 3.1 kilograms.” The service was previously known as Aboriginal maternity group practice, and operates from the North Metropolitan Health Service, Department of Health WA. Ms Gibson said staff understood the differing needs and culturally appropriate ways of working with the Aboriginal community and continually worked on developing a service that meets those specific needs. The team also worked with and shared their knowledge with other services to help improve health outcomes for the broader community, she said. The service also runs: • weekly community clinics in Midland and Mirrabooka; • Granny morning teas every two months; • community events; and • education sessions on various topics. Moort boodjari mia was awarded a $10,000 development grant as winner of the Team Excellence Award at the HESTA Primary Health Care Awards, sponsored by ME Bank. For more information, visit www.hesta awards.com.au

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44 Australian Australian Nursing Journal 13 volume 21 number 1 Nursing Journal_Sept 2012.indd JULY 2

11/04/2013 11:28:08 AM


Nurses urged to raise awareness of pap tests

Obstructive Sleep Apnoea By Dr Lea Budden

An estimated 1.5 million Australians suffer (9% of the population) with sleep disorders and 775,000 people have been diagnosed with obstructive sleep apnoea (Deloitte Access Economics 2011). Sleep disorders and their associated health complications cost the Australian health care system at least $818 million in 2010 according to Deloitte Access Economics (2011). Sleep is vital for the restoration process of the body and consists of cycles called ‘Rapid eye movement’ (REM) and ‘Non-rapid eye Movement’ (NREM). The REM cycle of sleep is classified as the lighter stage where dreaming occurs and NREM is considered the deep sleep where the body undertakes its restorative functions. Obstructive sleep apnoea (OSA) is a serious respiratory disease that can severely affect an individual’s quality of life. In OSA individuals have a reduced cycle of NREM sleep. This disease is often under-diagnosed even though the condition has serious consequences for the individual. Obstructive sleep apnoea can be defined as, “a clinical disorder marked by frequent pauses in breathing during sleep usually accompanied by loud snoring” (World Health Organization 2013). The airway becomes obstructed and may occlude, leading to the individual waking up gasping (National Heart Lung and Blood Institute 2013). Children can also develop OSA with the leading causes enlarged tonsils and adenoids (Australasian Sleep Association 2013). Clinical manifestations of OSA include the individual experiencing more than five episodes of apnoea lasting more than 10 seconds each hour during sleeping. These periods of apnoea in individuals experiencing severe obstructive apnoea can be as frequent as up to 600 per night with each lasting up to two minutes. Some of the other symptoms of OSA include loud snoring, daytime sleepiness, irritability, depression,

cognitive and memory problems. Untreated OSA can increase the risk of serious illness such as hypertension, obesity, cerebrovascular accident (CVA), diabetes, heart failure and myocardial infarction. The diagnosis of OSA is usually made through the individual undertaking a sleep test. This overnight test can occur in a facility or at home using a sleep monitor (which are now offered by many chemists in Australia). The treatment for OSA is Continuous Positive Airway Pressure (CPAP), changes to lifestyle factors such as reducing obesity, surgery and mandibular advancement splints (Australasian Sleep Association 2013). A sleep checklist is available online and can be used by nurses to screen patients for OSA (Sleep Health Foundation 2013). Assessment of OSA is an important role for nurses to provide a referral pathway of patients to doctors for further investigation and treatment, if necessary. References

Australasian Sleep Association. 2013. Obstructive sleep apnoea in children. Australasian Sleep Association. www.sleep.org.au/documents/item/73 [Accessed 2 May 2013] Australasian Sleep Association. 2013. Obstructive Sleep Apnoea. www.sleep.org.au/information/healthprofessionals-information/obstructive-sleep-apnoea [Accessed 2 May 2013] Deloitte Access Economics. 2011. Re-awakening Australia:The economic cost of sleep disorders in Australia, 2010. www.sleephealthfoundation.org.au/ pdfs/news/Reawakening Australia.pdf [Accessed 2 May 2013] National Heart Lung and Blood Institute. 2013. What is sleep apnea? www.nhlbi.nih.gov/health/healthtopics/topics/sleepapnea/ [Accessed 2 May 2013] Sleep Health Foundation. (2013). Health professional sleep checklist www.sleephealthfoundation.org.au/ files/pdfs/Checklist.pdf [Accessed 2 May 2013] World Health Organization. 2013. Obstructive sleep apnoea syndrome. www.who.int/respiratory/other/ Obstructive_sleep_apnoea_syndrome/en/ Dr Lea Budden is a Senior Lecturer in the School of Nursing, Midwifery & Nutrition at James Cook University in Townsville QLD

