NurseClick August 2017

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In the news

Australian College of Nursing update

A nursing business




Taking a uniform approach to infection prevention and control



Advanced practice nurse endoscopy

Health information technology





Meditation as a medicine

Rural and remote practice

Adjunct Professor Kylie Ward FACN, ACN CEO




EVENTS @ACN Community and primary health care nursing week





The CEDRiC toolkit development project

Registration as a nurse and midwife (dual registration) factsheet



Publishing details


Adjunct Professor Kylie Ward FACN, CEO of ACN

Welcome to the August edition of NurseClick.

It has been an eventful and exciting few weeks for the Australian College of Nursing (ACN), as we continue to provide a platform for nurses to join forces and drive necessary reforms across the Australian health care system. Bringing together a record-number of delegates from all around the country, the National Nursing Forum was held from 21–23 August at the Event Centre, The Star, Sydney. The Forum was an enormous success and a valuable opportunity to explore how we can Make Change Happen through a series of inspiring keynote speeches, concurrent sessions and masterclasses. Ultising technology to drive change in health care was a concept thoroughly explored by Danielle Miller in her concurrent session during the National Nursing Forum this year. In this edition of NurseClick, Danielle draws from her presentation and offers insights on leveraging IT systems to streamline, automate and enhance workflow in her engaging article, Health Information Technology. Innovations in health care delivery is a concept further explored in another one of our written abstract presentations, The CEDRiC toolkit development project. In this insightful piece, the authors evaluate a new model of service delivery focused on improving care for older adults while reducing potentially avoidable, hospital admissions. Education is a key step in improving the development and delivery of evidence-based care for older Australians.

At ACN, we offer a Graduate Certificate in Aged Care Nursing that provides an advanced grounding for developing the theoretical and practical aspects of management, clinical practice and education in aged care. In our informative article, Take control of your career, we provide a course overview and explore the numerous opportunities available for nurses working in the aged care sector. Our Graduate Certificate in Aged Care Nursing is designed and delivered by one of our passionate nurse educators and regular NurseClick contributors, Trish Lowe MACN. In her column this month, Trish emphasises the immense importance of upholding a uniform approach to infection prevention and control standards to enhance patient outcomes. Taking into account seasonal influences on hospital admission rates, Trish offers a timely reminder that the nursing workforce must remain committed to protecting patient safety and retaining public trust. Community and primary health care nurses are integral to ensuring patient safety and optimal health outcomes across the country. In September, we will shine the spotlight on this important field of nursing practice during Community and Primary Health Care Nursing Week. Make sure you read our feature article about this important campaign, so you can find out how to get involved and join us in raising the profile of community and primary health care nurses. I hope you enjoy the read!

Publisher Australian College of Nursing Editors Sally Coen Olivia Congdon Karen Watts Design Nina Vesala Emma Butz Enquiries Advertising

© Australian College of Nursing 2017 The opinions expressed within are the authors’ and not necessarily those of ACN or the editor. No part of this publication can be reproduced without permission from ACN. Information is correct at time of print. All files marked ‘Stock photo’ or credited to iStock or ThinkStock are representative only and do not depict the actual subjects and events described in the articles. Cover image: Thinkstock ACN publishes The Hive, NurseClick and the ACN Weekly eNewsletter.


is now available for all of our gradua te certificate cour ses

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In the news national Government announces Medicare-funded mental health assessments for pregnant women

This may not be the ‘biggest flu season on record’, but it is a big one This year, the number of laboratory-confirmed influenza (flu) virus infections began rising earlier than usual and hit historic highs in some Australian states.




Pregnant women will soon have access to free mental health assessments during and after pregnancy, under new measures being adopted by the Federal Government.

Dementia patients brought low by stigma

Impact of sitting on pregnancy examined

Social prejudice still exists towards people living with dementia, causing many patients to feel socially disconnected, research shows.

Australian researchers are examining whether interrupting prolonged sitting during pregnancy can improve blood sugar levels in mothers at risk of gestational diabetes.

States in the south-east are more inflamed by flu than those in the north and west.

Nearly 1500 people completed an Alzheimer's Australia online survey that investigated the challenges dementia patients face as well the impact any stigma has on them.

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Researchers say that recent evidence suggests that regular, brief bouts of gentle walking can lower post meal blood sugar levels compared to prolonged sitting. Read more

Dementia village mimicking small-town setting to be built in Tasmania

Breast implant-related cancer cases rise

Tasmania will become home to what is being touted as Australia's first suburban village designed specifically for people with dementia.

The number of Australian women diagnosed with a rare but deadly form of blood cancer linked to breast implants has risen, leading to calls from health experts for greater awareness.

As well as 15 tailored houses, the village will have a supermarket, cinema, cafe, beauty salon and gardens. Read more

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The decision is in response to recommendations made by a taskforce examining thousands of Medicare-funded services. Read more

Australian schools turn spotlight on wellbeing in bid to tackle student anxiety There has been a huge growth in wellbeing programs in schools in Australia, with nine in 10 independents schools now offering a wellness service to students and public schools following suit. A recent survey revealed that only 62%t of girls in secondary schools had a strong sense of wellbeing and more than 55% were assessed as anxious. Read more

Kids bike sales fall raises health alarm

STIs on the rise in Australia

A significant drop in the number of children's bikes sold has raised alarm bells among public health experts concerned about a lack of physical activity among young Australians. Data from the Australian Health Policy Collaboration at Victoria University shows children's bike sales have dropped by 22% in the past decade.

According to health data from the Kirby Institute, a staggering 18,588 cases of gonorrhoea were detected in 2015, up from 8,388 cases in 2006.

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Sexually transmissible infections are nothing new, but in recent years STI rates in Australia and other developed nations have been rising at an alarming rate.



In the news world Anti-inflammatory drug 'cuts heart attack risk'

Peanut allergy treatment 'lasts up to four years'

Artificial womb raises hope for premature babies

An oral treatment for peanut allergies is still effective four years after it was administered, a study has found.

Researchers hope an artificial womb used to incubate healthy baby lambs can be used in future technology for premature babies.

Children were given a probiotic, with a peanut protein, daily for 18 months.

This was the result of a long-standing collaboration involving researchers from the Women and Infants Research Foundation, the University of Western Australia, and Tohoku University Hospital, Japan.

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Five people die after using weight loss balloons for obesity U.S. officials are warning health providers about weight loss balloon devices after five people died unexpectedly shortly after being treated with them. The U.S. Food and Drug Administration (FDA) released a report that revealed that since 2016, five people have died after using a liquid-filled balloon weight loss system intended to treat obesity. Read more

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Plants 'hijacked' to make polio vaccine Plants have been ‘hijacked’ to make polio vaccine in a breakthrough with the potential to transform vaccine manufacture, say scientists. The team at the John Innes Centre, in Norfolk UK, says the process is cheap, easy and quick. Read more




Anti-inflammatory drugs could cut the risk of heart attacks and strokes, a study of 10,000 patients suggests.

Too much sugar could increase depression risk in men, study suggests

A trial of the drug canakinumab could represent the biggest breakthrough in treatment since the advent of statins to lower cholesterol, its authors say. Read more

People age better if they have a purpose in life

Men who consume a lot of added sugar in drinks, cakes and confectionery run an increased risk of depression, according to a new study.

Having a purpose in life may help people maintain their function and independence as they age, according to a new study published in JAMA Psychiatry.

Researchers from the University College London (UCL) looked at sugar in the diet and common mental health problems in a very large cohort of 5,000 men and 2,000 women recruited for the Whitehall II study in the 1980s.

People in the study who reported having goals and a sense of meaning were less likely to have weak grip strength and slow walking speeds: two signs of declining physical ability and risk factors for disability.

