Western Nurse Magazine December 2023 by ANF WESTERN NURSE MAGAZINE

December 2023

Incorporating Western Midwife

The official magazine for ANF members in WA

Ever considered a career in the country?

Eligible nurses and midwives can receive between $5,000 and $17,000 over 12 months on top of your salary and other financial incentives. Available at endorsed locations. T&Cs apply.

#WorkAndPlayInCountryWA 2 | Western Nurse December 2023

December 2023

Secretary's Report ANF State Secretary Janet Reah

Secretary’s report

2023 in review

Celebrating nursing through art

Welcoming a new WA Branch President

10 Answers to your legal questions 12 EBA News 13 A question from members: the ANF and the Labor Party 14 Christmas and New Years services 15 ANF name change 18 Across the Nation 20 Research Roundup

With the year coming to a close, I can’t say enough how proud I am of the ANF and yourselves, our members. We’ve been through a lot this year. From the threat of deregistration, multi-million dollar fines and a State Labor Government that plays hardball with the lives of WA’s nurses and midwives. Despite the challenges thrown at us, the ANF has pushed on and has achieved so much... We began our advertising campaign which you all undoubtedly would have seen or heard in some form, for our push for a 5 percent pay rise and ratios. This has seen WA Labor fall steeply in the polls and has put them on notice that the ANF will continue to fight for WA’s nurses and midwives. Despite the uphill battle for our wage campaign against an overpowered and overrepresented State Government, the ANF continues to prosper with over $50 million dollars in combined cash and assets. Though we are operating at massive profits, we still manage to have the lowest fees and offer the most services out of any other union in Western Australia. The ANF has utilised these assets further for members with our range of services which include:

22 Walk for Change

− Lowest union fees in WA for any type of membership.

24 ANF photo competition

− Our new Conference Series which saw sellout crowds at both the Legal Conference in June and Health and Safety Conference in August.

26 Around the Globe 29 The Brain Buster

− Free Legal, Social Media and other talks hosted by the ANF which contribute to CPD. − Free legal representation for work-related matters.

CONTINUING PROFESSIONAL DEVELOPMENT: CLINICAL UPDATES 16 Reducing needlestick injuries 30 Acute appendicitis

− Hugely discounted Holiday Units in Margaret River and Kalbarri year-round. Next year the ANF will be on the move, with an end needed for our overdue 2022 public sector EBA as we have a fresh wages negotiation due in October 2024. Aside from the public sector we have other private sector EBAs that need immediate settling. On top of all this, the ANF will continue its plans for a political party to run at the next State Election in early 2025, in which we aim to get proper representation in State Parliament made up of experienced nurses and midwives. Once the ANF Council has endorsed this plan, we expect to be putting a call out very soon to members for applications to be a candidate. With over 82 percent of ANF members polled voting for the creation of a party and over 43 percent of the public polled throwing their support behind us, we already have the backing needed to have a real effect in the next State Election. After years of neglect it’s time WA’s nurses and midwives, as well as all Western Australians, benefitted from the experience of nurses and midwives in the halls of WA’s Parliament.

December 2023 Western Nurse | 3

2023: the year that was 2023 was a momentous year for the ANF Between slow and difficult negotiations with the WA Government over the Public Sector EBA, a record breaking fine from the WAIRC, a huge advertising campaign, recommendations from the State Coroner in the Aishwarya case, the Legal Conference and the Work Health & Safety Conference, the ANF also asked members whether or not they would support and nurses a midwives party running in the state election. On top of all of that the ANF continued to provide the best support and services for our members, without raising our already low fees.

A hard fought year of Public Sector negotiations While members can be satisfied in knowledge that the ANF has spent much of 2023 arguing for the best possible agreement out of the Public Sector EBA negotiations, it is worthwhile to remember the hard road that we have traveled over that past year. The WA Labor Government has fought the ANF on better conditions and wages at every step of the way. Following a long stalemate, the new Premier Roger Cook agreed to meet with ANF State Secretary Janet Reah. “This is the first time a Premier had met with an ANF State Secretary during a wage negotiation in nearly 20 years,” Ms Reah said. “The Premier and I had a cordial meeting and our negotiations resumed, making practical progress in which both sides worked together to pass a deal to help ANF members.” Once the current negotiations come to a close, the ANF will shift its focus in 2024, to achieving a wage deal as well as improved

4 | Western Nurse December 2023

ANF State Secretary Janet Reah met with WA Premier Roger Cook this year to discuss wage negotiations.

conditions next year when our next EBA is set to be negotiated. This is just around the corner, and the ANF is committed to ensuring WA nurses are paid what they deserve, and that WA becomes competitive again.

The Heal WA campaign makes a big impact One of the most noticeable achievements for the past year was the massive success of the ANF’s Heal WA campaign. During the standstill in the Public Sector EBA negotiations, the ANF took the opportunity to remind the WA Government that nurses and midwives could not be ignored. The campaign ran across radio, online streaming, television, newspapers and social media to bring the fight into the public sphere and keep it there. The effect of the campaign was immediate. It generated a lot of interest from the public and the response from nurses and midwives was overwhelmingly positive. The campaign played a huge part in bringing the Cook Government back to the negotiating table.

A record breaking fine at the WAIRC Earlier in the year the ANF fought back against the possibility of huge fines and even de-registration by the WAIRC, in response to our October rally in 2022. The wonderful ANF legal team deserve full credit for their hard work in this matter. The initial threated $30 million dollar fine was reduced to $350,000, and the ANF remains a registered union.

ANF State Secretary Janet Reah said the fine and threat of deregistration were an attempt to deter the organisation from fighting for better pay and conditions for members. “Regardless of the WAIRC outcome, we have not stopped fighting for fair pay and ratios, and we continued to push the WA Government

A pilot program for nursing ratios in PCH ED Despite the challenges from the WA Government the ANF continued to push for a pilot program to establish proper ratios to protect both patients and staff at hospitals.

to enact the vital changes it needs to make,” Ms Reah said.

In order for these ratios to be effectively rolled out across the state it was vital that the Government tests and implements a model of ratios that works.

Nurses and ratios vindicated by the Coroner’s recommendations

Through persistent pressure and hard work, the ANF successfully lobbied the WA Labor into action, with a pilot program for ratios announced for Perth Childrens Hospital in mid-2023.

The highly publicised Coroner’s Inquest into the tragic death of

Since then patient ratios have already been improving working conditions for ANF members.

Aishwarya Aswath in 2021 drew to a close this year, with a number of recommendations made. ANF Secretary Janet Reah said the outcomes of this tragic case vindicated both nurses and the ANF’s recommendations. “Despite the WA Government attempts to throw the nurses on duty under the bus the ANF legal team secured a win, at long last vindicating nurses,” Ms Reah said, “As well as this, the Coroner made a list of common-sense recommendations, suggested by the ANF, with the WA Government needed to implement. This includes patient ratios and Safe Harbour laws which will protect nurses and midwives from unnecessary investigations. ANF WA Senior Vice President Loreta Murphy lead the charge in bringing Safe Harbour to the forefront of public discussion. Safe Harbour will ensure nurses and midwives who take the appropriate escalation steps, like those taken on the day Ashwarya died, will be protected from unnecessary investigation.

Business as usual, with great services for a fair price and two great conferences Given the current cost-of-living, on top of the day-to-day pressures of being a nurse or a midwife, the ANF decided members deserve the best possible protection and services for the lowest possible fees. The ANF again decided to keep fees at record lows. The ANF has the lowest fees of any union in WA, while also providing the widest range of services. Even with fees that are less than half the fees of all the other unions, the ANF continues to provide services that simply don’t exist in other more expensive unions. Our services include unlimited legal cover, journey cover insurance, personal injury insurance, affordable holiday units, free ANF merchandise, online education, free legal talks and a huge range of features on the iFolio App. The ANF has reported considerable financial gains, with over $50 million dollars in cash and assets to be invested back to members through support and services. 2023 also saw the return of the ANF conference series, with the highly successful Legal Conference and Work Health & Safety Conference. “Our Legal Conference in June and Work Health and Safety Conference in August saw over 700 ANF members come for two days of informative talks, all relevant to contemporary nursing and midwifery, and all counting towards your year CPD requirements,” Ms Reah said. “With headline speakers across the health profession, ANF members were given a trove of professional knowledge in the areas of Legal and Health and Safety.”

