NurseClick FOUR LEGGED THERAPISTS ANTIMICROBIAL USE CALLING ALL ACN SUPERHEROES!
more than just first aid
IN THIS EDITION
In the news – national
In the news – world
Australian College of Nursing update
Adjunct Professor Kylie Ward FACN, ACN CEO
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Four legged therapists
School nurses: more than just first aid
Calling all ACN superheroes!
Leading nurses forward
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What's happening in 2017?
Welcome! Adjunct Professor Kylie Ward FACN, CEO of ACN
Welcome to the February edition of NurseClick. With students returning to classrooms across the country over the past few weeks, it is important to acknowledge the invaluable role school nurses play in the provision of health services and ensuring children have the greatest chance of positive health outcomes at the earliest instance of life. Our feature article in NurseClick this month celebrates school nurses as leaders in our communities who drive the development of school health policies. In this engaging piece, School nurses: more than just first aid, we outline how nurses support the wellbeing, development and education of children within the school environment. Many of us join the nursing profession with a desire to help others and provide empathic care to our patients, however challenging work environments can sometimes lead to burnout, secondary traumatic stress and compassion fatigue. In her regular column, Vital Signs, one of our exceptional nurse educators, Trish Lowe MACN, explores this issue and outlines how advanced education preparation, resilience building and co-worker support can be an effective antidote to compassion fatigue. Mentoring and peer-support programs are an important avenue to foster the next generation of nurse leaders as they prepare to enter the nursing workforce. Within this edition of NurseClick, we outline how our new Emerging Nurse Leader
Mentoring Program draws upon the expertise and experience of our diverse membership base to support our exceptional up-and-coming nurses. Clinical facilitation is another exciting initiative that provides nurses with an opportunity to give back to this dynamic and diverse profession. In our highly informative article, Clinical facilitation: support a diverse nursing culture, we outline an exciting opportunity for readers to share their knowledge and skills with international nurses looking to join the Australian nursing community. Chief Nursing and Midwifery Officer for Western Australia, Adjunct Associate Professor Karen Bradley MACN is a highly accomplished nurse leader who provides a voice for our profession and leads transformational change across the Australian health care sector. In NurseClick this month, we celebrate Adjunct Associate Professor Bradley’s distinguished career and vital contribution to nursing in our ongoing CNMO profile series. Finally, we feature an article that offers valuable insights into the growing body of research surrounding animal assisted therapy. In this innovative piece, Four legged therapists, Jenny Holt discusses the benefits of equine and canine therapy used alongside other treatments for patients suffering from physical and mental health conditions. I hope you enjoy this inspiring read.
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ACN NURSING & HEALTH EXPOS 2017
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© 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 are representative only and do not depict the actual subjects and events described in the articles. Cover image: Stockphoto ACN publishes The Hive, NurseClick and the ACN Weekly eNewsletter.
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In the news national Breath test may help diagnose deadly cancers
Golden staph threatening indigenous kids
Flat head linked to developmental delays
Indigenous children in Australia are twice as likely to die from severe infections, like pneumonia and sepsis.
Babies with flat head syndrome may be at heightened risk of developmental delays, a study has found.
They are also seven times more likely to get a life-threatening golden staph infection, according to a University of Queensland study highlighting the health inequalities between indigenous and non-indigenous Australians.
A review of 19 research papers found delays in motor skills, language and cognition were detected in infants as young as six months with plagiocephaly or flat head. Read more
A simple breath test could soon be used to diagnose early cases of two deadly cancers.