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Neighbourhoods with more light have higher breast cancer risk, study says Large successful trial of probiotics in India A large Indian study of 4,500 newborn babies found that the right microbes can prevent a life-threatening condition called sepsis. Read more

A new study from Harvard has found greater risk of breast cancer in women who live in neighbourhoods that have higher levels of outdoor light during the night. The findings are based on the Nurses' Health Study (NHS), which has for decades been advancing our understanding of risks to women's health. Read more



Australian College of Nursing update Nurses urge Australians to have organ donation conversation ACN is highlighting the important role nurses play in organ and tissue donation during DonateLife Week last month. Led by the Organ and Tissue Authority, DonateLife Week (30 July-6 August) encourages Australians to register their donation decision and discuss their decision with loved ones. Only one in three Australians have joined the Australian Organ Donor Register, despite 81% believing registration of donation decisions is important (Woolcott Research, 2015).

ACN welcomes Opposition’s stance on aged care ACN commended Opposition Leader Bill Shorten’s acknowledgement of the need to address nurse staffing levels and training in the aged care sector. Mr Shorten made his comments on the ABC’s 7.30 Program: “When it comes to aged-care facilities, no question in my mind, we need to make sure if we have the right number of nurses on duty, are we getting the right training for people, are we charging too much in our TAFE to train people to do this vital work in the future?” Mr Shorten said. ACN is concerned by the lack of Commonwealth standards or regulations prescribing minimum staffing or skills mix requirements for Australia’s residential aged care facilities (RACFs). It has called for registered nurses to provide leadership and clinical supervision in RACFs at all times. In July 2016, ACN took the official view that regulation of RACFs should, at a minimum, mandate a requirement that a registered nurse (RN) be on-site and available at all times to promote safety and well-being for residents. Read more

ACN calls for Australians to have the right to die in place of their choosing In a recent media release ACN called on the Commonwealth Government to ensure Australia’s health care system respects and keeps pace with changing patient preferences, in particular a person’s wish to die with dignity in their own home, surrounded by loved ones. “We have delivered health care in this country in essentially the same manner for decades, which generally sees patients moved into care facilities, hospitals and hospices as they grow frail and end stage,” ACN CEO Adjunct Professor Kylie Ward FACN explained. “While we are fortunate enough to have one of the best health systems in the world, we must not become complacent and opposed to consumer-driven ways of delivering care.

“In particular, we must constantly work to make sure we are delivering health care in the manner and place that is best for individuals. “People’s preferences change. “We can see this in the increasing desire Australians have to age in place, and now we know they want to extend this to being supported to die at home.” Seventy per cent of Australians would prefer to die at home (Swerisson and Duckett, 2014), but currently only around 14% of people do so. Read more.

“Nearly two-thirds of our hospital workforce are nurses. Whether they are the first contact on the topic of organ donation with the family of a loved one on life support, to being involved in a transplant surgery, nurses play a pivotal role in care,” ACN CEO Adjunct Professor Kylie Ward FACN, said. “Such crucial roles require adequate education and training. We must invest in and support our nursing workforce. “The Australian College of Nursing lends its voice to calls for ongoing development and training for clinical and professional staff involved in organ and tissue donation. “The topic of organ donation can be a difficult discussion to have with loved ones, but it is an important one. ACN encourages Australians to engage in this conversation this week and register their donation decision. It could save a life, or several.” Read more


A nursing business


Lisa Hellwege MACN

A personal journey

“Work methodically, believe in yourself and your skills, and get out there and do something for you, your family and your community!�

Lisa Hellwege MACN

No matter what area of nursing I have worked in over my career, I have always felt strongly about providing a quality service where I am guided by my values and my desire to help people.

22 years after graduating from the University of Tasmania, this dream has become a reality within my own business. Following completion of my nursing degree in 1994, I moved to Brisbane to complete a graduate program at the Princess Alexandra Hospital. I remained in Brisbane for over 17 years working in different clinical areas, working for four years with a pharmaceutical company, and raising three beautiful girls with my then husband.


In 2011 we were badly affected by the Brisbane floods. We had been planning a move back to Tassie the following year. I saw the mud and the sadness in people’s faces alongside the subsequent devastation created by this silent event and I felt the call to move home. My mother offered us her home for as long as we needed – it was a relief to arrive back in Hobart to the bright colours and friendly faces. I commenced work almost straight away in the Eye Clinic at the Royal Hobart Hospital, and perchance relieved for another nurse who went on holidays from the Ear Nose and Throat (ENT) Outpatient Clinic. I loved this role and during my time there formed both personal and professional relationships with staff that I have maintained to this day. Unfortunately, my marriage broke down at this time; whilst amicable, these things are never easy. I focussed on work as a way of coping, undertaking a challenging project within the clinic and had a key role in improving processes. This gave me my first taste of forming a business case and it was at this time I started to think more creatively about where I was headed with my career and my life. I also observed the ENT consultants and registrar removing earwax via micro suction and curettage. I had heard about the dedicated micro suction clinics in Melbourne, and I started to imagine something similar working in Hobart. I felt that there was a gap in the market for a safe an effective wax removal service in Hobart; it amazed me that one did not already exist. A number of years after leaving the ENT clinic I decided, with the support of my wonderful new partner, to seriously explore this idea. We had so many things to consider, most importantly ‘keeping food on the table’ whilst chasing the dream.


The business plan was key to establishing whether my idea was commercially viable for my family and I – could I make this work? I tried to do this methodically, basing it on data and numbers and not gut feelings. I knew this process of documenting would show me where the failings were with the idea before it started to cost me money. In our case we had to consider the small population of Hobart relative to other capital cities (where such clinics were seemingly successful). Additionally, only a small percentage of that population have an issue with wax impaction, and of that group, an even smaller percentage seek to do anything about it – would that be enough to sustain a viable business? I had to undertake relatively costly formal training (in terms of fees and lost wages), to ensure I was suitably qualified and working within my scope of practice – this would require a month away from my family interstate and felt somewhat daunting. Furthermore, funding a new business is expensive – where would I find the money? Encouraged by a number of former colleagues and my partner, and armed with a desire to avoid returning to shift work which did not work for my family nor myself, I decided to dedicate myself to making it work. I commenced study online which led to my practical placement interstate to receive my Nationally Accredited Qualification. Unbeknownst to me the Tasmanian branch of the Australian Medical Association had authored a survey whilst I was away doing my training asking GP’s what they would think of a dedicated micro suction clinic. The results were overwhelmingly positive – such good timing! I remember thinking it’s funny once you start following your dream what can happen.

Upon my return I was eager to get started but there was work to do; purchasing equipment, finding a premises, organising insurance, establishing a brand and then working out how to market the business. It was a huge undertaking and not one for the faint of heart! We also had to ensure we were doing everything in accordance with Australian Health Practitioner Regulation Agency’s (AHPRA) mandatory registration standards, and the Nursing and Midwifery Board of Australia’s (NMBA) professional standards, codes and guidelines with areas I hadn’t had to think about before. From infection control through to advertising, I left no stone unturned with respect to compliance. This was important to me and it was in line with my strong values around quality care. So here we are nine months into the journey. We started a day a week while I maintained my existing role within the Tasmanian Health Service and I have transitioned across gradually. Whilst we are pretty much a stock standard struggling small business in our first year of operation I feel proud of the service we are providing and our achievements to date, even if financially it remains a challenge. We have been very well received by the general public and our referral base from audiologists, GP’s and practice nurses is continuing to grow. We maintain a values-based business and I think this is clear to anyone who interacts with our service. Providing evidence based care, working within our scope, and valuing people and relationships are all very important to us. And for me personally, having a supportive partner has also had a huge impact. I am a big reader of all things bio/autobiographical. I once read that "a business is simply an idea to make other people's lives better”, and now I understand that to be true! I am passionate about providing a service that exceeds expectations and

love the satisfaction that comes with putting clients first. If something isn’t working, I can improve it. So with great risks come great rewards in this way. There are so many areas of nursing in which we can apply our skills. I would encourage all of you to think about how you can use your skills to work more independently. Where is there a need for service? Where are the gaps in the health care market? What parts of your job do you love? I have seen a nursing foot care van driving around in Hobart and also read recently about a nurse led skin care clinic. My humble advice, for anyone with a desire to give and an idea, is to back yourself. Do your numbers and don’t rush to ‘give up your day job’ before you have some small successes. Work methodically, believe in yourself and your skills, and get out there and do something for you, your family and your community!