The ANF continued to push for enforceable ratios to protect nurses and patients.

The ANF will continue our Conference Series in 2024 with more dates and topics to be revealed in the coming months.

December 2023 Western Nurse | 5

An artistic expression of gratitude to nurses

The Western Nurse was lucky enough to meet with artist Claudia Woeltjes while she was in the process of creating the artwork.

Art can be an expression of many things, from hope to fear, from sadness to joy, and even love. It can also be an expression of gratitude, a way of thanking someone for their efforts and the challenges they faced. Artist Claudia Woeltjes wanted to express her gratitude to nurses, and to share that gratitude with as many people as possible. As part of her Master’s Degree in Fine Art at Curtin University Claudia has created a series of paintings depicting midwives, nurses and aged care workers, all captured in the calming green hues so often seen in healthcare settings.

6 | Western Nurse December 2023

The paintings, which show the myriad ways our nurses and midwives work to help and support their community, were then mounted on a trailer, so they can be moved from place to place. This idea of a moveable monument was central to Claudia’s overall vision for the artwork. Elsewhere in Australia and around the world, monuments to healthcare workers tend to be static, so they are often overlooked. “I felt that to just make a stationary monument would restrict the way the public viewed the monument. I would also have to choose

a particular spot where to put it. Then how would I let the world know it was there?” Claudia said. “On a trailer it is moving continuously. I can have it on the back of my car and I can drive it around on a weekend. “Or I can park in front of a hospital or in front of Roger Cook’s office,” Claudia added, with a laugh. In many ways, nurses are Claudia’s audience, but she stresses that it also the public more generally. “I want the public to understand how important nurses are to us. Everybody you speak says, ‘yes, we know that’, but do they really?

“I didn’t personally see the stress that they would have experienced, other than when I went up to their counter when I could see that they were discussing things or didn’t want to be disturbed perhaps. “But, inside my room, never ever did I feel the stress. “I picked up my partner from hospital the other day, after an operation, and there was no stress to be seen. It was amazing. These nurses are trained to be so calm. And yet I know they are going through a huge stress level, and I know that their job is very, very demanding. You don’t see that.” These experiences, and others like them, drew Claudia towards this project. The project itself has gone through a few changes since Claudia started. Initially Claudia had a greater focus on critical nursing. “I did want to paint critical nursing. I started off with a very different body of works and I discarded it all, because it just wasn’t right. “I started again from scratch. “I did a lot of research on the internet, just to get new ideas and to refresh old ideas because when you are in hospital, you kind of take it all in but you don’t remember it. You come out of it and say ‘I’m glad I’m out of here now, because I’m better,’ you just don’t take it in.” The end result of Claudia’s research and work has been the creation of a striking testament to the essential efforts of nurses and midwives. Particularly striking is the image of a nurse, clearly exhausted and sitting on the floor, perhaps after yet another long shift. This alone is something many of our readers will relate to.

“I’ve heard stories of where nurses have been badly treated by patients. I feel there is no need for that.

Claudia’s work was recently on display at the Curtin University as part of their Graduate Art Show.

“The message I want to share with nurses is, that we as the public do appreciate them and that we as the public want to show them gratitude.” This gratitude comes from personal experience, from when she was a child growing up in Austria right up until now. Claudia recalls fondly the first time she can remember meeting a nurse. “When I was nine I had my appendix out in Vienna, and I didn’t want to leave the hospital because the nurses were so nice to me.” Since then, she has had a number of positive interactions with nurses.

“I’ve had a few hospital visits. I’ve seen how hard the nurses were working. And I've followed the news items about the treatment they received the government and the unfairness of nursing ratios and overwork. I drew closeness to all of this, and I thought these nurses deserve to be honored the same way as any heroes.” During her stay in hospital, what struck Claudia most was how the nurses kept the stress they were feeling away from those they were caring for. December 2023 Western Nurse | 7

First new ANMF WA Branch Council President in 25 years

The recent ANMF WA Branch Council election saw a new Branch President for the first time in 25 years, with Trish Fowler choosing to step down from the role to allow new leadership, and the election of Loreta Murphy as the new WA Branch President. This change in leadership gives pause for a reflection on a remarkable period of stability within the ANMF WA Branch Council, and the beginning of an exciting new chapter in the history of the organisation.

Reflecting on a long career of service Thanks must go to Trish Fowler for her 25 years of dedication and service at ANMF WA Branch Council President. Ms Fowler started her long career in nursing nearly 50 years ago, on the east coast. She told the Western Nurse earlier in the year that her decision to train as a nurse was something she doesn’t really consider to be a decision. “I spent six months as an Assistant in Nursing in 1975 while waiting to start my hospital-based training at St Vincent’s Hospital in Sydney in the middle of 1976. I completed my training and registered in mid-1979,” Ms Fowler said. “Nursing, for me, was a family thing. It’s in the blood, so it didn’t occur to me to do anything else.” Working on the east coast, Ms Fowler joined the NSW Nurses Association during her training. She went on to work in the Middle East for several years, returning to Australia more permanently in 1992. After being in WA for a few years Ms Fowler decided to settle and make this her permanent home. She became a job rep soon after joining the ANF. “Being a member of the ANF is a total no-brainer,” Ms Fowler said.

8 | Western Nurse December 2023

“It’s the insurance you need but hope never to have to use. You don’t buy a new car and then drive it out of the lot without vehicle insurance, so why would you work in an industry like ours and not be an ANF member? “It also helps that I have always been a very political person and I have, all through my career, spoken up for my colleagues where there was injustice.” In 1998 Ms Fowler was appointed as ANF IUWP and ANMF WA Branch President to fill a casual vacancy. She was elected to the role in 1999. Over the next 25 years Ms Fowler has been instrumental in leading the Branch Council and ensure things ran smoothly. In fact, she considers the two decades years of peaceful accord for both ANF IUWP and ANMF WA Branch Councils to be her single greatest achievement. Leaving her position with the ANMF Branch Council Ms Fowler has plenty of great memories from her tenure. “I’ve always enjoyed getting out and meeting our members,” Ms Fowler said. “Representing WA at the Federal Council table, being part of the ANF delegation at the South Pacific Nurses Forum in Vanuatu and then Western Samoa are a couple of stand outs. There are far too many great moments.” She leaves some well-considered advice for successor, Ms Murphy. “You’re a highly experienced, accomplished and qualified Registered Nurse and the mother of adult offspring. You’ve got this!” “Don’t forget to relax and enjoy the ride and when all else fails remember the Standing Orders and the Rules.” Ms Fowler remains ANF IUWP President.

Stepping into the future Loreta Murphy brings years of experience in nursing, and a long history of involvement with the ANF, to her new role as ANMF WA Branch President. She started working in the nursing profession to help people and she firmly believes that, as President, she will be able to reach out and help nurses and midwives across the state. Her desire to support those who need it has always overcome what she describes as “her desire to avoid combative situations”. “I hate fighting, I hate arguments. But I hate injustice more,” Ms Murphy said. “I see a lot of injustice in nursing. It could be a nurse working triple shifts, or nurses being blamed for things that are out of their control. I want to see these things stop.” “I care deeply about representing others and I am honoured to have an opportunity to push Safe Harbour Legislation. I want to continue to represent nursing in a professional fashion bringing to light errors or mistruths presented by government, instead articulate the facts and not screaming for a fight. “I am not drawn to adversarial situations but my Irish heritage and being the great granddaughter of one Australia’s first suffragettes, means I will stand up and be counted when injustice is occurring.” This drive to help those in need was what prompted her to become a nurse. “I wanted to study health sciences, and corny as it sounds, I wanted to be in a service industry. I wanted to help people. My family

were heavily involved in St Vincent De Paul growing up. There was always an expectation that you gave to others. “During my training I worked as an enrolled nurse as after the first twelve months at university you were eligible to be registered. I worked across Victoria doing agency shifts for the next couple of years while studying.” She commenced her graduate year at St Vincent’s Hospital, Melbourne in February 1990. Ms Murphy is looking forward to starting in her new role, and she thanks the State Secretary and outgoing President for their commitment. “I really admire Trish and Janet and all their hard work and dedication they have towards our nursing and midwifery profession. Ms Murphy joined the ANF in Victoria as a novice nurse and quickly became a job rep. “I’ve always enjoyed an active involvement in hospital committees. I joined the ANF because I felt there were a number of industrial issues at work, leaving staff vulnerable and putting patient safety at risk.” Going forward Ms Murphy hopes to continue to be a positive and effective voice for members. “I hope I can see Safe Harbour Legislation eventuate, and I will work to ensure Professional Indemnity is always available for members.” The Western Nurse congratulates Ms Murphy on her appointment.