Discovery of inflammation protein boosts breast cancer prevention efforts Adelaide researchers may have found a better way to use anti-inflammatory drugs to prevent breast cancer. The Hospital Research Foundation has identified a protein that causes inflammation and increased breast density in some women, increasing their cancer risk. Read more
Findings from a large trial involving more than 300 patients have shown that the test can identify stomach and oesophageal cancers with 85% accuracy. Read more
New 'smart needle' to make brain surgery safer A new high-tech medical device to make brain surgery safer has been developed by researchers at the University of Adelaide. The tiny imaging probe, encased within a brain biopsy needle, lets surgeons see at-risk blood vessels as they insert the needle, allowing them to avoid causing bleeds that can potentially be fatal.Â Read more
Pre-eclampsia breakthrough could see reflux drug Nexium help treat deadly pregnancy complication Researchers have stumbled across a major breakthrough in their quest to treat the potentially fatal pregnancy complication preeclampsia. Pre-eclampsia occurs when the placenta releases a toxin into the mother's bloodstream, damaging her organs and forcing the early delivery of her baby. Read more
Quarter of school children are bullied, survey finds A survey released by mental health service, ReachOut, found that a quarter of people aged 14 to 25 years old have been a victim of bullying in the past 12 months. It also found the highest incidence of bullying occurred at school. Read more
Children younger than classmates more likely to be on medication, study finds Children who are younger than their school peers are much more likely to be on medication for attention deficit hyperactivity disorder than their older classmates, a new study has found. Researchers analysed data from more than 300,000 Australian school children aged between six and 10. Read more
Blood cancer death rates on rise in Australia Blood cancer death rates in Australia have soared by a fifth in just 10 years, according to new figures released last month. The latest figures from the Australian Bureau of Statistics show that more than 4400 people across Australia died from blood cancer in 2015, compared with 3700 in 2006. That is an increase of nearly 20%. Read more
In the news world Scientists inhibit brain tumor cell growth, paving way for new treatment Glioblastoma is a particularly aggressive form of brain cancer that can be difficult to treat.
New research, however, may have found a drug that can inhibit the protein driving its growth.
Virtual reality could help treat vertigo
Girls lose faith in their own talents by the age of six
Eating disorders not just for young women, study finds
Virtual reality could be used to diagnose and treat visual vertigo, according to a team of Cardiff University psychologists.
Girls start to see themselves as less innately talented than boys do when they are only six years old, a group of US researchers have said.
The team is working to develop virtual environments to help with diagnosis and rehabilitation.
They said the disheartening results suggested the problem could snowball to affect future careers.
Eating disorders such as anorexia and bulimia are more commonly associated with adolescence or early adulthood. But a new study, published in the journal BMC Medicine, found that one in every 28 women aged 40 to 50 are thought to have an active eating disorder.
Artificial intelligence could be used to identify skin cancer Artificial intelligence (AI) can identify skin cancer in photographs with the same accuracy as trained doctors, say scientists. The Stanford University team said the findings were incredibly exciting and would now be tested in clinics. Eventually, they believe using AI could revolutionise health care by turning anyone's smartphone into a cancer scanner. Read more
However, less than three in 10 seek help for their problem.
Depression may be as bad for the heart as obesity
Doctors have long known of an association between psychological and physical health, but mental illness wasn’t considered to be a major risk factor for ailments like heart disease, until now.
Self-stigma may raise risk of metabolic syndrome
A German study has found depressed mood and exhaustion to be on par with high cholesterol levels and obesity as a risk factor for cardiovascular disease—the only greater risk factors being smoking and high blood pressure. Read more
A number of studies have shown that individuals who are obese are often stereotyped as ‘lazy,’ ‘lacking in willpower,’ or ‘unattractive.’ New research from the University of Pennsylvania finds that internalising such negative perceptions may increase the risk of metabolic syndrome for people who are obese, independent of weight. Read more
Diseases most likely to cause public health emergencies The World Health Organisation has published a list of priority diseases that need urgent research and development in order to prevent public health emergencies in the near future. The list includes nine disease categories for which few or no medical countermeasures exist due to market failures or lack of scientific knowledge. Read more
Anti-inflammatory diet could reduce risk of bone loss in women Anti-inflammatory diets—which tend to be high in vegetables, fruits, fish and whole grains—could boost bone health and prevent fractures in some women, a new study suggests. Researchers examined data to compare levels of inflammatory elements in the diet to bone mineral density and fractures, and found new associations between food and bone health. Read more
ACN deeply saddened by Melbourne’s Bourke Street Mall Tragedy
ACN congratulates Australia Day 2017 Honours Recipients
ACN was deeply saddened to hear about the tragic events that occurred in Melbourne’s Bourke Street Mall in January.
ACN congratulates all Australia Day 2017 Honours Recipients.