The micro suction and curettage procedure involves the use of small instruments and gentle suction to remove wax blockages under direct observation with ‘loupes’; binocular glasses fitted with a bright light to maintain direct vision into the ear. The procedure is safe and effective and removes wax blockages without the use of water.

Editor’s note: Lisa Hellwege is the Director at Earworx and volunteer State Coordinator for OHNNG – a national nursing education body. Earworx is a Hobart based professional earwax removal service located at 181 Harrington Street, Hobart TAS.



Vital signs

Taking a uniform approach to infection prevention and control By Trish Lowe MACN

Australia is currently in the grip of winter. Due to seasonal influences on the incidence and hospital admission rates for respiratory conditions, infection prevention and control is at the forefront of consumers’ minds. It is during high admission periods such as this, that health professionals and the Trish Lowe MACN system as a whole, come under scrutiny. As a profession, nurses are committed to ensuring public safety and maintaining confidence in the health system. While care audits indicate that nosocomial infection rates are trending ever downwards, observable practices such as hand hygiene and the ways in which nurses present themselves when in uniform have the capacity to impact on consumer confidence (NSW Ministry of Health 2017, p. 1; Ward 2017, p. 116). Therefore, vigilance is required to ensure infection control standards and the high standing of the nursing workforce are maintained. Registered and enrolled nurses are accountable to the Nursing and Midwifery Board of Australia (NMBA) and obliged to adhere to the standards, codes and guidelines, which guide practice.

These are most notably the Registered Nurse Standards for Practice (Nursing and Midwifery Board of Australia (NMBA) 2016), Code of Ethics (NMBA 2013a) and Code of Professional Conduct for Nurses in Australia (NMBA 2013b). The Code of Ethics for Nurses in Australia – Standard 6 states, "Nurses value a culture of safety in nursing and health care’, and, ‘support the development of risk management processes and a practice environment designed to reduce the incidence and impact of preventable adverse events in health care" (NMBA 2013a, p. 5). Similarly, the Code of Professional Conduct for Nurses in Australia – Standard 9 indicates, "Nurses maintain and build on the community’s trust and confidence in the nursing profession’, and, ‘if the good standing of either individual nurses or the profession were to diminish, this might jeopardise the inherent trust between the nursing profession and the public necessary for effective therapeutic relationships and the effective delivery of nursing care" (NMBA 2013b, p. 4). Therefore, maintaining safety and quality in health care, along with public trust, is paramount. Strategies to do so include publishing data which convey positive health care outcomes and role modelling exemplary behaviour.



“…uniforms help identify the health professionals ‘project a professional image’ and ‘inspire confidence when worn correctly’.” In recognition of the fact that "there is no single cause of infection’ and that ‘at least half health care associated infections are preventable", the National Safety and Quality Health Services Standards (Australian Commission on Safety and Quality Health Care – ACSQHC – Standard 3), published a comprehensive list of recommendations aimed at preventing and controlling health care associated infections (ACSQHC 2012, pp. 27-30). These were integrated into key strategies, which have been widely implemented across the health system and included – hand hygiene audits, antimicrobial stewardship, adherence to standard precautions, reduction of central line infections in ICU and effective use of environmental cleaning products (NSW Ministry of Health 2017, p. 1). As a result, data provided by the NSW Ministry of Health revealed hospital acquired infections have been successfully and consistently reduced throughout the January 2010 to June 2014 period (NSW Ministry of Health 2017). Yet despite these encouraging trends, the emergence of multi-resistant “superbugs” receive sensational media coverage and remain concerning for consumers. Consumer dissatisfaction has been expressed at infection control practices, which are perceived as being substandard or non-traditional (Ward 2017). Health professionals wearing their uniforms in an “unprofessional” manner, or in “unclean” environments – such as on public transport – are examples of practices which have caused concern for some consumers (Ward 2017).

In 2010, the UK National Health Service (NHS) recognised this concern and sought to allay it by issuing guidelines for health care workers on the wearing, laundering and storage of work wear. These included covering the uniform completely when in transit, changing uniforms daily and washing uniforms separately on the highest possible temperature allowable for the fabric (Nazarko 2014, p. 300; Ward 2017, p. 118). Electricity prices in Australia are currently among the highest in the world (Dayman 2017). Australian households are employing all means possible to counter these, for example, washing clothes in cold water (Dayman 2017). Therefore, the guidelines provided by the NHS resonate and provide a timely reminder for health professionals of the importance of adhering to all infection control policies, particularly those pertaining to the laundering and storage of work wear. As stated by Nazarko (2014, p. 305), uniforms help identify the health professionals, "project a professional image" and "inspire confidence when worn correctly". While there is no evidence that bacteria found on uniforms contributes to hospital infections, it is acknowledged that uniforms do become more contaminated over the course of a shift and should be changed immediately if soiled by bodily fluids (Nazarko 2014; Potter & Justham 2012). Similarly, the wearing of: clothing below the elbow, jewellery, piercings and tattoos, carry their own public perception, health and safety concerns and are therefore discouraged by health sector uniform policies (Ward 2017, p. 3).

The rates of hospital acquired infections are trending downwards, due to the implementation of well documented, evidence based strategies. Nurses are committed to protecting public safety and retaining public trust. Health professionals are accountable to the public and must do all that is possible to model exemplary behaviour, therefore vigilant enforcement of all policies pertaining to infection prevention and control – including those relating to hand hygiene and work wear policy – must be reinforced, especially during high risk periods.

Cover doesn’t always mean protection. Find out more

References: Australian Commission on Safety and Quality in Health Care 2012, National Safety and Quality Health Service Standards, ACSQHC, Sydney. Dayman, I 2017, ‘South Australia power prices to rise to highest in the world on Saturday, energy expert warns’, ABC News online, news/2017-06-28/sa-has-most-expensive-power-prices-in-the-world/8658434 Nazarko, L 2014, ‘Uniforms and their place in preventing infection’, British Journal of Health Care Assistants, vol. 8, no. 6, pp. 300-305. New South Wales Ministry of Health 2017, Healthcare Associated Infection, Author, North Sydney, viewed 13 July 2017, hai/Pages/default.aspx Nursing and Midwifery Board of Australia 2013a, Code of Ethics for Nurses in Australia, NMBA, Melbourne, Nursing and Midwifery Board of Australia 2013b, Code of Professional Conduct for Nurses in Australia, NMBA, Melbourne, Codes-Guidelines-Statements/Professional-standards.aspx Nursing and Midwifery Board of Australia 2016, Registered Nurse Standards for Practice, NMBA, Melbourne, Potter, YC and Justham, D 2012, ‘Washing and changing uniforms: is guidance being adhered to?’ British Journal of Nursing, vol. 21, no. 11, pp. 649-653

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Ward, D 2017, ‘Implementing infection prevention and control precautions in the community’, British Journal of Community Nursing, vol. 22, no. 3, pp. 116-118



Advanced practice nurse endoscopy SA Health Nurse Endoscopist Model of Care

Sonny Ward, Project Officer, Nursing and Midwifery Office, SA Health

The Nurse Endoscopist project marks the first in a new era of advanced practice nursing roles. The Queen Elizabeth Hospital, a public hospital in South Australia, has welcomed the implementation of an exciting new Nurse Endoscopist Model of Care pilot project. Three experienced nurses have been recruited to the advanced practice role and commenced as Nurse Endoscopist trainees at the end of June. The Nurse Endoscopists are working under the supervision of medical practitioners to perform colonoscopy on carefully triaged, low-risk, non-complex cases. Currently in the orientation phase of their training, the trainees will soon embark on their first residential clinical skills development workshop. SA Health is working in collaboration with Austin Health, Victoria, to provide a component of their twelve-month training which will lead to a Certificate in Gastroenterology through the University of Hull in the United Kingdom. The training pathway consists of three learning modules; clinical knowledge, skills development training, and supervised clinical practice. The introduction of the SA Health Nurse Endoscopist model is built on extensive international and national experience from the United States of America, United Kingdom,