The Australian Nursing and Midwifery Federation WA Branch elections results The ANF recently announced the results of the ANMF WA Branch elections. The Western Nurse wants to thank the ANF members who took the time to participate as well as all the members who put themselves forward for election. Over 10 percent of members cast a formal vote in the election, a turnout is similar to previous ANF elections. Positions were open for Branch President, two Branch Executive Committee Members, a Branch Executive Committee Member (Casual Vacancy) and nine Branch Councillors.

Lee Collison was elected as Branch Executive Committee Member (Casual Vacancy). There were nine available positions as ANMF WA Branch Councillor. Maddison Bromwich, Jamie Puls, Virginia Power, Christian Pansini, Elaine Daniels, Lisa Natoli, Kammy Cassey, Tegan Simmonds and Andrea Magill were elected to this position. Congratulations go to all the successful candidates, and we wish you the best in your roles within the Council.

The results were as follows:

The first meeting of the new ANMF WA Branch will be held

Loreta Murphy has been elected WA Branch President.

in January 2024.

David Poole and Liz Kilkenny were elected as Branch Executive Committee Members.

Thanks must also go to outgoing ANF Branch Councillors for their time and service. December 2023 Western Nurse | 9

Your legal questions answered 500 ANF Members attended our Legal Conference earlier this year. It was an opportunity to listen to experts from across the nation on a range of legal subjects affecting nurses, midwives and other health professionals. We had so many questions from attendees that it was impossible to answer them all, so we followed-up up with our presenters and shared your questions with them.

Is it our duty to provide CPR in the community? For example, if someone knows that you are a nurse and not giving CPR to someone who needs it? As a matter of law, no. There is no duty to come to the aid of a stranger. There is nothing in the Nursing and Midwifery Board’s Code of conduct for nurses (1 March 2018) about rendering assistance in an emergency. The shared code of conduct that applies to the registered health professions other than nursing and midwifery, medicine and psychology says (at [1.4]: Treating patients in emergencies requires practitioners to consider a range of issues, in addition to providing best care. Good practice means you should offer assistance in an emergency that takes account of factors such as your own safety, your skills, the availability of other options and the impact on any other patients under your care, and continue to help until your services are no longer needed. That is good advice even if not in the Code of conduct for nurses. A practitioner should also consider whether their peers would consider failure to provide CPR in the particular circumstances, demonstrates “knowledge, skill or judgment possessed, or care exercised by, the practitioner in the practice of the health profession in which the practitioner is registered is below the standard reasonably expected of a health practitioner of an equivalent level of training or experience” (Health Practitioner Regulation National Law WA Act 2010 (WA) Schedule, Part 1, s 5 definition of ‘unsatisfactory professional performance’).

What’s the difference legally between saying a resident refused/resident chose not to have treatment? Is it playing with words? It’s just playing with words. Presumably someone says the patient “refused treatment” if they, the practitioner, really thinks the patient should have the treatment and they really want to administer it and the only thing that is stopping them is the patient’s choice. They may say the patient "chooses" not to have treatment when the practitioner discusses the options, and the doctor says “this treatment is available” but thinks the decision not to have it is reasonable in the circumstances.

Dr Michael Eburn is an Australian lawyer, with a strong background in legal issues that affect emergency services workers. He spoke at the conference about the conflict between a duty to act in a patient’s best interests and the patient’s right to self-determination.

But it’s just playing with words, in either case it’s the patient’s choice not to have treatment and a practitioner cannot administer treatment without the patient’s consent.

When does duty of care supersede patient rights? Never.

10 | Western Nurse December 2023

Clinical judgement is required to determine whether it is appropriate to assess for Gillick competence, and if it is appropriate to proceed with a proposed treatment for a minor. In situations such as assessing whether a 14-year-old is competent to consent to removal of wisdom teeth under general anaesthetic, it is important to discuss your assessment for Gillick competence with your supervisor and treating team in order to make an informed decision.

Regarding the Gillick competent minor what sort of documentation is required by the hospital/ treating team/ nursing staff - and does it only apply to one particular treatment or a whole admission? As with any nursing intervention, your assessment, findings and rationale for decision-making should be documented clearly in the patient notes.

Kate Rowan-Robinson is a registered nurse who specialises in clinical governance, with a background in sexology, and health and medical law. She spoke about medical consent, the mature minor and Gillick Competence.

I’ve been under the impression that the age of written consent for medical procedures/ operations at hospital is 16 years of age. Does Gillick Competence override this? For example, can a 14-year-old sign the consent for removal of wisdom teeth under general anaesthetic? It is always important to refer to your own facility’s policy and procedure when making decisions around Gillick competence. However, there may be clinical situations that do not neatly fit into your facility’s policy/procedure, and it may become necessary to consider whether it is appropriate to assess for Gillick competence. As with all assessments for Gillick competence, you need to consider whether the individual can: • Understand the nature, consequences and alternatives of a proposed treatment • Retain the information provided • Use the information provided to weigh up their decision • Communicate their decision It is less likely Gillick competence will apply the younger a minor is, or the bigger a proposed treatment is.

Gillick competence is always applied per proposed treatment, as the capacity for a minor to consent will depend upon the nature of the proposed treatment. Many proposed treatments may be applied across a hospital admission, and (depending upon the age and maturity of the minor) there will likely be variances in capacity for consent with the varying levels of intervention; this may be anything from taking a temperature with a forehead thermometer, to administering IV antibiotics or having major surgery. The minor may be capable of consenting to none, some, or all of the proposed treatments, so it is important to be continually assessing against each proposed treatment or intervention.

If I release a minor to someone else’s care, say, getting picked up by their “mother”, what lengths am I expected to go to to certify that it is indeed their mother, or another person that will be responsible for the child? If you have concerns about releasing a minor into the care of another individual, and whether they can be verified as a person responsible for the minor, always refer to your facility’s policy and discuss with your supervisor.

How does the Gillick competence work in a minor who is already under Guardianship act or DCF? Gillick competence works the same for each individual, regardless of whether the minor is under the care of a parent, guardian or the state. The Western Nurse will publish more answers to your legal questions over the next few editions. Write to us at western.nurse@anfiuwp.org.au if you have another question for Dr Eburn or Ms Rowan-Robinson. December 2023 Western Nurse | 11

EBANews The Enterprise Bargaining Agreement team at the ANF have their work cut out from them, supporting members across over 70 separate EBAs. Our team are working hard to ensure members are getting the best deal possible.

EN and RN agreement settled at St John of God The latest SJOG EN agreement has been settled and was approved by the Fair Work Commission. The SJOG RN agreement was taken to ballot in late September and was approved with a 55 percent majority. SJOG’s final offer included a 3 percent wage increase which was given as an administrative increase in January of 2023 and a further 3 percent in December 2023. In good news for non-permanent staff, casual loading was increased to 25 percent. There were also increased entitlements to purchased leave and compassionate leave. SJOG also made significant improvements to their salary sacrifice program.

A long and complex process with Lifeblood The EBA arrangements with Lifeblood (the Australian Red Cross) have been slowed by the complexity of the situation, but a resolution draws closer.

It isn’t all bad news. Overall WA members will see an increase in their annual leave from four to five weeks, along with a wage increase of 3 percent and a further 2.5 percent increase over the life of the agreement. After further negotiations led by WA our members will now be included in the 3.8 percent increase that will apply from the date of a positive ballot. They will be an increase from 12 to 15 days of personal leave and six days of professional development leave (before there was none) as well as improvements to other types of leave including DV, ceremonial, compassionate and gender affirmation leave. The negotiating team are continuing to work to improve the agreement with WA participating in a federal office application to the Fair Work Commission for conference to attempt to resolve the remaining disputes.