“ACN sends sincere condolences to the families of those who have lost their lives, and those who have been injured will remain in our thoughts,” said ACN CEO Adjunct Professor Kylie Ward FACN. “ACN is mindful that nurses and our professional colleagues are providing care to so many touched by this tragedy. "We are proud of their leadership at such a difficult time and encourage them to seek any support that they may need now or in the days ahead.” ACN encourages anyone that needs help to contact any of the following helplines: • • • • •
Lifeline on 13 11 14 MensLine Australia on 1300 789 978 Suicide Call Back Service on 1300 659 467 Beyond Blue on 1300 22 46 36 Headspace on 1800 650 890
"On behalf of ACN’s Board, Distinguished Life Fellows, Fellows, Members and staff, I congratulate all Australia Day 2017 Honours Recipients,” ACN CEO Adjunct Professor Kylie Ward FACN said. “I want to especially congratulate Professor Catherine Turner, Ms Elizabeth Bowell MACN, Ms Noela Davies MACN, Emeritus Professor MaryAnn Bin-Sallik, Ms Gillian Biscoe, Ms Denele Crozier, Ms Judith Kennedy, Ms Marilyn Beaumont, Mrs Heather Hewett MBE, Mrs Julianne Whyte, Ms Kerryn Ernst, and Lieutenant Colonel Nicholas Duff for their service to nursing. “All the recipients show exceptional nursing leadership qualities that enhance health outcomes for the community."
SOURCE: THE AUSTRALIAN
Australian College of Nursing update
ACN welcomes new Federal Health Minister and Federal Aged Care and Indigenous Health Minister ACN welcomes the announcement by the Prime Minister, the Hon. Malcolm Turnbull MP, welcoming the Hon. Greg Hunt MP as Australia’s new Health and Sport Minister and the Hon. Ken Wyatt MP as the new Minister for Aged Care and Indigenous Health. “On behalf of ACN, I congratulate Minister Hunt and Minister Wyatt on their new roles,” ACN CEO Adjunct Professor Kylie Ward FACN said. “Nurses understand the societal and economic forces that shape health and aged care, and we look forward to working with both Ministers to improve care outcomes." ACN is the preeminent and national leader of the nursing profession, whose mission is to enhance health care by advancing nurse leadership. Nurse leaders are powerful change-agents in improving care and play an essential role in the reform agenda. ACN is committed to ensuring that health and aged care systems are person centred and sustainable for future generations.
ACN is excited to announce that FEE-HELP is now available on our Graduate Certificate courses. Visit our website for more information. Advancing nurse leadership www.acn.edu.au
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Four legged therapists
The benefits of therapy animals If there’s one thing the Internet has taught us, it’s that looking at photographs and videos of adorable animals is the quickest way to brighten a dark day. But what if your dark day is actually a depressing week, month or year? What about those who suffer from mental health disorders such as Autism, Post Traumatic Stress Disorder or those undergoing chemotherapy? Is surfing the net for a kitten playing Chopsticks really going to cut it? Despite the scepticism that still surrounds it, Animal Assisted Therapy (AAT) is one of the most rapidly growing industries in the past decade and is often used alongside other treatments to help patients who suffer from mental and physical health conditions. Two of the most popular forms of AAT are equine and canine therapy.
Equine Therapy Horses are known to respond immediately to their riders, mirror their emotions and even synchronise their heartbeat. This ability to quickly establish a connection makes them the perfect animal therapist. Equine therapy combines physical, occupational, and speech-language therapy into one, to make it seem like the patient is having fun as opposed to ‘being treated’. More frequently than ever, it is equine therapy that is also being used for cancer patients.
Physically, people learn to improve their balance, co-ordination and even muscle strength. Mentally, it helps many to regain their confidence and selfesteem; having to handle the horse and its reins gives them a new sense of control. However, the best part of equine therapy is that it happens outside of the medical environment, which reminds the patient to focus on the present and decreases the sense of isolation that may have grown. The fact that they are bonding with something living, other than nurses, doctors and visitors, creates a calming presence and reduces stress significantly.