Netherlands, Canada and China. Since 2010, both Victoria and Queensland have successfully implemented Nurse Endoscopist Models of Care and other jurisdictions are considering similar models. An abundance of evidence clearly articulates health workforce reforms can be implemented without compromising patient safety and that Nurse Endoscopists, under proper supervision, can perform at the same level of procedural competency as doctors. The Nurse Endoscopist role is an example of workforce innovation, where health professionals work at full scope of practice in an environment which combines varying talents. The role reaches beyond the provision of a technical procedure, the breadth of which is intended to augment the current workforce, improve endoscopy services, and most importantly, improve patient outcomes. Advanced practice nurse endoscopy means real benefits to patients and public health services. Access to timely endoscopy services underpins delivery of cancer care and is necessary to support the delivery of highquality health care to South Australians. Nurse Endoscopists can contribute to improving access to services for patients requiring follow up screening and review services. The introduction of advanced practice nurse endoscopy enables medical staff to better manage and treat patients by delegating appropriate cases to highly qualified advanced practice nurses. This in turn allows better

access to medical specialists for complex and advanced endoscopic cases. Bowel cancer is the second most commonly diagnosed cancer, affecting one in 12 of the population by the age of 85, with the majority of cases diagnosed in patients aged over 50 years. However, it can be treated effectively in 90% of cases if detected early. Colonoscopy plays a crucial role in the diagnosis, treatment and ongoing surveillance of bowel cancer. The growing demand for colonoscopy screening services in South Australia is driven by a range of factors including: • Increasing public expectations and awareness in relation to health and health services including the value of screening programs such as the National Bowel Cancer Screening Program • The predicted dramatic rise in demand for colonoscopies as a result of the National Bowel Cancer Screening Program, which will be fully implemented by 2020 • South Australia’s ageing population • An increase in lifestyle conditions, such as obesity, which are associated with gastrointestinal comorbidities. The Nurse Endoscopist project marks the first in a new era of advanced practice nursing roles. This momentous occasion allows our pioneering Nurse Endoscopist trainees the opportunity to make a real difference to the lives of patients here in South Australia.



Health information technology Utilising technology to make change happen in health care

By Danielle K. Miller PhD (c), MSN, RNC

Health information technology (HIT) offers hospitals and health care Danielle K. Miller systems the tools to integrate data from a clinical, financial, and operational perspective that yields analytical insight into their organisations. Leveraging technology to manage labour costs can be used by collecting the data from the electronic medical records that drive clinical staffing and clinical assignments to deliver superior patient, clinical and financial outcomes. Technology can be leveraged as health care organisations pursue the Quadruple Aim, which includes the goal of improving the work life of health care providers, comprising of clinicians and staff,

as well as seeking better cost, quality and outcomes.

The movement towards patient centered care strategies embraces key trends in health care:

Health care organisations need more than a way to hire the right staff per the needs of the patient, schedule staff, and track time and attendance. They need a strategic clinical and operational plan to assist them in their efforts to optimise patient outcomes, improve employee satisfaction and maximise revenue.

• Retaining and recruiting top talent into your organisation

The increasing advances and development of technology in health care offer the opportunity for increased availability of data to drive operations and the potential to support evidence-based management decisions (Hyun et al, 2008). As challenges continue to rise, there is an enormous opportunity to leverage technology to provide better patient care to patients and improve clinical outcomes using real time, actionable data by implementing an evidence-based nurse workload tool combined with a staffing and scheduling system that utilises innovations in technology.

• Providing care based on the unique needs of the patient • Staffing per the needs of the patient • Scheduling in a proactive manner to decrease cost • Interoperability to drive decision making Leveraging technology to make change happen in health care begins with people. How can you use technology to hire the best person to retain and recruit individuals that are a cultural fit inside of your organisation? Combining the best science-driven processes with patented technology and years of experience provides a solution that allows you to decrease turnover, improve performance, streamline hiring processes, and reduce risk.


Once you have hired the right person, you can base staffing decisions on matching patients with the best health care providers who possess clinical competencies and behaviors that match the unique care needs of your patients. Patient characteristics play a large role in acuity-based staffing, as not all patients with the same disease or disorder have the same needs (Mensik, 2014). This technology allows for evidenced-based staffing. With clear visibility and tools regarding the individual and unique needs of patients in real time, front line leaders can make more efficient and effective staffing decisions that are data-driven to help optimise outcomes. This can be on a unit level or from an enterprise wide perspective. Providing real time, direct visibility across the entire organisation, front line leaders will be able to make better informed staffing decisions that have an enormous financial and clinical impact on the organisation. Optimal staffing should be based on the needs of the patients. Those needs extend beyond those that can be captured in a typical patient

“When organisations can fully leverage health IT systems, their providers can streamline, automate, and enhance workflow.”


classification system. Unfortunately, a patient classification system may not be accurate enough to be used for resource allocation or for decision making (Fasoli, Fincke & Haddock, 2011). The standard patient classification systems fail to adequately capture the workload of the nurse or accurately predict the nurse staffing requirements needed to provide great patient care. Nursing decisions are based on evidenced based research. When deciding on technological tools for clinical decision support, it is important to choose tools that are valid and reliable. Utilising an evidenced based methodology to determine patient needs and staffing requirements, health care organisations can provide their front-line clinicians with support to staff and manage communication care requirements for each patient. Managers will have the data they need to build budgets, and leaders will have the data they need to help maintain equitable workloads. Finance can easily align patient workload requirements to the organisation’s fiscal standards, while IT can interface with applications to meet system requirements that meet the needs of the patients. Technology allows for the automation of staffing and scheduling, which can allow for organisations to control expenses related to labor cost, especially escalating overtime costs. Connecting real time data about providers’ scheduled hours to the time and attendance data, in combination with the required hours needed, front line leaders can be proactive and avoid overtime before it occurs, as well as determine the most

appropriate resources to meet unique patient care needs in a cost-effective manner when additional staff is needed. The use of technology also lends to the empowerment of nurses by allowing them more control of their work schedule. The automation and flexibility increases nursing engagement, which in turn results in more engagement with patients. Implementation of a robust scheduling system allows for non-value added tasks, such as filling a shift or sending mobile shift offerings, to be automated and streamlined within a few clicks and completed in a matter of minutes, compared to making several calls to secure adequate staffing. An additional benefit of automation is the assurance of a fair and equitable nursing assignment to allow clinicians adequate time to provide the best care possible to patients. An automated staffing system ensures there is standardisation and equity within staffing practices across departments and/or the organisation. Lastly, leveraging technology can be used to drive decision making in delivering the right care to the patient. Interoperability is essential to achieve this, which allows for different technology systems and software applications to communicate and exchange data. Health care providers can use the data that has been exchanged to drive faster coordination of care and clinical decisions that impact patient care. When data can be moved from one location to another and the end user has the data in real-time, it can be used in a meaningful way.

Having data flow freely among systems and departments without sacrificing the clarity and integrity of information is critical. As health care providers, you need fast and reliable access to all sources of clinical, financial, and operational data. This data often resides in disparate enterprise applications across multiple locations, including local electronic medical records (EMR) systems in physicians' offices. Implementing a robust interface solution will ensure the ability to facilitate the movement of data to make more well informed decisions that impact patient care. In conclusion, analysis of data requires insight into processes and delivered workflow to identify potential areas for process improvement. Utilising the innovations in technology can provide clinical decision support to nurse leaders, which can be used to improve patient outcomes, increase patient and employee satisfaction, and provide care in a more cost-effective manner. When organisations can fully leverage health IT systems, their providers can streamline, automate, and enhance workflow. This allows for providers to spend more time doing what they entered health care for — to provide care to patients. References: Epstein, R. M., & Street, R. L. (2011). ‘The Values and Value of Patient-Centered Care.’ Annals of Family Medicine, 9(2), pp. 100–103. < content/9/2/100> Fasoli, D., Fincke, M., & Haddock, K. (2011). ‘Going beyond patient classification systems to create an evidence-based staffing methodology.’ Journal of Nursing Administration, 41(10), pp. 434-439. Hyun, S., Bakken, S., Douglas, K., & Stone, P. W. (2008). ‘Evidence-Based Staffing: Potential Roles for Informatics.’ Nursing Economic$, 26(3), pp. 151–173. Mensik J. (2014, February). ‘What every nurse should know about staffing.’ American Nurse Today, 9(2). <>



Community & Primary Health Care Nursing week

Nurses where you need them 18–24 SEPTEMBER 2017

Community and Primary Health Care Nursing Week is held annually to raise awareness of the vital role nurses play in our communities. This year, Community and Primary Health Care Nursing Week will be held from Monday 18 to Sunday 24 September.