Offer rejected at Serco Serco, at the Acacia Prison, has been moving quickly to progress high level engagement with staff and our members on their latest EBA. The current offer from Serco includes a 3 percent wage increase per year for two years, and it will also include back pay of 3 percent. Serco have also agreed to the $3,000 one off cost of living payment to help support their workers. After a clear rejection by the members of the offer, the employer is now reviewing the offer to try and make improvements before presenting a new offer.

Progress continues at Ngala

Lifeblood previously worked under different state-based agreements. This changed recently when Lifeblood executives moved to amalgamate a majority of their state-based agreements into one national agreement. The process has been long and complex, due in part to the large number of people involved in the meetings. Often more than 90 representatives will attend, including branch representatives, individual bargaining representatives, representatives from other unions and member representatives.

Ngala went to ballot with a positive result of 97 percent of members voting in favour of the agreement. The agreement saw improvements to the amount of Parental Leave and access from the completion of one year of employment instead of the previous two years required. The final agreed wage increase was 3 percent a year for two years which was an increase on the initial offer.

WA's position is complicated as, unlike other states, our agreement does not expire until 30 June 2024. This means other states can consider different options as part of negotiations not available to our members, such as industrial action.

A number of agreements have been either approved by Fair Work or have been successful at ballot. A number are also about to go to ballot, as the ANF EBA team work to finalise agreements postponed by employers during COVID.

While the current offer would see national members receive a significant pay increase in most roles, this increase is the result a move away from a system of increments and introducing a banding system. Not only would this compress the current increments into a smaller progression scale, but the ANF is also concerned that the employer has no intention of creating a way to progress through the bands that would benefit workers until the next agreement. This could affect workers’ pay increases.

These include the Aurora EBA. This was a difficult agreement, with members initially voting it down, in favour of better conditions. The ANF EBA team were then able to negotiate a better wages offer, which resulted in a positive ballot result and has just been approved by the Fair Work Commission.

There are still a number of outstanding entitlements that the employer needs to decide upon, but it is likely there will be a reduction in offered entitlements. We are likely to see a loss of the ability to self-certify personal leave evidence, this will instead return to the request of the employer. Union engagement leave will likely be reduced from eight days to three. A major win was the recovery of the allowance for shifts starting before 7 am. While the Victoria allowance was ultimately decided on, this is a further improvement for WA members.

We have successfully started negotiations with Silver Chain nonnursing agreements, as well as with Opal Aged Care, RAAFA, Sexual Health Quarters and Little Sisters of the Poor.

There will likely be an increase to the notice period to four weeks when the employee resigns. There have also been changes to the wording of the redundancy and dispute resolution clause that we are still working on changing.

12 | Western Nurse December 2023

Progress generally across the board

The Seaforth Gardens EBA went to ballot and returned a positive result, with 80 percent of members voting for the agreement.

An update on the Aged Care wage case The EBA team have written to all aged care employers asking for them to provide their updates rates after the commencement of the wage increases required by the Fair Work Commission wage case. This was done to ensure all aged care employers are meeting their requirements. The ANF EBA team has received and followed up on a number of responses and enquiries from our members. The team has also started following up with those employers who have yet to provide an adequate response to our enquiries.

Member Question

Why doesn’t the ANF associate ourselves with the Labor Party – would this not give us greater bargaining power? There are a litany of reasons why the ANF WA has remained proudly independent. For one, there is a common misconception that being associated with the Labor Party – founded on workers’ rights – will help us achieve better wages and conditions, or even a say in the makeup of a Labor Government due to our power. I ask one question: have other unions associated with the Labor Party gained these better wages and conditions in recent years? The answer quite simply is no. For example, since WA Labor came into power in 2017, wages have fallen dramatically across the public sector, which occurred when former Premier McGowan decided to cap pay rises in 2017 at $1,000 per year. Despite over a dozen unions being affiliated with WA Labor, they had no say or effect in preventing or bettering this policy whatsoever. The Labor Party simply threw all public sector workers under the bus. But that isn’t the only time the Labor Party have turned their backs on WA’s nurses and midwives. The Labor Party have also continually prevented the ANF from being party to the Enrolled Nurses Agreement, essentially stopping the ANF from representing EN’s in WA even though we

overwhelmingly represent EN’s and now Carers. Despite these facts, the United Workers Union get to negotiate their agreement. As well, we need not mention the current wage negotiation debacle with the Cook Government, who simply treat WA’s nurses and midwives with contempt. Other unions as well charge exorbitant membership fees that go straight into the Labor Party’s coffers, even though those same workers get wage increases which undervalue them in return from the same political party. This is a core reason why the ANF has never associated ourselves with any political party. Our independence is our strength and that is what a union should do. As well as the public sector, the ANF of course does not only deal in the public sector nurses and midwives. We of course represent over 20,000 private sector members in which affiliation with WA Labor would not benefit them. Finally, historic ANF member polls have shown split voting support for both major parties, as well as some minor party support. For the ANF to be affiliated with a party that over half of the members do not vote for would be divisive and undemocratic. A union’s job is to independently negotiate with the elected government of the day. If that government of the day happens to be the opposite of who we would be aligned with, for example the Liberal Party, what incentive do they have to negotiate in good faith if there is instant distrust via association of their opponent? The ANF will continue to be the strongest union in WA, which has come from our strict independence. December 2023 Western Nurse | 13

Need help?

Talk to the ANF

ANF services continue over Christmas and New Years period The ANF will continue to provide services over the Christmas and New Year period. That means the ANF Helpline service, membership inquiry service as well as the ANF email inquiry service will operate as usual, with the exception of the public holidays: Christmas Day (Monday 25 December), Boxing Day (Tuesday 26 December) and New Years Day (Monday 1 January). The emergency after-hours service provided by ANF State Secretary Janet Reah will also continue over this period. Members can book their Helpline appointment via iFolio as per usual. We understand that work, and therefore work-related issues, does not stop just because it the holidays, so we will still have staff on hand to respond to ANF members requiring our assistance.

We are here to help. Don’t hesitate to book a time to talk via Helpline through your iFolio. 14 | Western Nurse December 2023

ANF to become ANMF

The ANF Council has passed a motion to change the name of the Australian Nursing Federation Industrial Union of Workers, Perth (ANFIUWP) to include midwives. The motion for a new name was brought forward by ANF Councillor Jane-Anne Gardner, who recommended the change in a letter to Council earlier this year. The decision was welcomed by ANF State Secretary Janey Reah, who said the name change will ensure both nurses and midwives are equally acknowledged. The motion to change the ANF’s name was passed with a unanimous vote from the Council. In her letter, Councillor Gardner said that as the ANFIUWP represents midwives and midwifery is seen as a stand-alone profession it was in the best interest of the ANFIUWP to add midwives to the name. “By not having midwives in the name a cohort of potential members and those who are already members could feel unheard and not acknowledged,” Councillor Gardner said. “It is true nursing and midwifery are both aligned as professions, but they are both very different from each other. Historically to be a midwife you needed to be a registered nurse however this has not been the case for many years.” ANF State Secretary Janet Reah thanked Councillor Gardener for formally bringing this matter to Council.

“Changing the name of the ANFIUWP to include midwives has been a popular idea voiced by of our members. Now with this formal motion we are making change a reality,” Ms Reah said. “I know the many midwives in our organisation will be pleased to see the name changed. Members can expect to see the new name change coming into effect in the next year.” The ANF Council resolution changes the ANFIUWP rules to add the word Midwifery to the title to then become the Australian Nursing and Midwifery Federation Industrial Union of Workers, Perth or ANMFIUWP.