Canine Therapy Therapy dogs, on the other hand, are often brought in to visit the patient and are known to decrease loneliness and isolation by offering companionship. Scientific research has proven that stroking a dog prompts our bodies to release serotonin, prolactin and oxytocin (what are known as ‘feel good’ hormones) while decreasing the stress hormone, cortisol. They are therefore known to help with depression. Both equine and canine therapy help those with disorders such as Autism, Down’s Syndrome and Cerebral Palsy by increasing their attention span. They build on the pre-existing human-animal bond and help to reduce blood pressure and improve the patient’s overall cardiovascular health.
EMMA BUTZ/RAYE SOMMERS DESIGN
By Jenny Holt
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School nurses: more than just first aid Nurses employed throughout Australia’s education system play an integral role in promoting and supporting healthy communities and the wellbeing, development and education of children within the school environment. School nurses also play an invaluable part in ensuring children have the greatest chance of experiencing positive health outcomes later in life. The role of a school nurse is multifaceted and, at times, brings with it unique challenges. This includes assisting children with chronic and complex health conditions, children who come from culturally and linguistically diverse backgrounds and children whose circumstances are often complicated by societal issues, such as poverty and family violence (Council on School Health, 2008). School nurses function as leaders in their community. As a health professional within the school system, the school nurse may act as a leader in the development of school health policies. School nurses in Australia play an invaluable role in the provision of health services and ensuring children have the greatest chance of positive health outcomes at the earliest instance in life.
A STORY FROM AN EXCEPTIONAL SCHOOL NURSE… By Britta Crozier MACN Registered Nurse, President School Nurses Association of NSW As a school nurse I encountered a young Indian student that I noticed had extremely dry, patchy skin. I made an effort to engage this young man in conversation and tried to establish a connection with him, as I thought he would be more inclined to seek help or advice if he needed it. I checked his enrolment details and noticed that the family had declared that he had Cystic Fibrosis. The Principal had indicated that he would require an Independent Health Care Plan, which is used in the Department of Education, but none had been developed in the two years that he had been at the school. His mother arrived at the school one morning with a large bottle of medication and asked that I call her son down to the office as he had forgotten to take his daily medication. I noted that it was Creon. This was my opportunity to ask her about her son’s health condition and enquire as to the impact it was having on his daily attendance at school.
Initially she was reluctant to discuss it, and reluctant for me to develop an Independent Health Care Plan. She was concerned about singling her son out, drawing attention to his condition and embarrassing him. After much discussion and a meeting with both parents, reluctantly but gradually they began to see how disclosing information would allow her son to have regular toilet breaks, drinks in class, consideration given to his ability to finish his assignments on time and an explanation for his often prolonged absences from school or lateness on some days. He would gain support from his teachers and peer group. It became apparent that this young man was suffering from terrible constipation and often needed to use the toilet for prolonged periods, rendering him late for school. His skin was extremely dry and flaky and he was underweight for his age. His mother would often seek me out to get advice as to what to do next. He spent long periods in hospital, which would have simply have been recorded as absent due to sickness prior to communication with relevant members of staff.
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“School nurses in Australia play an invaluable role in the provision of health services and ensuring children have the greatest chance of positive health outcomes at the earliest instance in life.”
Eventually he signed out of school and I lost contact with him and his family. I felt that although I do not know the outcome of this young man’s disease that I was able to open up the lines of communication for him and his mother. Teaching staff became aware and stopped sending letters home reporting unsatisfactory outcomes and failure to hand in assignments.
They became more supportive and realised that it was more important for him to simply come to school, mix with his peer group and feel welcome, accepted and supported. His mother received advice, comfort and an awareness that her son’s illness was not shameful but rather an unfortunate event that he had no control over. She often came in to just chat about the difficulties she was facing; her son’s increasing aggression as he grew to understand the progress of his disease. She was always extremely thankful for any advice and support.
Earlier intervention at the school level may have improved the outcome for this young man but intervention at the point it occurred allowed for better communication and understanding of his disease by others that would not have known, had I not acted. Reference Council on School Health 2008, 'Role of the school nurse in providing school health services', Paediatrics, vol 121, no 5, pp. 1052-1056.
EDITOR'S NOTE Britta’s story was originally published in our 2016 Community and Primary Health Care Nursing Week eBook. Click here to access the eBook and read more inspirational stories from community and primary health care nurses, researchers and consumers.