Get involved today! Community and Primary Health Care Nursing (CPHCN) is vital to the health and wellbeing of our society. However, CPHCN is not well recognised by politicians, the broader health care community and the general public. Raising awareness of CPHCN supports the shifting of care from the acute to the primary health care sector. Nurses lead and provide care in many community-based health services across the country, striving to improve equity of access for the hardest to reach communities and promoting the integration of health care delivered by a range of services.

Join the celebration! Host an event during the week to celebrate community and primary health care nurses. You could hold a social gathering, lecture, morning tea, lunch or any other event of your choosing! We encourage participants to wear orange clothing in support of the week and take the opportunity to read stories from our eBook. Make sure you register your event online to receive a free hosting kit containing materials to help promote and celebrate your event. Don’t forget to share photos on social media using the hashtag #nurseswhereyouneedthem. Visit our website for more information and to get involved today.

With thanks to the support of our official sponsor



Meditation as a medicine Marie Louise, Co-Founder Evolve Yourself Institute

Meditation is a word popping up everywhere. Once viewed as an alternative practice by small Marie Louise subgroups, it’s now entering the mainstream. The more studies that are being conducted are leading to an increasing quantification of the benefits that meditation provides. So the momentum is worth listening to. Stress as a leading cause of sickness is increasingly prominent, and the analysis of the disease is under the telescope. As understanding of the havoc stress places on immunity,

cardiovascular and metabolic functioning grows, so does the detrimental biochemical impacts on brain structure. Dr Linda Mah, the author of research findings from University of Toronto said: “Pathological anxiety and chronic stress are associated with structural degeneration and impaired functioning of the hippocampus and the prefrontal cortex, which may account for the increased risk of developing neuropsychiatric disorders, including depression and dementia” (Mah L et al., Curr Opin Psychiatry, 2016). Stress is on the rise in the hustle and bustle of modern life. Where the word “busy” is the new norm and “should” and “musts” are on your to-do list, it’s no wonder depression, anxiety and stress-related illness are increasing. You could roll your eyes and say “it’s never going to change”, “pressures are here”, “you have to stress to get anything done”. But, what if there

was a practice that could change the state in which you react to those life situations? What if there was a medicine that reversed the signs of an aging mind and melted the motion of sickness. Would you take it? There is increasing evidence around the benefits of meditation, specifically as a practice to relieve stress. A recent study (Neuroscience Letters, Vol 556, 2013) from Beth Israel Deaconess Medical Centre suggests that the brain changes associated with meditation and stress reduction may play an important role in slowing the development of age-related cognitive disorders and dementia. Participants were randomised two to one, either to a group who participated in Mindfulness-Based Stress Reduction (MBSR) using meditation and yoga, or a control group who received normal care. The results of MRI imaging showed that the group engaged in MBSR had significantly improved functional connectivity.



“There is increasing evidence around the benefits of meditation, specifically as a practice to relieve stress.” “What surprised us was, for a condition that has few other treatment options—and without Food and Drug Administration (FDA) approval medications to stop the progression to dementia—an intervention [like meditation] may impact the very areas of the brain most affected by Alzheimer’s disease,” said Rebecca Erwin Wells, MD, MPH (Neuroscience Letters, Vol 556, 2013).

“It opens minds to the tool as a resource for healing. With advancements in technology, the ability to see the once unseen shows us the benefits of ancient practices. Stress is like poison; it creates a toxic biochemical mix within the internal system creating illness. A calm state creates chemicals that regenerates and renews, allowing the body to do what it does so well and heal”.

If stress is a precursor to age-related illness, such as dementia, meditation could just be the medicine needed for the mind (Gaser 2013). Researcher Christian Gaser from Jena University shared that, “the mental processes in meditation trigger the growth of new brain cells”. In their recent study evaluating brain scans of 50 non meditators and 50 meditators, the researchers (Neuroimage Volume, 134, 2016) found that brain age was an average of seven years younger than chronological age in meditators, than those who didn’t mediate.

Marie Louise has seen the power of a calm state first hand.

“These findings suggest that meditation is beneficial for brain preservation, with a slower rate of brain aging throughout life,” said Gaser (2013). As the complexities of the mind breakdown and meditation’s positive relationship gains greater understanding, there will be further solutions for sicknesses that creates so much pain. “It is refreshing and exciting information rising within scientific studies of meditation and its benefits”, says Marie Louise, co-founder of Evolve Yourself Institute.

“A young 9-year-old client could not open her eyes because of her eczema. My goal was to provide her with tools that would calm her central nervous system regularly. With reflection on life situations that cause diseases, a practice of 10-minute morning and night meditations, and using the tool of breath; I saw a clearing of her eczema on her face in 16 days. This was empowering for this young child, and not an isolated incident. I see meditation as a powerful practice to support any healing. This is definitely a great reason to be curious about meditation, it might just be your medicine.” Slow the time of age with meditation as a tool: 1. Start your meditation practice with five-minute guided meditation

4. When thoughts of worry, to do and shoulds and shouldn’ts consume you, use your body as a cue to get you here and now. 5. Take on a breath practice of diaphragmatic breathing to calm your central nervous system 6. Get into nature. Nature has a way of slowing the body down, your environment affects your internal state, choosing environments that serves you helps regeneration 7. If time is an issue, bring micro moments of breath and presence into your day. On the toilet, hall, or desk.

References Eileen Luders, Florian Kurth, Arthur W Toga, Katherine L Narr, Christian Gaser 2013, Meditation effects within the hippocampal complex revealed by voxelbased morphometry and cytoarchitectonic probabilistic mapping, Frontiers in psychology 4: 07 Harvard Medical School Osher Research Center, the Division of General Medicine and Primary Care at BIDMC and NIH National Center for Complementary and Alternative Medicine (NCCAM) K24 AT004095, accessed 27 July 2017, < Wells-Meditation.aspx> Neuroimage 134 2016, Estimating brain age using high-resolution pattern recognition: Younger brains in long-term meditation practitioners, accessed 27 July 2017, < S1053811916300404> Neuroscience Letters, Volume 556, Meditation's impact on default mode network and hippocampus in mild cognitive impairment: A pilot study, accessed 27 July 2017, < S0304394013009026?via%3Dihub>

The Army is now recruiting Nursing Officers A career as an Army Nursing Officer offers variety and challenges in employment and travel not always available in the normal hospital environment. You will gain experience and skills that will equip you for advancement in the Army, and will also be in high demand in your profession. You’ll also enjoy great benefits like free medical and dental, world class training, subsidised accommodation, excellent salary packages, work/life balance and unique experiences.

To find out more about becoming a Nursing Officer search ‘Army Nurse’.