The Western Nurse wants to hear from you If you have a story to share about your profession, current practices or research, milestones you have reached or achievements and awards received by you or your team, then the Western Nurse encourages you to get in touch. We are always on the lookout for new stories. Get in contact by email at western.nurse@anfiuwp.org.au to share your stories. We also encourage you to send through photos. You can also send through any questions you have about the Western Nurse publication. We hope to hear from you soon. The Western Nurse

December 2023 Western Nurse | 15

CONTINUING PROFESSIONAL DEVELOPMENT

ANFClinical Updates Reducing the number of needlestick ANF iFOLIO CLINICAL UPDATE:

Reducing number injuries inthe health care of needlestick injuries incomplete health care Read this article and the quiz to earn 1 iFolio hour Read this article and complete the quiz to earn 1 iFolio hour There is no standardised surveillance system for recording the number of needlestick injuries (NSIs) among Australian healthcare workers, however it was reported in 2012 that one in nine nurses in Australia experienced at least one NSI in the past 12 months.1 In addition, 80% of reported NSIs involved a contaminated needle.1 Despite calls for policy reform, including the mandated use of safety engineered medical devices (SEMDs), Australia does not have legislation or jurisdictional directives mandating the adoption and use of SEMDs.1

TYPES OF SHARPS AND INJURY OCCURRENCE Hollow bore needles, especially those used for blood collection or intravascular catheter insertion, are of particular concern because they are likely to contain residual blood. Non-hollow bore sharps, such as glass vials and suture needles, have also been involved in sharps incidents.2 The use of sharp devices exposes nurses and midwives to risk of injury and potential exposure to blood borne viruses, including hepatitis B, hepatitis C and human immunodeficiency virus (HIV).2 Sharps injuries most often occur:2 • During the use of a sharp device on a patient (41%), • After use and before disposal of a sharp object (40%), and • During, or after, appropriate or inappropriate disposal of sharp devices. (15%). The risk of being infected with hepatitis B, hepatitis C and HIV is:3 • 6–30% after an injury with a needle contaminated with the hepatitis B virus, • 1.8% after an injury with a needle contaminated with hepatitis C, and • 0.3% after an injury with a needle contaminated with HIV.

16 | Western Nurse December 2023

Table 1: Examples of hollow bore and non-hollow bore sharps associated with injuries2

Hollow bore sharps

Non-hollow bore sharps

Disposable needles/syringes

Glass vials

Steel-winged (butterfly) needles

Dental probes

Intravenous catheter stylets

Scalpel blades

Multi-sample blood collection needles

Suture needles

Arterial blood collection syringe needles

Retractors

Aspiration needles

Skin or bone hooks

Injector pen needles

Sharp electrosurgical tips

SAFETY ENGINEERED MEDICAL DEVICES

SEMDs, and of these 19.4% were not, or only partially, activated.4

A Safety engineered medical device is a non-needle sharp or needle device used to withdraw body fluids, access a vein or artery, or administer medications and other fluids. It has a built-in safety feature, or mechanism, that reduces the risk of the healthcare worker being exposed to bloodborne pathogens.1 SEMDs can be used in place of most conventional needles and sharp devices.1

Of the 6,718 non-safety devices, 30.6% were capped needles or capped needle syringes. Overall, 75% of hollow bore needles were capped or naked, indicating that many healthcare workers were at risk of NSIs when handling the sharps after use through recapping.4

TYPES OF SEMDS There is a growing number of devices engineered to improve safety for healthcare workers including:1 • Lancets, • Syringes, needles and injecting devices, • IV access insertion devices, • Blood collection and venepuncture, • Pre-loaded syringes, • IV delivery systems, • Surgical scalpels, and • Suture needles.

THE FREQUENCY OF SEMD NON-ACTIVATION A 2014 audit of 167.9kgs of sharps from 102 sharps containers collected from 27 hospitals across five Australian capital cities identified a problem with non-activated and improper disposal of sharps.4 Of the 9,651 hollow bore needles, 30.4% were

Statistical data released in the US in 2019, revealed a high rate of non-activated safety devices.5 After collating the results of 1,335 reports from hospitals and healthcare facilities, the data demonstrated that NSIs were caused by a needle or sharp medical device with a safety design 52.2% of the time.5 In 71.6% of those instances, the safety mechanism was not activated – or only partially activated (19.6%).5

KEEPING STAFF SAFE: REDUCING NEEDLESTICK INJURIES – 2020 NSW HEALTH AWARDS Finding no significant reduction in NSIs after introducing safety awareness initiatives, healthcare workers in the NSW’s Hunter New England Local Health District (LHD) took proactive action. 6 They worked collaboratively with NSW Health and introduced a project mandating the ‘use of standardised safety engineered sharps devices for subcutaneous and intramuscular injections’. The result was a 31% reduction in needlestick injuries from hollow bore needles in 2019, compared to 2018, and a 60% overall reduction in 2020.6

RECOMMENDATIONS FOR REDUCING NSIS IN HEALTHCARE FACILITIES

• Use instruments, rather than fingers, to grasp needles, retract tissue, and load/ unload needles and scalpels.

Always place wall-mounted units away from general waste bins to avoid risk of incorrect disposal.2

The Australian Guidelines for the Prevention and Control of Infection in Healthcare recommend that each healthcare facility has a policy on the management of NSIs, and on providing immediate post-exposure advice for sharps injuries and other blood or body substance incidents involving healthcare workers.2 Generic policies may not be relevant for these types of exposures.2

• Give verbal announcements when passing sharps.

TRAINING AND EDUCATION

• Avoid hand-to-hand passage of sharp instruments by using a basin or neutral zone.

The Australian College for Infection Prevention and Control is the peak body for infection prevention and control professionals.

EXPOSURE AND INFECTION CONTROL The Victorian Government Department of Health offers useful guidelines for organisations on what should be included in facility based protocols7. It recommends that all health services develop their own infection control protocols for communicable diseases. These should include clear written instructions on the correct action to take after an exposure to blood or body fluids and substances.7 The instructions should include the contact details of an appointed medical officer, details of the laboratory that will process emergency specimens, a pharmacy that stocks prophylactic medication, and procedures to examine the incident, and consider any changes to prevent reoccurrence. Lastly, it recommends prescribed details for prompt reporting, evaluation, counselling, treatment and follow-up be included.7

NSI PREVENTION: ADHERENCE TO SAFE HANDLING AND DISPOSAL PROCEDURES Adherence to the basic principles associated with the proper handling and disposal of sharps reduces the risk of NSIs:2 Illustration 1: Positioning a sharps container2

• Use round-tipped scalpel blades instead of pointed sharp-tipped blades. Whether gloves protect against bloodborne infectious agents has not been determined.2 While gloves may reduce the volume of blood on the external surface of a sharp, the residual blood in the lumen of the hollow bore needle is not affected.2

POSITIONING SHARPS CONTAINERS All used single-use syringes and needles, scalpel blades and other sharp items, such as capillary tubes and glass, should be placed in an appropriate container.2

The college now includes the state and territory infection control associations and healthcare workers can apply for credentialing in infection prevention and control.2

REFERENCES 1. Medical Technology Association of Australia. 2012 [cited 2021 August 7]. Use of safetyengineered medical devices (SEMDs) to improve prevention of needlestick and sharps injuries in the healthcare setting. Available from: https://www.mtaa.org. au/sites/default/files/uploaded-content/ website-content/Sharpsv5.pdf

Containers should be clearly labelled, puncture and leak proof, and conform to Standards AS 4031:1992 and Amendment 1: 1996, AS/NZS 4261: 1994 and Amendment 1: 1997 or a relevant international standard, for example – ISO 23907:2019.2

2. National Health and Medical Research Council, Australian Commission on Safety and Quality in Health Care. May 2019 [cited 2021 August 7]. Australian Guidelines for the Prevention and Control of Infection in Healthcare. Available from: https:// www.nhmrc.gov.au/sites/default/files/ documents/infection-control-guidelinesfeb2020.pdf

Locate the containers at the point of use, or as close as practicable to the use area. Reusable sharps requiring transport to a reprocessing area must be placed in a puncture-resistant lidded container.2

3. Canadian Centre for Occupational Health and Safety (CCOHS). July 2018 [cited 2021 August 7]. OSH Answers Fact Sheets. Available from: https://www.ccohs.ca/ oshanswers/diseases/needlestick_injuries. html

Sharps must by accessible to the healthcare worker, but out of reach of children or others to prevent hands and fingers entering the disposal unit. They must also be placed in a secure position or mounted on a wall to prevent tipping – approximately 125cm off the ground.