Over time, this young man became less and less interested in coming to school and appeared to finally have an idea that this disease had no cure and there was no point in getting an education. His mother tried to seek external work experience for him but this was difficult as he required toilet facilities and time to use it frequently. He developed an addiction to online gaming and preferred to stay at home and use his computer than to come to school.
Calling all ACN
Be a mentor to our exceptional Emerging Nurse Leaders
Objective of the mentoring program The objective of the mentoring program is to provide ENLs with the opportunity to access support from experienced ACN Fellows and Members in progressing their nursing careers to enable: • Further understanding of their own leadership potential • Insight into professionalism of nursing • Professional networking • Insight into nursing policy issues Our ENLs are exceptional individuals that continue to amaze us. Trust us you will want to be associated with them! Just read Evan’s story in our October edition of NurseClick and you will know what we mean.
Objective of the ENL program The ENL program is designed to develop skills, build confidence and provide opportunities for nurses to represent the nursing profession as leaders. It focuses on developing leadership skills through a blend of formal education, self-reflection, mentoring and action based learning opportunities. It is a self-paced nine-month program, based on adult and action learning principles. Nurses will lead their learning experiences and are offered a wide range of activities. Participants are awarded points as they progress through the program, which can also make them eligible for additional benefits. Head to our website for more information about the ENL program and click here to find out more about becoming a mentor.
ACN is looking for mentors for our 2017 Emerging Nurse Leaders (ENLs). If you like the idea of using your own experiences and insights to support a future nursing superstar then this is the opportunity for you!
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Leading nurses forward Get to know Adjunct Associate Professor Karen Bradley MACN, Chief Nursing and Midwifery Officer for Western Australia.
Karen’s distinguished career began as a registered nurse at Sir Charles Gairdner Hospital in Perth WA. Karen then joined St John of God Hospital Subiaco where she rose through the ranks to become the Director of Inpatient Services. Since then, Karen has worked in a variety of clinical, education, health service management and leadership roles within private, public, metropolitan and rural health service settings across the state.
In every state and territory across the country, our Chief Nurse and Midwifery Officers (CNMO’s) provide a vital professional link between the Department of Health, and the Australian nursing and midwifery community.
ACN is publishing a series of articles about our CNMO’s throughout the next few editions of NurseClick. This edition, we are profiling, Adjunct Associate Professor Karen Bradley, Chief Nursing and Midwifery Officer for Western Australia, whose experience and expertise as a nurse leader has seen her achieve remarkable outcomes while in this role.
SOURCE: WESTERN AUSTRALIAN HEALTH
Our CNMO’s play a key role in developing a collaborative and strategic approach to nursing and midwifery at a state and national level. They provide leadership, advice, information and guidance on all issues related to nursing and midwifery.
Adjunct Associate Professor Karen Bradley MACN, Chief Nursing and Midwifery Officer, Western Australia Adjunct Associate Professor Karen Bradley MACN was appointed Chief Nursing and Midwifery Officer for Western Australia in 2014.
Prior to her appointment as the WA CNMO, Karen held the position of Area Director of Nursing and Midwifery with the South Metropolitan Health Service. In this role, she provided professional leadership, planning and strategy for over 6,000 nurses and midwives. In her current role, Karen is responsible for setting the strategic, professional and workforce oriented agenda for the nursing and midwifery professions in WA. She provides a voice for our profession and leads transformational change across the health care sector. Karen is passionate about working with others to create safe, supportive, rewarding and patient focused workplace environments where nurses and midwives are empowered to practice to their full scope. She is a valued member of ACN and we look forward to continuing to work collaboratively with her in 2017.