Nurses are being encouraged to increase awareness in the community of the need for two yearly pap smears for women, with the latest figures showing a slight drop in uptake of the national cervical screening program. More than 3.6 million women were screened under the national cervical screening program (NCSP) in 2010-2011, figures released from the Australian Institute of Health and Welfare (AIHW) released last month show. More than 80% of women had pap tests within a five year period however only 57% of women in the target age group (20-69 years) screened through the NCSP had a test every two years as recommended, compared with 58% in 2009-2010 and 59% in 2008-2009. Despite the slight fall in participation, detection of high-grade abnormalities remained high. In 2011, for every 1,000 women screened, eight women had a high-grade abnormality detected reinforcing the need for early detection and treatment. Participation ranged from 52% in areas of lowest socioeconomic status to 63% in highest socioeconomic areas. Uptake of the NCSP was highest in inner regional areas (58%) and lowest in remote areas (55%). “The good news is than incidence rates and mortality rates have both halved since the NCSP was introduced in 1991, remaining at their historic lows of nine new cases and two deaths per 100,000 women since 2002,” AIHW spokesman Justin Harvey said. However the number of new cases of cervical cancer for Aboriginal and Torres Strait Islander women was more than twice that for non-Indigenous women, and mortality rate five times that of other Australian women. Federal Health Minister Tanya Plibersek said the cervical screening program was currently under review, including strategies to improve participation by women not having regular screens. The review is due for completion mid-2014.

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http://www.healthcareconferences. com.au/healthcare-conferences/ healthcare/assistants-in-nursingconference

calendar JUL AUG UK Association for the History of Nursing Colloquium

History of Colonial and Post-Colonial Nursing 4 July 2013, Lecture Theatre, Faculty of History, University of Oxford, George Street, Oxford UK. To register for the Colloquium, please visit http://www.oxforduniversity stores.co.uk/browse/product. asp?catid=294&modid=5&compid=1 1st Annual Worldwide Nursing Conference

Health Disparities 8-9 July 2013, Hotel Fort Canning, Singapore. www.nursing-conf.org/index.html Australasian Association of Bioethics & Health Law Conference

Pivotal Moments/Future Horizons – Continuity and Change in Australian Bioethics 11-14 July 2013, Sydney Law University School. www.cdesign.com.au/aabhl2013 Nursing Informatics Australia Conference

New Age Workforce: Blending Professional and Digital Behaviours 15 July 2013, Adelaide Convention Centre, South Australia. Call for papers now open. www.hisa.org.au/page/hic2013nursing Lung Health Promotion Centre at The Alfred

16 July - Presenting & Educating With Confidence 17-19 July - Asthma Educator’s Course 25-26 July - Smoking Cessation Facilitator’s Course Lung Health Promotion Centre at The Alfred Ph: (03) 9076 2382 Email: [email protected] Cancer Nurses Society of Australia 16th Winter Congress

Connecting Cancer Care 25-27 July 2013, Brisbane Convention and Exhibition Centre, Qld. www.cnsawintercongress.com.au Email: [email protected]

46

Prostate Cancer World Congress incorporating the 14th Australasian Prostate Cancer Conference

Together in discovery and care 6-10 August 2013, Melbourne Convention & Exhibition Centre. Visit: www.prostatecancercongress.org.au Victorian Perioperative Nurses Group (ANF) Vic Branch 50th State Conference and AGM

Gold Standard: 50 years of perioperative education 1963-2013 8-9 August 2013, The Sebel, Albert Park, Victoria. www.vpng.org.au SONs (Society of Neuromuscular Sciences) 39th Annual Conference

12-16 August 2013, Thredbo Alpine Hotel, Victoria. www.sons.net.au ‘Diabetes Update’ study day with Kathy Mills, RN, MEd, Credentialled Diabetes Educator

For EN/RNs covering lifestyle education, blood glucose meters, drugs and insulin. 16 August 2013 from 9.30am-4.30pm at ANF Carson Conference Centre, level 7, 540 Elizabeth Street, Melbourne. Cost: Early bird special (pay by 9 August) is $200 Full registration fee: $230 All queries to Kathy via email only at [email protected] The Mental Health Services (TheMHS) 23rd Annual Conference

Forging the Future 20-23 August 2013, Melbourne Convention Centre, Victoria. www.themhs.org Lung Health Promotion Centre at The Alfred

22-23 August - Spirometry Principles & Practice 28-30 August/18-19 September Respiratory Course Lung Health Promotion Centre at The Alfred Ph: (03) 9076 2382 Email: [email protected] Australian College of Children and Young People’s Nurses (ACCYPN) biennial conference

Connecting in children and young people’s health care 24–27 August 2013, Melbourne Convention and Exhibition Centre, Victoria. www.accypn2011.event planners.com.au/index.php 2nd Annual Assistants in Nursing Conference 2013

29-30 August 2013, Sydney Harbour Marriott.