4. Grimmond T. May 2014 [Cited 2021 August 7]. Frequency of use and activation of safety-engineered sharps devices: a sharps container audit in five Australian capital cities. CSIRO Publishing. Available at: https:// www.publish.csiro.au/HI/HI14009 5. nternational Safety Center December 2019 [cited 202 August 7]. EPINet Report for Needlestick and Sharp Object Injuries. Available from: https:// i nt e r n at i o n a l s afe t yce nt e r. o rg / w p content/uploads/2020/06/2019-EPInetNeedlestick-Sharps-Summary.pdf 6. NSW Government. 2020 [cited 2021 August 7]. 22nd Annual NSW Health Awards 2020, Keeping Staff Safe – Reducing Needlestick Injuries. Available from: https://www.health. nsw.gov.au/innovation/2020awards/Pages/ reducing-needlestick-injuries.aspx 7. Victoria State Government health.vic. n.d. Managing exposures to blood and body fluids or substances. Available from: https:// www2.health.vic.gov.au/public-health/ infectious-diseases/infection-controlguidelines/manage-exposure-blood-bodyfluids-substances

December 2023 Western Nurse | 17

LATEST NEWS AND RESEARCH

AroundtheGlobe “However, Australia’s largest orchid lineage, which accounts for over 60 percent of Australia’s orchid species diversity, originated in Australia and dates back more than 40 million years.

UNICEF has procured nearly 15 million HPV vaccines on behalf of the Government of Nigeria. According to the WHO, over 16 million girls could be protected in Nigeria alone by 2025.

“In contrast, most orchid species worldwide originated fairly recently in Earth’s history, within the last 5 million years.”

Orchids at risk of extinction Up to 45 percent of all known flowering plant species across the world could be under threat of extinction, with orchids particularly at risk, according to the State of the World’s Plants and Fungi 2023 report, published by the Royal Botanic Gardens, Kew. Australia’s national science agency, CSIRO, contributed to the report. CSIRO orchid researcher, Dr Katharina Nargar was a senior author of the report’s chapter on orchids. “Plants and fungi sustain life on Earth and provide valuable ecosystem services, food, medicine, clothing, and raw materials. But the natural world is threatened by the dual crises of climate change and biodiversity loss,” Dr Nargar said. “With some 350,000 species of vascular plants, which includes trees, shrubs, ferns and flowering plants like orchids already known to science, researchers are in a race against time to scientifically name and assess as many as 100,000 more.” Worldwide, scientists name about 2,500 new plants each year. New estimates suggest as many as three in four undescribed vascular plants are already likely to be threatened with extinction.

Nigeria to vaccinate 7.7 million girls against HPV Nigeria has announced an ambitious new human papillomavirus (HPV) vaccination program, aiming to reach 7.7 million girls. This will be the largest single round of HPV vaccination in Africa, with girls aged 9 to 14 to receive a single dose of the HPV vaccine in a bid to reduce the instances of cervical cancer. According to the World Health Organisation, cervical cancer is the third most common cancer in Nigeria, and it is the second most common cause of cancer deaths in women aged between 15 and 44. In 2020, the last year for which data is available, Nigeria recorded 12,000 new cases and 8,000 deaths from cervical cancer. Nigerian Minister for Health and Social Welfare Muhammad Ali Pate says the loss of about 8,000 Nigerian women yearly from a disease that is preventable is completely unacceptable. “Cervical cancer is mostly caused by HPV, and parents can avoid physical and financial pain by protecting their children with a single dose of the vaccine,” Minister Pate said. “The onset of the vaccination campaign is an opportunity to safeguard our girls from the scourge of cervical cancers many years into the future.

Dr Nargar said recent DNA sequencing had added to botanical knowledge based on physical characteristics and challenged previously held beliefs on the evolution and distributions of orchids.

“As a parent myself, I have four daughters, all of them have had the same HPV vaccine to protect them against cervical cancer. I’d like to implore fellow parents to dutifully ensure that this generation of our girls disrupt the preventable loss of lives to cervical cancer in addition to other untold hardship, loss and pain.”

“New data suggests the orchid family did not originate in Australia as we thought. Instead, it originated in the northern hemisphere around 83 million years ago before it spread across the world,” Dr Nargar said.

The vaccination program begins with a fiveday mass vaccination campaign in schools and communities across the country. The vaccine will then be incorporated in routine immunization schedules within health facilities.

26 | Western Nurse December 2023

Massive World War Two bomb discovered under Athens airport The Greek army has reportedly diffused a 226 kilogram World War Two era bomb discovered at a building site in Glyfada, a southern suburb of Athens. The giant explosive was unearthed at the former airport of Ellinikos, which is currently undergoing large-scale urban redevelopment. The unexploded bomb is believed to be a relic of World War Two, having sat idle under the airport for decades. Members of the Land Mine Clearance Battalion defused the device using thermite in order to avoid an explosion, with support from a number of other agencies and emergency services. Following the successful operation, Mayor of Glyfada Giorgos Papanikolaou reported that all was now well. “World War Two may have ended almost eight decades ago, but its scars are still present in our country, even underground,” Mayor Papanikolaou said. The mayor thanked all the agencies who cooperated in the operation, including the special battalion of the Army, Greek Police and Traffic, the Fire Brigade, Civil Protection for the municipality and the municipal Police. “A complex and sensitive operation was carried out in an absolutely perfect way,” Mayor Papanikolaou said.

The mayor also thanked the residents of the neighbourhood for their co-operation. “Residents and visitors of our city suffered a two-hour inconvenience, but everyone’s safety comes first and the important thing is that everything was done without the slightest risk to any of our fellow citizens.” However, this does not necessarily mean there is no risk of further devices being uncovered, as the airport had been bombed extensively during World War Two.

Dr Tedros Adhanom Ghebreyesus, WHO Director-General said Egypt has gone from having one of the world’s highest rates of hepatitis C infection, to being on the path to elimination in less than 10 years.

“Agriculture Specialists seized the box, and the excrement was destroyed via steam sterilisation per United States Department of Agriculture destruction protocol,” the statement said.

“Egypt is an example to the world of what can be achieved with modern tools, and political commitment at the highest level to use those tools to prevent infections and save lives,” Dr Ghebreyesus said.

US Customs and Border Protection reminded travellers that all ruminant animal faeces require a Veterinary Services Permit for entry into the United States.

Bird sabotages town’s power with fish

“There is a serious possibility that other similar bombs or missiles will be found buried in the subsoil of the area. Therefore we will be in constant cooperation with all the relevant bodies,” Mayor Papanikolaou said.

Several thousand residents of Sayreville New Jersey were left without power for about two hours, after a fish destroyed a vital transformer in the area. Evidence collected at the scene of the incident strongly suggests the fish was dropped by a passing bird. The Sayreville Police Department reported via a statement on Facebook that the local power company found a deceased fish on a damaged transformer and that the resulting fish-related damage had caused power outage affecting residents in the Lower Sayreville area. This power outage was described by police as “a major inconvenience”.

Egypt a step closer to eliminating hepatitis C

Giraffe faeces seized by US customs

The World Health Organisation has congratulated the Arab Republic of Egypt, which is on the path to completely eradicating hepatitis C.

While customs officials around the world must be used to seeing all manner of strange things, US Customs and Border Protection agriculture specialists at Minneapolis – Saint Paul International Airport, were no doubt left scratching their heads after a passenger declared a box of giraffe faeces.

The WHO said Egypt has become the first country to achieve the “gold tier” status on the path to elimination of hepatitis C, putting the on track for hepatitis elimination, defined at fewer than 5 per 100,000 new cases per year before 2030. Egypt reduced the incidence of new infections from 300 per 100,000 in 2014 to 9 per 100,000 in 2022. Dr Meg Doherty, WHO’s Director of Global HIV, Hepatitis and STI Programmes said Egypt is an inspiration to many other countries are working towards the elimination of hepatitis C, hepatitis B or mother to child transmission of hepatitis B. “Similar achievements are within reach of many countries if they follow Egypt’s example – and use the tools available and assure political commitment,” Dr Doherty said.