Chief Nursing and Midwifery Officer for Western Australia, Adjunct Associate Professor Karen Bradley MACN, ACN CEO Adjunct Professor Kylie Ward FACN, and Director General of the Department of Health, Dr David Russell-Weisz at the Nursing and Midwifery Executive Leaders Breakfast Forum
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Examining burnout, secondary traumatic stress, compassion fatigue and compassion satisfaction Nurses and midwives work in challenging environments. They are repeatedly exposed to traumatic injuries, ethical dilemmas and provide care which at times, seems futile. They frequently Trish Lowe MACN experience death, dying and distress. Work environments can be stressful, with the rigors of shift work leaving little time or energy for social engagement and effective work/life balance. These conditions
predispose health professionals to burnout, secondary traumatic stress and compassion fatigue. Therefore, these under researched concepts require attention. As the terms are erroneously and interchangeably used, it is worth clarifying definitions, before examining variables which predict and ameliorate their impact. Burnout (BO) is described as the negative emotional reaction to workplace stressors and presents as emotional exhaustion, depersonalisation, negativity and diminished regard for personal and professional accomplishments (Hinderer et al 2014, p. 160). As burnout is linked to workload, patient acuity, individual coping mechanisms and professional experience, it can be ‘contagious’ among staff cohorts. Poor treatment and feeling overlooked
by supervisors and managers are also strong predictors of burnout. Burnout has the capacity to compromise patient safety due to reduced empathy and inertia (Hinderer et al, 2014; Leiter & Maslach 2009, cited Sheppard 2015, p. 57). Conversely, secondary traumatic stress (STS) is an emotional response to traumatic events or distress experienced by another and presents as irritability, anger, intrusive thoughts and sleep disturbance (Hinderer et al. 2014, p. 161). Secondary traumatic stress may be ameliorated by professional experience, particularly when complimented by collaborative management and effective co-worker support (Hinderer et al 2014; Stamm 2010, cited Sheppard 2014, p. 57). However, compassion fatigue (CF) describes the cumulative effects of traumatic experiences
on the ability of health care workers to nurture themselves, their colleagues, patients and families (Figley 1995, cited Hinderer et al 2014, p. 161). Compassion fatigue results in the perception that one’s role brings more distress than satisfaction and leads to low morale, impaired performance, absenteeism and workforce attrition (Stamm 2010, cited Sheppard 2015, p. 57). Compassion fatigue is viewed as the most serious manifestation of accumulated disharmony, resulting from the ‘convergence of secondary traumatic stress and burnout’ (Cocker & Joss 2016). Health professionals experiencing compassion fatigue tend to disengage from their patients as a way of shielding themselves from suffering (Buurman, Mank, Beijer & Olff 2011, cited Sheppard 2015, p. 58).
By Trish Lowe MACN
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Vital Signs As a result, determining the most effective intervention is also challenging. Following a systematic review of the literature, Cocker and Joss (2016) stated that, while 10: 13 studies reported interventions which resulted in “significant improvement in at least one element of CF, no study reported positive change in all three indicators (STS, BO, CS) and only one study had a follow up period of longer than eight weeks”, making it difficult to determine the effectiveness of CF interventions over time.
“Burnout is the negative emotional reaction to workplace stressors...”
Compassion satisfaction, on the other hand, describes the feeling of accomplishment and reward associated with caring for patients (Figley 1995, cited Hinderer et al 2014, p. 161). Advanced educational preparation, co-worker support, resilience building and professional experience facilitate the development of compassion satisfaction and has been found to be the most effective antidote to burnout, secondary traumatic stress and compassion fatigue (Cocker & Joss 2016; Hinderer et al, 2014). Yet questions remain as to why workplace stress affects practitioners differently. For example,
Dutton and Rubenstein’s Theory of STS reactions (1995, cited Hinderer et al. 2014, p. 161) highlights a complex interplay between variables stating that exposure to traumatic events (e.g. years in current positon and percentage of direct patient care) combined with nurse reactions to stress (e.g. BO, CF, CS), one’s individual coping strategies (e.g. access to support, stress relief, coworker relationships), and personal and environmental characteristics (e.g. age, gender, ethnicity, marital status, education and years in nursing), all combine to influence an individual’s reaction.
However, taking this information into account and recognising the diversity evident within the nursing and midwifery workforce, in terms of educational preparation, gender, experience and clinical setting, are vital first steps. And while research continues, the employment of collaborative management styles, provision of advanced educational preparation and co-worker support aimed at building resilience, appear to be the most rational solutions.