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12th Australian Palliative Care Conference

3–6 September 2013, National Convention Centre, Canberra. www.palliativecare.org. 13th National Leadership and Learning Conference

New frontiers and big ideas 5-6 September 2013, Rydges South Bank, Brisbane. www.matereducation. com.au/conference 8th Council of International Neonatal Nurses (COINN) International Conference

5-8 September 2013, Belfast, Northern Ireland. www.coinn2013.com/ British Society for the History of Paediatrics and Child Health Autumn Meeting

6-7 September 2013, Chancellors Hotel & Conference Centre, Manchester UK www.BSHPCH.com Victorian School Nurses Conference - 100 Years of School Nursing

7 September 2013, Brighton Grammar School, Melbourne, Victoria. Any queries to Mary Zito Mobile: 0421 875 186 or Email: [email protected] ANF Vic Branch in collaboration with NENA

2013 Professional Issues in Practice Conference 19-20 September 2013, Melbourne Convention and Exhibition Centre. Ph: (03) 9275 9333 or email: records@ anfvic.asn.au 8th Conference of the Australian College of Nurse Practitioners

24-27 September 2013, Hotel Grand Chancellor, Hobart. www.dcconferences.com.au/acnp2013

Two Day Diabetes Update for Nurses

Diabetes Australia – Vic provides a range of innovative programs for health professionals. The programs are delivered by Credentialled Diabetes Nurse Educators and Accredited Practising Dietitians and provide the latest evidence based information on diabetes, current management and research. 9 &10 October 2013, 9am to 4.30pm at the Carson Conference Centre, Level 7, Australian Nursing Federation (ANF), 540 Elizabeth Street, Melbourne Vic 3000 Programs include: Two Day Diabetes Update for Nurses; Diabetes in Aged Care Setting and Diabetes for Disability Support Workers http://www.diabetesvic.org.au/ health-professionals/workshops 11th International Conference for Emergency Nurses

A spring carnival for emergency nursing – today’s winners and tomorrow’s champions 9-12 October 2013, Etihad Stadium, Melbourne. www.cena.org.au Australasian Nurse Educators Conference

Purposeful partnerships for practice 9-11 October 2013, Te Papa, Wellington, New Zealand. www.nursed.ac.nz/ Audiometry Nurses Association of Australia Inc Annual Conference

16-18 October 2013, Mercure Hunter Valley Resort (NSW). www.anaa.asn.au The Joanna Briggs Institute International Convention

The 2013 campaign for getting evidence into policy 21-23 October 2013, InterContinental Adelaide, South Australia. www.2013convention.joannabriggs.org Lung Health Promotion Centre at The Alfred

24-25 October Spirometry Principles & Practice 31 October-1 November Managing COPD Lung Health Promotion Centre at The Alfred Ph: (03) 9076 2382 Email: [email protected]

OCT NOV Australian College of Midwives 18th Biennial Conference

1-4 October 2013, Wrest Point Hotel, Hobart. www.acm2013.com/ 3rd World Parkinson Congress

1-3 October 2013, Montreal, Canada. The World Parkinson Congresses provide an international forum for the latest scientific discoveries, medical practices and care initiatives related to Parkinson’s disease. www.worldpdcongress.org/ 15th Congress of Aboriginal & Torres Strait Islander Nurses Conference & Annual General Meeting

All the same but totally different 6–8 October 2013, Pavilion on Northbourne, Canberra. Call for abstracts closes 31 July 2013. www.catsin.org.au

Lung Health Promotion Centre at The Alfred

12 November Presenting & Educating With Confidence 13-15 November Asthma Educator’s Course 21-22 November Smoking Cessation Facilitator’s Course Lung Health Promotion Centre at The Alfred Ph: (03) 9076 2382 Email: [email protected] Profound Healing – Sustainable Wellbeing Conference

23-24 November 2013, Pullman Hotel Melbourne, Albert Park. Take charge of your health and wellbeing while exploring new ways to help others. www.gawler.org

Please contact Jenny on 03) 54427857 or [email protected] or Fay on 03) 5443 8280 or [email protected] or Joan on 03)5443 6850 or [email protected] or mail to PO Box 509, BENDIGO 3552

network LISTER HOUSE – WHAT ARE YOUR MEMORIES? From 1950 to 1989, Lister House at 37 Rowan Street Bendigo was home to the Northern District School of Nursing, a unique school that provided theoretical training for 108 schools of nurses across the Loddon Mallee Region. The Northern District School of Nursing Graduates Association is compiling a history of the Northern District School of Nursing in order to publish a book. If you were associated with the school in any capacity, whether you studied or worked at Lister House, your recollections are important and we would like to hear from you. This is an opportunity for you to contribute anecdotes, photographs and experiences of your time at Lister House. The book will be a vital historical record of this unique School of Nursing.