More curious still was the passenger’s intended use for the droppings. According to an official statement from US Customs and Border Protection a passenger returning from Kenya arrived at MSP and was selected for inspection by CBP agriculture specialists.

While the exact events leading up to the fatal incident remain unclear, police hypothesised that the most likely culprit was a passing bird, which dropped the fish while passing over the area. There have also been reports in the American media that the repair crew responding to the incident had seen what appeared to be claw or talon marks on the body of the deceased fish. The statement from the Sayreville police, which referred to the fishy victim as “Gilligan”, went on to say that the avian suspect in the case was “last seen heading south”. “If you see him do not try to apprehend him. Although he isn’t believed to be armed he may still be very dangerous,” the statement read.

The passenger declared the giraffe faeces and stated she had obtained the droppings in Kenya and planned to make a necklace. According to the statement, the passenger went on to say this was not the first time she had made jewellery out of animal droppings, stating that she had previously used moose faeces at her home in Iowa. December 2023 Western Nurse | 27

28 | Western Nurse December 2023

THE BRAIN BUSTER

9 11

14 15

19 20

23 25

27 28

30 31

34 35

40 41

1 Fertile, able to reproduce (6) 5 --- review, assessment by colleagues or fellow students to judge the quality and originality of a medical article (4) 9 Less common (5) 10 Lower back bones (5) 11 Fancy French cake (6) 13 Edible green pod also known as lady’s finger (4) 15 University head (4) 16 One of the vital signs used by medical partitioners to assess a patient’s general health (5,8) 20 Foot digits (4) 22 Aslant, leaning (6) 24 Country associated with acupuncture (5) 25 Attempt (3) 27 Syringes (7) 28 Dangers associated with a medical procedure (5) 30 Taverns (4) 31 Transparent part of the eye (6) 33 3,4-Methylenedioxymethamphetamine (1,1,1,1) 35 Medical condition in which superficial blood vessels become enlarged and twisted (8,5)

46 47

CLUES ACROSS

39 Inflammation of the eye (4) 41 It sits atop the neck (4) 42 Small mechanical device (6) 45 Grinding tooth (5) 46 French farewell (5) 47 Small rip in a muscle (4) 48 Symbols of authority (6)

DOWN 1 2 3

Thick mist (3) Incision (3) Religious leaders and medical professionals of ancient Celtic history (5) 4 Public Health ---, stringent ru le or restriction designed to minimise the effects of COVID-19(5) 5 Pokes (5) 6 Responsible service of alcohol (1,1,1) 7 Minor body pain (4) 8 Vital nutrient found in every cell of every living organism (9) 12 Swedish supergroup (4) 14 Wake up someone from a stupor (5) 15 Put off, dissuade (5) 17 Livers, kidneys and lungs etc (6) 18 Fake medication with no active properties (7)

19 Long slithery fish (3) 21 Body parts that don’t lie, according to Shakira (4) 23 Tunnel or narrow space connecting one area to another (7) 24 Long DNA molecule with part or all of the genetic material of an organism (10) 25 Process by which medical professionals determine the order of priority of providing treatment (6) 26 Pull, tug (4) 29 Rascal, rogue (5) 31 Slice up meat or flesh (5) 32 Keanu Reeve’s character in The Matrix (3) 34 Dr Moreau lived on one (4) 36 Furniture wood (5) 37 --- medical bill, unpopular invoicing strategy whereby patients may pay for the same treatment twice (5) 38 --- nerve, also known as the tenth cranial nerve (5) 40 Shout (3) 41 Type of therapy used to treat the symptoms of menopause (1,1,1) 43 Where you go to get fit and build up your muscles (3) 44 Tasmania (abbrev) (3)

Down: 1 Fog, 2 Cut, 3 Druid, 4 Order, 5 Prods, 6 RSA, 7 Ache, 8 Magnesium, 12 ABBA, 14 Rouse, 15 Deter, 17 Organs, 18 Placebo, 19 Eel, 21 Hips, 23 Passage, 24 Chromosome, 25 Triage, 26 Yank, 29 Knave, 31 Carve, 32 Neo, 34 Isle, 36 Cedar, 37 Split, 38 Vagus, 40 Yell, 41 HRT, 43 Gym, 44 Tas. Across: 1 Fecund, 5 Peer, 9 Rarer, 10 Sacra, 11 Gateau, 13 Okra, 15 Dean, 16 Blood pressure, 20 Toes, 22 Aslope, 24 China, 25 Try, 27 Needles, 28 Risks, 30 Inns, 31 Cornea, 33 MDMA, 35 Varicose veins, 39 Stye, 41 Head, 42 Gadget, 45 Molar, 46 Adieu, 47 Tear, 48 Stamps.

December 2023 Western Nurse | 29

CONTINUING PROFESSIONAL DEVELOPMENT

ANFClinical Updates Acute appendicitis: ANF iFOLIO CLINICAL UPDATE:

Acute appendicitis: a clinical update this article and update complete the quiz to earn 1 iFolio hour aReadclinical Read this article and complete the quiz to earn 1 iFolio hour Acute appendicitis is an inflammation of the appendix (see Illustration 1).1 It is usually caused by an obstruction of the appendiceal lumen.1,2 The main causes of obstruction are appendicolith (calcified deposit within the appendix), stool, lymphoid hyperplasia, intestinal parasites, and appendiceal tumours.1,2 The obstruction causes the appendix to fill with mucus leading to the distension of the lumen and an increase in intraluminal and intramural pressure.1,2 The increased pressure results in small vessel occlusion and lymphatic stasis, and as the vascular and lymphatic compromise advances, the wall of the appendix becomes ischemic and necrotic.1,2 As the condition progresses, bacterial overgrowth occurs in the obstructed appendix causing the formation of pus and acute inflammation.1,2 Once significant inflammation and necrosis occur there is a risk of perforation and abscess formation.1 However, perforation is not necessarily the inevitable.3 Appendicitis typically presents acutely, usually within 24 hours of onset, but it can also present as a more chronic condition.1 Acute appendicitis is the most common cause of abdominal pain requiring surgery.4 Acute appendicitis most commonly occurs in people between the ages of 10 and 30.2,5 The highest incidence of acute appendicitis is in children and adolescents.2 It is rare in children under the age of five.6 There is a slight male to female predominance; the lifetime risk of appendicitis is 8.3% in males and 6.7% in females.2

SIGNS AND SYMPTOMS The most common symptom of acute appendicitis is abdominal pain.1,5 The pain typically presents initially as a dull pain centred on the belly button that progresses to a sharp pain localised in the lower right side of the abdomen.1,5 The pain may be worse when the abdomen is touched, or the patient is taking deep breaths, coughing, sneezing, or walking.5,7

30 | Western Nurse December 2023

Table 1: Appendicitis Inflammatory Response Score2

Feature

Score

Vomiting

Pain in right inferior fossa

Rebound tenderness

Light

Medium

Strong

Body temperature ≥38.5°C Polymorphonuclear leukocytes

White blood cell count

C-reactive protein concentration

1 70-84%

≥85%

10-14.9x109/L

≥15x109/L

10-49mg/L

≥50mg/L

Other common signs and symptoms of appendicitis include fever, nausea, vomiting, loss of appetite, constipation, diarrhoea, and abdominal bloating.5,8,7

COMPLICATIONS Acute appendicitis can lead to a ruptured appendix which can cause serious complications, such as peritonitis and abscesses.5,7 Peritonitis, an infection of the lining of the abdomen, may occur if the appendix ruptures and the infection spreads in the patient’s abdomen.5,7 Peritonitis can be very serious, if left untreated it may lead to sepsis, multiple organ failure, and death. 5,7 An abscess may also form around a ruptured appendix.5

DIAGNOSIS As the symptoms of acute appendicitis are similar to other disorders, such as gastroenteritis, ectopic pregnancy, ovarian torsion, Crohn disease, and infections, diagnosing appendicitis can be difficult.1,8 An acute appendicitis diagnosis is generally made using a combination of clinical assessment, including a detailed history and physical examination, blood tests, and urinalysis.1,5

The higher the score, out of a maximum of 12, the greater the likelihood of appendicitis:2 • A score of 0-4 indicates a low probability of appendicitis – recommend outpatient follow up if unaltered general condition • A score of 5-8 is indeterminate – recommend active observation in hospital with diagnostic imaging according to local protocols • A score of 9-12 indicates a high probability of appendicitis – recommend surgical exploration.