Call 13 19 01 or visit /Army

2. Alleviate chronic stress from your life, with a practice of becoming present 3. Take up a movement practice of yoga, tai chi, nature walks

REG0340P Nurse_Ad_158x61_v2.indd 1

26/5/17 10:24



The National Nursing Forum 2017 a massive success! From 21–23 August, ACN welcomed more than 470 attendees to our annual National Nursing Forum (NNF) at the Event Centre, The Star, Sydney. The Forum was a massive success with a record-number of delegates from across the country and profession. The program informed and inspired delegates through an impressive line-up of keynote speeches, concurrent sessions and masterclasses delivered by leaders in nursing, health and government. Through our theme, Make Change Happen, we explored the creative ways that nurses can make a difference to individuals, communities and social determinates of health at a local, national and global level. From our Speed Leading: Speed Learning and Networking Session to our Gala Dinner, there were numerous networking opportunities available throughout the event. Nurses had the chance to form meaningful connections and valuable relationships with colleagues working across all settings and levels of the health care system. The energy, excitement and passion for our profession and organisation was palpable at the National Nursing Forum this year. Thank you to everyone who attended and contributed to this incredible event. See you on the Gold Coast!

With thanks to our Forum Partners and Sponsors



National Nursing Forum Scholarship Recipients Thanks to HESTA and our Partners and Sponsors who provided ten lucky delegates with a free registration to the National Nursing Forum

Judy Hitchcock MACN Registered Nurse, Port Hedland I am very grateful to HESTA for sponsoring my attendance at the 2017 National Nursing Forum in Sydney. Motivational and energising are the descriptors that best encapsulate the conference. Presentations were diverse, prompting selfreflection on professional practice and reminding us that, as the custodians of the nursing profession, the responsibility for effecting change in practice lies with each and every one of us. I was particularly impressed with many of the concurrent sessions that addressed challenging nursing issues found in remote and rural areas, and provided strategies for implementing positive change. I found the masterclasses to be the most beneficial, particularly Philip Darbyshire’s direct and forthright delivery for change in practice; namely to not be resistant to change but resistant to stupidity. Finally, the insightful Oration given by Dr Glenn Gardner, RN, PhD, FACN, HFACNP will be shared with my colleagues, not least the closing statement: “We must all make change happen.”

Aaliya Fanham Masters Student, University of Melbourne

Alison Graham MACN (Undergraduate) Student, University of Notre Dame

Claire Crossley MACN Clinical Facilitator, QLD Health

The National Nursing Forum 2017 was quite literally an eye-opening, excitement-filled and desire-provoking experience. I was really able to discover and explore the vast scope of the nursing profession and the opportunities available to me as a student and a soon-to-be, new graduate. The conversations with individuals that have the same passions and interests as myself and who had so much experience, was invaluable. Their advice and words of wisdom have and will continue to shape my career goals. The presentation of novel research has sparked a desire within me to challenge, investigate and make changes to really enhance the nursing experience for patients, nursing staff and the multidisciplinary team. Finally, I made some amazing networks with individuals that helped shape my vision for my nursing career and found mentors that will continue along with my journey in nursing. The skills I have developed will assist me in growing both personally and professionally to achieve my goals and advance nursing forward. I look forward to the journey ahead and would like to thank both ACN and HESTA for this opportunity.

Through the amazing experience of the National Nursing Forum, I became very proud of my career choice to become a registered nurse. The experience taught me to realise my full potential; that as a final year nursing student I am a future leader in health care. Being surrounded by such knowledgeable and welcoming nurses, I felt comfortable networking and engaging in discussion. It was so empowering meeting likeminded people and realising that together we can make change happen.

What an absolute privilege it was to attend the ACN NNF thanks to HESTA. What a fantastic couple of days of learning and networking. My highlight of the Forum was the guest speaker at the Gala Dinner, Ms Louisa Hope – what an inspiration. During the Forum I attended the masterclass on clinical leadership and mentoring by Dr Drew Dwyer FACN. I have already started using some of the techniques that I learnt. I also found the speed leading of great use – met some awesome leaders and got some great ideas. Thanks again for the great experience. Looking forward to the Gold Coast in 2018.

Leana Maria Ragaza Student, Western Sydney University As a first year nursing student, The National Nursing Forum was an overwhelming and incredibly fascinating learning experience. Furthermore, I learned about the latest research into nurses' mental health, ethical issues, and leadership. I met admirable people and they shared their experiences with me and gave me advice. I think that the most important thing I can take away from this experience is that nursing is evolving constantly, which means that nurses must continually develop their practice and adapt no matter their field.

Yvonne Mckinlay FACN Practice Manager, General Practice Cremorne The NNF has enabled me to reconnect with old work colleagues and to make connections with student nurses, middle and advanced career nurses from other states through the Speed Learning: Speed Leading and Networking Session and the Gala Dinner. I will provide feedback to nursing colleagues in my work environment and we will look for opportunities to make change happen.


Christine Cummins Acting Psychiatric Nurse Consultant Bendigo Health

Bridget Hayes MACN Mental Health Clinical Nurse Educator Illawarra Shoalhaven Local Health District

I was the lucky recipient of a scholarship provided by South Pacific Private enabling me to attend the National Nursing Forum in Sydney. I am employed with Bendigo Health in central Victoria as an Acting Psychiatric Nurse Consultant with the Psychiatric Services Professional Development Unit. We are a small team focussed on enhancing nursing practice, supporting undergraduate nursing placements and running a successful graduate nursing program. The Forum allowed me to explore current practices and research that are adding value to leadership, mentorship, education and change making within the nursing profession. The occasion also allowed me to participate in networking opportunities that increased my knowledge and respect for the diversity and complexity of nursing practice. I would like to take this opportunity to thank South Pacific Private for providing the scholarship and the Australian College of Nursing for hosting a fabulous event.

I was grateful for the opportunity through ACN and NSW Health to attend the NNF, as I would not have otherwise. I was able to listen to an array of professionals, clinicians and academics talk on subjects related to change, and feel this has reinforced to me the importance of education and support for nurses. It is interesting to hear through speeches and in conversation with a variety of other delegates, that change is a constant in our lives and workplaces. How we implement and receive change is important in our ability to move forward, adapt, and ultimately provide care that is quality, consumer-focused and collaborative. As a newly appointed Clinical Nurse Educator, I aim to be open to change and facilitate conversation that looks forward, rather than back.

Jade Robertson Student, Queensland University of Technology The National Nursing Forum was an invaluable experience for me as a student, the opportunity to talk to various nurses who have all had different nursing paths. Being able to listen to world leaders speak, ignited a fire of motivation. In particular, there were two points that stood out for me. The first was when listening to Mr Robert Nieves talk about his grandmother’s health journey and how important it was to remember when making a health plan to include the patient and ask what they what, remembering that we are all here to implement patient centred care. The second was the 'How emojis are changing care' concurrent session, hearing how this department made change happen and catered their communication techniques to their patients, and the positive outcomes and relationships that were able to be built was inspiring.

Lore Dionne Candelaria MACN Associate Lecturer – Clinical Education Specialist, Sydney Nursing School The National Nursing Forum 2017 tackled topical issues that confront the nursing profession in this country. The keynote speeches have given me insight on relevant topics around various fields of nursing that I could share to my students as we prepare them to become the future of the health care workforce.


Rural and remote practice My undergraduate experiences


Devashrii (Devi) Dobe` President SMANA (Student Midwives and Nurses Association) University of the Sunshine Coast

Dreams they say are merely goals we don’t speak of… although my life’s experience, my passion, and my enthusiasm landed me in Cooktown on a clinical placement Devashrii (Devi) Dobe` adding further seed to my dream to nurse in a rural and remote setting. Growing up in Western Queensland fashioned me into an activist for Indigenous issues and I have wrestled most of my life with the destitution and poor outcomes many Indigenous people experience compared to my own middle classed upbringing. Nursing was one of the vehicles for me to make a difference and I am returning to the profession I love after many years away.

“I fell in love with the people that I had the honour of caring for each day, their stories and their humour.”