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References: Cocker, F & Joss, N 2016, ‘Compassion Fatigue among Healthcare, Emergency and Community Service Workers: a Systematic Review’, International Journal of Environmental Research and Public Health, vol. 13, no. 618, doi: 10.3390/ ijerph13060618 Hinderer, KA, VonRueden, KT, Friedmann, E, McQuillan, KA, Gilmore, R, Kramer, B & Murray, M 2014, ‘Burnout, Compassion Fatigue, Compassion Satisfaction and Secondary Traumatic Stress in Trauma Nurses’, Journal of Trauma Nursing, vol. 21, no. 4, pp. 160-169 Sheppard, K 2015, ‘Compassion fatigue among registered nurses; Connection theory and research’, Applied Nursing Research, vol. 28, pp. 57- 59, http://dx.doi. org/10.1016/j/apnr.2014.10.007
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Antimicrobial use Key findings from the Antimicrobial Use and Resistance in the Australia Surveillance System. Professor John D Turnidge and Adjunct Professor Kathy T Meleady
The increased occurrence of AMR, together with the sharp decline in the development of new antimicrobials, will result in there being fewer antimicrobials to treat infections when existing ones become ineffective. As a result, infections that could once be treated or prevented may once again become life-threatening. Many medical procedures relying on antibiotics to control infection, such as chemotherapy, organ transplantation, joint replacement surgery and neonatal care, will become riskier. A key in the fight against AMR is to understand the extent of resistance and inform targeted strategies to reduce overuse, and inappropriate
use, of antimicrobials. The Australian Commission on Safety and Quality in Health Care (the Commission) is bringing together this information in one system â€“ the AURA Surveillance System. The AURA 2016: First Australian report on antimicrobial use and resistance in human health was released in June 2016. The report contains data on antimicrobial use in the general community, hospitals and aged-care homes; key emerging issues for AMR; and a comparison of the incidence of AMR in Australia with other countries. AMR is increasing the risk of harm to patients. Nurses provide a pivotal role in patient care and therefore, have a significant role to play in preventing and containing AMR. It is vital for all health care professionals to understand the impact of antimicrobial use and AMR in Australian health care settings. This article discusses these issues and the initiatives underway to help nurses control health care associated infection.
Inappropriate antimicrobial use has impacted the spread of antimicrobial resistance (AMR) worldwide. Antimicrobial use in the Australian community is high with nearly half (46%) of Australians being dispensed at least one course of antimicrobials in 2014 (ACSQHC, 2016). Resistance to antibiotics is commonly found in Australian hospitals, and increasingly in the community.
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AURA 2016 Australia has a high rate of antimicrobial use compared with many other countries, and this use is often inappropriate (ACSQHC, 2016). There is also significant variation in prescribing rates across states and territories and local areas, but the reasons for this are unclear (ACSQHC & NHPA, 2015).
HOSPITALS On any given day in 2014, around 38% of patients in Australian hospitals were receiving antimicrobial therapy (ACSQHC, 2016). Around 23% of these prescriptions were considered inappropriate, and around 24% were noncompliant with guidelines (ACSQHC, 2016). The main reasons for inappropriate prescribing were that the antimicrobial was not indicated; the spectrum was too broad; or there was an incorrect dose, frequency or duration of therapy (ACSQHC, 2016). Prescriptions for surgical prophylaxis are a significant concern; this indication is the most common reason for prescribing antimicrobials in hospitals (13% of all prescriptions), of which more than 40% were deemed inappropriate (ACSQHC, 2016). Best practice guidance states that the proportion of surgical prophylaxis that continues
for longer than 24 hours should be less than 5%. In Australian hospitals, this proportion is 36% (ACSQHC, 2016). Six antimicrobials account for more than 50% of antimicrobial use in Australian hospitals: amoxicillin–clavulanate, flucloxacillin, cefazolin, amoxicillin, doxycycline and cephalexin (ACSQHC, 2016). It is therefore important to ensure appropriate prescribing and use of these highly used antimicrobials.