Validated clinical scores, such as the appendicitis inflammatory response (AIR), adult appendicitis score (AAS), Alvarado score, and paediatric appendicitis score (PAS), can be used to determine the likelihood of appendicitis to guide further investigation and treatment.2,4 Scoring systems rely on a combination of factors derived from physical symptoms and laboratory tests to produce a numerical score to rule in or rule out a diagnosis of acute appendicitis.2,9 The best performing clinical prediction scores for adults are the AIR score (see Table 1) and AAS.2,3 In children the Alvarado score and PAS are useful to exclude appendicitis.2 The mnemonic MANTRELS covers the factors described by the Alvarado score (see Table 2).9 Diagnostic imaging, such as abdominal ultrasound, magnetic resonance imaging (MRI) or computed tomography (CT) scans, may also be used to confirm a diagnosis of acute appendicitis when appendicitis is suspected but unclear from the clinical assessment, blood tests, and urinalysis.1,4,5

Table 2: Alvarado score9

Feature

Illustration 1: Appendicitis

Score

Migration of pain to the right iliac fossa

Anorexia

Nausea or vomiting

Tenderness in the right iliac fossa

Rebound pain

Elevated temperature >37.3°C

Leukocytosis

Shift of white blood count to the left

The higher the score, out of a maximum of 10, the greater the likelihood of appendicitis:2,9 • A score of 0-4 indicates appendicitis is unlikely • A score of 5-6 is indicates appendicitis is possible • A score of 7-8 indicates appendicitis is probable • A score of 9-10 indicates appendicitis is very probable.

DIAGNOSIS IN PREGNANCY Diagnosing acute appendicitis can be particularly challenging during pregnancy as abdominal complaints are common.4 Additionally, the presentation of acute appendicitis may be atypical due to displacement of the appendix by the gravid uterus and physiological leucocytosis.4 The preferred initial imaging method for suspected acute appendicitis during pregnancy is graded compression transabdominal ultrasounds.3 If the ultrasound is inconclusive, an MRI should be conducted.3

TREATMENT Uncomplicated acute appendicitis The usual treatment for uncomplicated acute appendicitis is surgery to remove the appendix known as an appendectomy.2 There are two types of surgery to remove the appendix: open appendectomy and laparoscopic appendectomy.5 In an open appendectomy an incision 2-4 inches long is made in the lower right-hand side of the abdomen and the appendix is removed through the incision.5 In a laparoscopic appendectomy three small incisions are made in the abdomen and a cannula is used to inflate the patient’s abdomen with carbon dioxide gas, a laparoscope is inserted, and the appendix is removed through one of the incisions.5 A laparoscopic appendectomy is generally preferred as it is associated with a shorter hospital stay, reduced postoperative pain, reduced risk of wound infection, and better cosmetic results compared with open appendectomy.2 However, if the patient’s appendix has ruptured and the infection has spread an open appendectomy may be needed.5

There is emerging evidence to suggest that a nonoperative, antibiotic-only approach may be reasonable to treat appendicitis in select patient populations.2 However, the evidence supporting a nonoperative approach to treating appendicitis continues to be conflicting and further research is needed.2 There is more evidence to support a nonoperative approach in children than in adults.2 An antibiotic-only treatment approach is not recommended if an appendicolith is present.2

Complicated acute appendicitis The usual treatment for complicated acute appendicitis involving acute peritonitis is an appendectomy.5 Complicated appendicitis involving perforation or abdominal abscess is initially treated with intravenous antibiotics and drainage of the pus and fluid.3,5 An interval appendectomy is performed once the infection has cleared if the symptoms are not completely resolved.3,5

REFERENCES 1. Jones MW, Lopez RA, Deppen JG. Appendicitis. 2021 [cited 2021 Sep 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing LLC. Available from: https://www.ncbi.nlm.nih.gov/ books/NBK493193 2. BMJ Best Practice. Acute appendicitis [Internet]. London: BMJ Publishing Group Ltd; 2021 [cited 2021 Sep 10]. Available from: https://bestpractice.bmj.com/topics/en-us/290/pdf/290/Acute%20 appendicitis.pdf 3. Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg [Internet]. 2020 [cited Sep 10];15:27. doi: 10.1186/s13017-020-00306-3 4. Agency for Clinical Innovation: Emergency Care Institute. Clinical Resources [Internet]. Acute Appendicitis; 2020 [cited 2021 Sep 9]. Available from: https://aci.health.nsw.gov.au/networks/eci/ clinical/clinical-tools/abdominal-emergencies/acute-appendicitis 5. Johns Hopkins Medicine. Johns Hopkins Medicine [Internet]. Appendicitis; 2021 [cited 2021 Sep 9]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/appendicitis 6. The Royal Children’s Hospital Melbourne. Factsheets [Internet]. Appendicitis; 2020 [cited 2021 Sep 10]. Available from: https://www.rch.org.au/kidsinfo/fact_sheets/Appendicitis 7. National Health Service. Health A-Z [Internet]. Appendicitis; 2019 [cited 2021 Sep 10]. Available from: https://www.nhs.uk/conditions/appendicitis/symptoms/ 8. Healthdirect Australia. Healthdirect [Internet]. Appendicitis; 2020 [cited 2021 Sep 10]. Available from: https://www.healthdirect.gov.au/appendicitis 9. Cadogan M. Life in the Fast Lane [Internet]. Alvarado score; 2020 [cited 2021 Sep 11]. Available from: https://litfl.com/alvarado-score

December 2023 Western Nurse | 31

ANF Education Free legal talks open for ANF members date

time

topic

location

Tuesday, February 06

6pm

Discrimination

ANF Office + Zoom

Tuesday, February 08

12pm

Discrimination

ANF Office + Zoom

Tuesday, February 13

6pm

Defamation

ANF Office + Zoom

Tuesday, February 15

12pm

Defamation

ANF Office + Zoom

Tuesday, February 20

6pm

Coroners Court

ANF Office + Zoom

Tuesday, February 22

12pm

Coroners Court

ANF Office + Zoom

Tuesday, February 27

6pm

Social Media

ANF Office + Zoom

Tuesday, February 29

12pm

Social Media

ANF Office + Zoom

Tuesday, March 05

6pm

Resolve workplace issues

ANF Office + Zoom

Tuesday, March 07

12pm

Resolve workplace issues

ANF Office + Zoom

Tuesday, March 12

6pm

Workers Compensation

ANF Office + Zoom

Tuesday, March 14

12pm

Workers Compensation

ANF Office + Zoom

Topics covered The ANF offers informative talks on topics relevant to contemporary nursing and midwifery, all for free.

Places are available on a range of topics: Coroners Court: Learn more about coroners' investigations including discussions on the role of the coroner, the inquest process, evidence gathering, being a witness, making statements and other legal considerations surrounding coroners' reports.

Documentation: A handy refresher on the importance of proper documentation, best practices for record-keeping, legal requirements for documentation and how to maintain accurate and comprehensive records.

Social Media: Take part in discussions around potential legal

issues that can arise from its use including privacy concerns, defamation, intellectual property infringement, professional boundaries and ethical considerations when using all types of online media platforms.

Book your place at an ANF talk today using iFolio.

Discrimination: This talk covers the legal framework surrounding discrimination, including laws, regulations and case precedents, with reference to the various forms of discrimination, such as gender, race, age, or disability and provide guidance on how to prevent and address such issues in professional settings.

Defamation: Defamation involves making false statements that harm someone's reputation. We explain the elements of a defamation claim, how to minimize the risk of defamation in the context of the workplace, defences against defamation and the potential consequences of defamatory statements on your registration and your wallet.

Workers’ Compensation: This session covers the essentials that all members must know about the Workers’ Compensation process and how to make it work for you rather than your employer if you are injured at work.

Resolve workplace issues: This important information is useful for all members, and it covers the process of resolving issues at your workplace.