My second day on placement was spent at a primary health care clinic in an Indigenous community – it was gritty, dusty, heartbreaking and exhilarating. A young boy brought himself to the clinic explaining that the wild boar he had been trying to feed “purple grass” had mauled his leg. Apparently my surprise didn’t show and I behaved as though it’s a story I heard every day! My time in these centres were spent attending dressings (the reasons for many of them seem unbelievable now that I’m home in my own office), suture removal, diabetes care and education, and many “Bicillin” injections for rheumatic heart disease. I quickly became adept at taking down a dressing without

surprise at what lay beneath! The heat, the fact that numerous families live together and share bedding, lack of sanitation, high rates of diabetes and poor nutrition made for interesting wound care that I relished. The health care workforce in the rural and remote practice included a nurse, paramedic, counsellor, mortician, ambulance driver, confidant and everything in between! I figuratively sat at the feet of each one of my buddy’s and soaked up the knowledge and wisdom that they freely shared. I soon became used to bouncing along dirt roads in the 4x4s, negotiating the dogs who were not always friendly (an essential skill on the Cape), and the weird and wonderful presentations. This place strangely felt like “home” and as I write this I am missing the Cape deeply. I felt like the luckiest student nurse in the world to find myself placed in the emergency department (ED) for a large part of my placement. During one emergency, my role was to apply pressure to an active arterial bleed; the smell of blood, vomit and alcohol was overpowering but I felt part of a team – a small, fairly unimportant part – but a team member nonetheless and I loved every second. I fell in love with the people that I had the honour of caring for each day, their stories and their humour. One of the highlights was an Indigenous man who I had cared for in the renal unit and now in the ED. He said “Ya got guts eh, with ya hair and lips (I’m assuming in reference to my bleached blonde hair and trademark red lipstick) commin’ to a place like dis…but ya deadly eh.” He will never know how proud I was to hear his words! The ECGs that boggled my mind in lectures became more understandable during my placement and I even found my first Wenckebach-type heart block… Patho eat your heart out! Thank you ACN for the scholarship that meant I was financially supported to achieve this

experience; it was everything I had hoped for and so much more. I feel so proud to be a student of the University of the Sunshine Coast, I feel grateful every day that I can gain an education in such a supportive and friendly environment. I drew on so much of what I had learned in lectures and tutorials and especially from those lecturers that have taught me cultural diversity and shared experiences of remote practice. I cannot thank my Nurse Unit Manager Katrina Seng, enough – her and the team at Cooktown Hospital and the primary health clinics went out of their way to ensure I had a rich and varied experience. Katrina’s door was always open and her words of encouragement and support on my placement report are treasured. I hope to return to the Cape for my internship next year and then for my grad year as I continue the steps to realise my goal of becoming a remote area nurse. Katrina’s wisdom and leadership is something I hope to emulate, as I become a more experienced nurse. If you are reading this and wondering if rural and remote practice is for you, please consider a placement away from a regional area. I was exposed to so much on this placement and the lessons will stay with me always. For many graduates the dream is to work in a large shiny hospital… my dream is the gritty, dusty, grass roots of rural and remote Australia. I loved the complexity of medical issues, the variety – from trauma through to mental health and the fact that I could really get to know my patients. In the future I will continue my studies with a focus on public health. The poor health that many of our Indigenous people experience is one of my areas of passion. Cooktown has further fuelled my fire and anyone that knows me knows I have passion to spare with drive to match! I cannot wait to get back to my new semester, which means I’m another step closer to returning to the Cape! I hope they will have me!



The CEDRiC toolkit development project Changing the care of older adults with an acute illness

By Wallis M, Coates K, Johnston C. M., Bannink N, & Craswell A. Introduction The Care coordination through Emergency Department, Residential Aged Care and Primary Health Collaboration National Nursing (CEDRiC) project Forum presentation aimed to evaluate a new model of service delivery focused on improving care for older adults while reducing, potentially avoidable, hospital admissions (Craswell et al. 2016). The CEDRiC model consists of two interconnected services: The Health Intervention Program for Seniors (HIPS) in residential aged care facilities (RACFs) and the Geriatric Emergency Department Intervention (GEDI) situated in hospital

Emergency Departments (EDs) (Marsden et al., 2017). The initial CEDRiC project was trialled in one RACF and one ED and found to improve health outcomes and reduce hospital costs. This project sought to develop a toolkit to aid in dissemination of this model of care.

The interventions HIPS utilised an onsite Nurse Practitioner Candidate (NPC), supported by a clinical nurse, to deliver an advanced level of primary care to residents. Any RACF staff member could refer a resident to HIPS, and residents could self-refer. The NPC, in collaboration with visiting General Practitioners (GPs) provided treatment and care within the facility and ensured that residents were not sent to ED unnecessarily. If a transfer was required, the NPC would coordinate the goals of transfer with the GEDI nurse in the ED. The

GEDI team offered a dedicated, single point of contact in the ED for all people aged 70 years and over, including RACF residents. GEDI nurses provided rapid review and prioritised care for the older person on presentation to ED. GEDI nurses, supported by a physician champion, identified older people with the highest needs; provided targeted assessment; streamlined patient flow; provided clear and timely inter-sectoral communication; focused transition planning; and ongoing health professional education and training (Marsden et al. 2017). The CEDRiC model commenced development in early 2013 and was evaluated using a structure,

process and outcome framework (Donabedian 2003) including health economic analysis. Although each service can be implemented independently, the evaluative research outcomes (under review) demonstrate that in combination, HIPS and GEDI can improve health outcomes of older people. This strengthens the capacity of the ED to deliver high quality, appropriate care for older adults and improves interaction between the RACF, primary and secondary healthcare sectors. To enable the translation of this successful model into other health services, the CEDRiC toolkit was developed. Knowledge translation bridges the divide between research and clinical practice.


However, there remains a failure to translate research into practice and policy (Grimshaw et al. 2012). Toolkits are a flexible way of linking research to clinical practice, packaging evidence and knowledge translation information (Yamada et al. 2015). This packaging codifies specific information and may include; tools, templates, pocket cards, algorithms, summaries and guidelines to support the translation of knowledge, educate the user and facilitate behavioural change and fill knowledge gaps (Barac et al. 2014).

Design of the CEDRiC toolkit The CEDRiC toolkit is designed to be used by health professionals and health service executives interested in introducing this model for the acute care of older adults into their organisation. Stakeholders may include, but are not limited to: RACF directors, nursing staff, GPs, ED nursing and medical staff, hospital managers, executive staff, specialist physicians and geriatricians. Design of the CEDRiC toolkit was identified as crucial to the implementation of the service in interested health care organisations. Reported barriers to effective knowledge translation are lack of time and resistance to change, inaccessibility of research and health professionals’ lack of knowledge, attitudes and skills in appraising evidence (Grimshaw et al. 2012). Ensuring that the toolkit was designed to be user friendly and engaging was also important. Goals needed to be clearly identified and to include current evidence-based support and a synthesis of the findings of recent research (Grimshaw et al. 2012). The intended audience included both healthcare professionals and health service executives. These groups have different knowledge needs with respect to service delivery change. These different needs were identified and built into the toolkit. To achieve this, collaboration between clinical staff (medical and nursing), primary


healthcare staff and researchers was an important aspect in the design. Understanding how behaviours change and how to facilitate or address barriers to change also needed to be addressed within the program design and toolkit. Targeted and tailored information to match the knowledge needs of the users to the intended outcomes was attempted in the CEDRiC toolkit. Finally, explication of the theory underpinning the CEDRiC model was clearly outlined to support the behaviour change processes that underlie intervention implementation (Cane, O'Connor & Michie 2012).

Toolkit Structure The toolkit commences with an overview of the CEDRiC model and summary of the findings from the evaluative research project. It is divided into the following sections: 1. Implementation of HIPS into the residential aged care sector:

a. Identify the need b. Pre-implementation planning

c. Collaborations

d. How to perform the intervention

2. Implementation of GEDI into the ED setting:

a. Identify the need

b. Pre-implementation planning

c. Recruiting staff to fill key roles

d. How to ‘GEDI’

3. Strategies, policies and appropriate tools related to ensure safety and quality for the implementation of the models of care.