Launceston General Hospital Ex Trainees, February 1977 reunion Anyone interested contact Deanna Ellis at coachtramtours@ bigpond.com please include postal address, phone contact and email address The Queen Elizabeth Hospital, Adelaide, Group 5/83 30-year reunion 13 July 2013 for dinner, venue to be confirmed. Contact Catherine Turner (nee Donato) Email: [email protected] Mobile 0400 727 275 or Liz Fitzgerald Email: [email protected] Mobile 0413 042 992 for further information Royal Children’s Hospital, 3/83, 30-year reunion 5 October 2013, 6.00pm @ Naughtons Hotel, Parkville, Victoria. Contact Catie Bortolot Email: [email protected] or Mobile 0419 358 114 or Simone Quinton Email: [email protected] or Mobile 0416 184 724

Royal Melbourne Hospital, Group 383, September 1983 30-year reunion 12 October 2013. Contact Margaret Ricardo (nee Ferguson) Email: [email protected]. au Mobile: 0417 129 908 or join the Facebook page rmh383@ groups.facebook.com Box Hill Hospital, group 64, 40-year reunion 26 October 2013. Contact Brenda “Crumpie” Ph: 03) 9729 1973Epworth Hospital, Group 84/1, 30- year reunion 22 February 2014, venue and further details to be advised. Contact Gina Akers Email: [email protected] Mobile: 0418 560 913 Epworth Hospital, Group 84/1, 30 year reunion 22 February 2014. Venue and further details to be advised. Contact Gina Akers Email: [email protected] Mobile: 0418 560 913

Profound Healing Sustainable Wellbeing Conference 23 – 24 November 2013 Pullman Hotel Melbourne, Albert Park

Take charge of your health and wellbeing while exploring new ways to help others Endorsed by RCNA for 12.5 CNE points Phone: 1300 651 211 Email: [email protected] BOOK NOW www.gawler.org

Please contact Cathy Fasciale at [email protected] if you would like to place a notice.

The Gawler Foundation A not for profit organisation

www.ato.gov.au


Whilst there is greater interest in studying these phenomena, it is not clear that nurses and midwives are heeding the cautions and putting strategies in place in their lives to offset the health impacts of work.

Sally

By sally-anne jones anf federal vice president

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health. By focusing on promoting resilience and balance in our lives, this conference will move beyond documenting the health issues that confront health professions and focus on the positive transformation and empowerment of the health workforce. Clearly this will enhance our capacity to deliver better quality care to our patients. We will have international speakers who will confront us and rejuvenate our passion to recreate a positive culture within our workplace by ensuring we are truly informed about the complexity of the issues around health professionals’ wellbeing. Researchers will present the most up to date research in this field, while clinicians and medico-legal experts will guide us through difficulties that affect all of us in our day to day work such as mandatory reporting and registration related issues affected by health professionals’ health status. The dynamic pre-conference workshops presented by experienced clinicians and experts in self-care are designed to teach us how to care for our colleagues and to develop our skills to maintain our health. Registrations are now open for this

ARE YOU LOOKING AFTER YOURSELF? There are many sources in the academic literature that explore the physical impact and potentially deadly outcomes long term on the health of nurses and midwives because of their work. Additionally, being professions that are engaged in a high degree of emotional labour, there are impacts on resilience, emotions, moods and social relationships – at work and at home. Fatigue and burnout in the caring professions also feature in the literature, so the concepts are not new. Whilst there is greater interest in studying these phenomena, it is not clear that nurses and midwives are heeding the cautions and putting strategies in place in their lives to offset the health impacts of work. On 3-5 October 2013 in Brisbane, a conference is being held that recognises the enormous benefits for nurses, doctors, dentists, physiotherapists, pharmacists and other allied health professionals who engage collaboratively in the creation of a healthier workforce. Building on previous experience hosting doctors’ health conferences, the multidisciplinary organising committee provide a positive forum with the theme of Caring for you: Caring for others. Whether we work in a small private practice or a large health institution, this conference will challenge us all to make personal and organisational decisions to enhance our own


conference. I strongly encourage you to visit the website to explore the speakers and workshops on offer. I think this provides something different for you to consider attending – take away something new to help you look after yourself while you are looking after others! Visit: www.hphc2013.com.au

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