4. A ‘how to’ guide for ongoing evaluation, including analysis, evaluation, quality and safety measures with examples of evaluation tools to support implementation The CEDRiC toolkit was developed according to the standard recommended by Yamanda et al., (2015) that toolkits should have a purpose and rationale, components that are developed and informed by high quality evidence, a comprehensive implementation process, and a rigorous evaluation plan. Although this toolkit was designed for use in Australia, it can be implemented throughout the world. There may, however, be some adaptations required to ensure compliance with local laws and accreditation standards. It is designed as an interactive document which contains text, vignettes and links to resources. The appendices contain useful documents to assist facilities such as; example position descriptions, and key responsibilities for those roles.

Facilitation and knowledge translation Evaluating health care service delivery is fundamental to clinical practice improvement, improved efficiency and cost-effectiveness (Hall et al. 2012). Development of this toolkit aims to establish a guide for the dissemination of the CEDRiC model so that the service can be translated into other healthcare settings. It is planned to evaluate the effectiveness of the toolkit in facilitating the implementation of the CEDRiC model at other sites. Only after an evaluation of the effectiveness of the toolkit will it be possible to confirm the degree to which the toolkit supports knowledge transfer (Proctor et al. 2011). Such evaluation will include measures of acceptability, adoption or uptake of the interventions and appropriateness or perceived fit of the innovation (Proctor et al. 2011). The toolkit developed will initially be used for implementation of the GEDI

model in three emergency departments in Queensland and an evaluation of the useability and knowledge translation into practice will be done in parallel. It is envisaged that facilitation of the model will occur in tandem with toolkit use following the tenets of knowledge translation and the integrated iPARIHS framework (Harvey & Kitson, 2016).

Conclusion This paper describes the development of the CEDRiC toolkit created to communicate the intervention to organisations wishing to implement this model. The interventions are underpinned by rigorous research of both the HIPS and GEDI interventions that together formed the CEDRiC Project. The toolkit will be available free of charge once completed. Further to development, robust evaluation of the toolkit will add to the strength of model implementation strategies. References Barac, R, Stein, S, Bruce, B & Barwick, M 2014, 'Scoping review of toolkits as a knowledge translation strategy in health', BMC Medical Informatics and Decision Making, vol. 14, no. 121, pp. 1-9. Cane, J, O'Connor, D & Michie, S 2012, 'Validation of the theoretical domains framework for use in behaviour change and implementation research', Implement Sci, vol. 7, no. 37. Craswell, A, Taylor, A, Coates, K & Broadbent, M 2016, 'Care collaboration through emergency department residential aged care and primary health collaboration.', ANMJ, vol. 23, no. 7, p. 45. Donabedian, A 2003, An Introduction to Quality Assurance in Health Care, Oxford University Press, Oxford, UK,. Grimshaw, J, Eccles, M, Lavis, J, Hill, S & Squires, J 2012, 'Knowledge translation of research findings', Implementation Science, vol. 7, no. 50, pp. 1-17. Hall, C, McCutcheon, H, Deuter, K & Matricciani, L 2012, 'Evaluating and improving a model of nursing care delivery: a process of partnership', Collegian, vol. 19, no. 4, pp. 203-10. Harvey, G & Kitson, A 2016, 'PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice', Implement Sci, vol. 11, p. 33. Marsden, E, Taylor, A, Wallis, M, Craswell, A, Broadbent, M, Barnett, A, Nguyen, K, Crilly, J, Johnston, C & Glenwright, A 2017, 'A structure, process and outcome evaluation of the Geriatric Emergency Department Intervention model of care: a study protocol', BMC Geriatrics, vol. 17, no. 76, pp. 1-8. Proctor, E, Silmere, H, Raghavan, R, Hovmand, P, Aarons, G, Bunger, A, Griffey, R & Hensley, M 2011, 'Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda', Administration and Policy in Mental Health, vol. 38, no. 2, pp. 65-76. Yamada, J, Shorkey, A, Barwick, M, Widger, K & Stevens, BJ 2015, 'The effectiveness of toolkits as knowledge translation strategies for integrating evidence into clinical care: a systematic review', BMJ Open, vol. 5, no. 4.



Take control of your career Graduate certificate in aged care nursing ACN’s Graduate Certificate in Aged Care Nursing will provide you with the principles of aged care nursing practice in order to improve your knowledge and skills for the provision and coordination of evidence based nursing care for the older person. Aged care is a growing sector within the health care industry and holds many future growth opportunities and challenges for nurses, which graduates of this course will be empowered to address. Career opportunities may include: • Specialist nursing roles • Clinical education roles • Management roles. Course overview The course provides an advanced grounding for developing the theoretical and practical aspects of management, clinical practice and education in aged care nursing. The single units of study in this course draw upon the student’s nursing

experience in aged care and combine this experience with theory, current research and best practice guidelines. Our unique blend of electives allows students to further explore a specific area of interest related to areas such as continence, dementia care and wound management. This course enables students to: • Demonstrate a specialist knowledge base within aged care • Develop specialist clinical practice and advance their clinical decision making skills • Engage in and maintain effective therapeutic relationships • Implement professional, educational and leadership skills to provide support for other clinicians and contribute to patient care • Critically analyse current literature and nursing practice to provide evidence based contemporary care • Promote the professional aged care nurse’s role within the multi-disciplinary team • Advocate for clients within all aged care environments.

Why study with ACN? ACN is a leading provider of postgraduate and vocational education for registered and enrolled nurses. When you study with ACN you can be confident that you have chosen a college that is recognised for providing courses with a strong clinical focus and evidence based practice. Our comprehensive courses are designed and developed by nurse educators to ensure that they build your clinical skills and advance your knowledge in your specialty area of practice. With leadership and management skills embedded in our courses at all levels, when you enrol in a course with ACN, you can be sure you are investing in the progression of your career.

Further information, including the units offered and key dates can be found at


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Registration as a nurse and midwife (dual registration) factsheet The Nursing and Midwifery Board of Australia (NMBA) provides resources for nurses and midwives to practise safely, including factsheets which answer some common questions on standards, codes, guidelines and other requirements. There are 28,554 people who are registered as both a nurse and midwife (dual registration). To ensure that these registrants and employers are aware of the registration requirements the NMBA has recently published a factsheet on holding dual registration.

How do I meet my registration requirements as both a nurse and a midwife? If you are registered as both a nurse and midwife, you must meet the requirements of the NMBA’s mandatory registration standards in both professions. This means you must be able to demonstrate that you have met the recency of practice, continuing professional development and professional indemnity insurance requirements relevant to your practice in both nursing and midwifery.

Recency of practice To demonstrate recency of practice you need to have evidence to support recent practice within your context/scope, knowledge and skills in each profession.

The NMBA standards for practice provide nurses and midwives with a framework for assessing practice. To help you to determine if you have recent practice as both a nurse and a midwife you can use the standards for practice to evaluate your own practice. For nurses, these are the Registered nurse standards for practice 2016, the Nurse practitioner standards for practice ( 2014) and the Enrolled nurse standards for practice 2016. For midwives these are the National competency standards for the midwife 2006 (under review). The NMBA recognises that there may be certain elements of practice common to both nursing and midwifery professions. You should use these standards to consider if you meet the requirements for the NMBA Recency of practice registration standard as both a nurse and a midwife when renewing your registration each year.

Continuing professional development (CPD) The CPD activities you undertake should be relevant to your context of practice, maintain your competence and build on your knowledge and expertise as both a nurse and midwife.

To demonstrate compliance with the NMBA Continuing professional development registration standard you must complete CPD activities to support both your nursing specific skills and knowledge and your midwifery specific skills and knowledge, within your context of practice. There may be some CPD activities that can be counted as evidence for both nursing and midwifery CPD hours. For more information please refer to the NMBA guidelines and fact sheet for CPD.

Professional indemnity insurance Under the National Law, nurses and midwives must not practise the profession in which they are registered unless they hold appropriate professional indemnity insurance (PII) arrangements in relation to their practice. If you are registered as both a nurse and midwife, you must have professional indemnity insurance relevant to all aspects of your practice in both nursing and midwifery to demonstrate compliance with the NMBA Professional indemnity insurance arrangements registration standard. You can find more helpful factsheets on the NMBA website. Topics include enrolled nurses and medicine administration, re-entry to practice, and many more.