COMMUNITY Australia has the eighth highest community antimicrobial prescribing rate among Organisation for Economic Co-operation and Development (OECD) countries, and this rate is more than double that of countries that prescribe the lowest volumes of antimicrobials (OECD, 2015). In 2014, more than 30 million antimicrobial prescriptions were supplied under the Australian Government’s Pharmaceutical Benefits Scheme (PBS) and the Repatriation PBS to almost 11 million Australians (ACSQHC, 2016). More than 50% of people with colds and upper respiratory tract infections were prescribed antimicrobials unnecessarily in 2014 (ACSQHC, 2016). Antimicrobial use in all age groups increases during the winter months, and the
number of prescriptions for antibiotics show prominent seasonal variation, indicating potential misuse for the treatment of viral illnesses such as colds and influenza (ACSQHC, 2016). A large proportion of patients with acute tonsillitis, acute or chronic sinusitis, acute otitis media or acute bronchitis received an antimicrobial, despite antimicrobial treatment not being routine therapy in most cases (Adraenssens et al, 2011). A large proportion of antimicrobials prescribed were not those recommended by guidelines (NPS Medicinewise, 2015). Repeat prescriptions are frequently ordered for commonly prescribed antimicrobials, such as amoxicillin and cephalexin, where a repeat is not needed to complete a treatment course (Drug Utilisation Sub-Committee, 2015).
AGED-CARE HOMES A specific pilot in aged care facilities, the Aged Care National Antimicrobial Prescribing Survey (acNAPS), was undertaken in 2015 across 187 aged-care homes and multipurpose services. It found that 11.3% of residents were on antimicrobial therapy, but only 4.5% had a suspected or confirmed infection (acNAPS, 2016).
Around one in five antimicrobial prescriptions written in these facilities were for residents who had no signs or symptoms of infection (acNAPS, 2016). For residents who did show signs or symptoms, two-thirds of prescriptions were inappropriate when assessed against McGeer infection criteria (McGeer et al, 1991).
KEY FINDINGS: ANTIMICROBIAL RESISTANCE Australia has different patterns of antimicrobial resistance to other countries. Some organisms, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium, are of particular concern. Community-associated MRSA strains are responsible for around 60% of hospital-onset staphylococcal bacteraemia, and also cause a substantial proportion of infections in the community that result in hospitalisation. Vancomycin resistance in E. faecium causing serious infections is between 45% and 66% (ACSQHC, 2016). Streptococcus pneumoniae resistance to macrolides, tetracycline and co-trimoxazole is now 20–30%, which limits second-line treatment options for lower respiratory tract infections in the community (ACSQHC, 2016).
WORKING TOGETHER One of the key messages arising from the AURA Surveillance System is that antimicrobial use is a significant driver of AMR; the more we use antimicrobials, the more likely it is that resistance will develop. Appropriate use of antimicrobials can be life-saving, but inappropriate use needs to be monitored and minimised to prevent and contain resistance. The Commission’s work to develop the National Safety and Quality Health Service (NSQHS) Standards, including Standard 3 – Preventing and Controlling Healthcare Associated Infections, provides a platform for health care professionals in the delivery of high quality health care. The Commission has supported a number of important initiatives to prevent and contain AMR, such as the National Healthcare Associated Infection (HAI) Prevention Program. This includes its National Hand Hygiene Initiative, a national program to standardise hand hygiene practice and placement of alcohol-based hand rub in every Australian hospital. Hand hygiene has been identified as a high priority for the prevention of HAI worldwide, as it is a highly effective intervention. As part of this Program, a series of education modules have been developed to support staff who undertake infection prevention as part of their clinical role. Similarly, the Commission’s Antimicrobial Stewardship Clinical Care Standard aims to help health care professionals ensure that a patient with a bacterial infection receives optimal treatment with antibiotics.
As part of the National Surveillance Initiative, the Commission has developed implementation guides for use by Australian hospitals and organisations to support the implementation of surveillance for Staphylococcus aureus bacteraemia (SAB), Clostridium difficile infection (CDI) and Central Line Associated Bloodstream Infections (CLABSI). The AURA Surveillance System will continue to provide a comprehensive picture of patterns and trends in antimicrobial use and resistance to guide improvements in infection control, antimicrobial stewardship and antimicrobial prescribing practices. Hospitals, multipurpose services and aged care homes are strongly encouraged to participate in the surveillance undertaken by AURA’s partner programs, including NAPS, acNAPS, the National Antimicrobial Use and Surveillance Program and the Surgical NAPS (a new program focusing on surgical prophylaxis). References Adraenssens N, Coenen S, Tonkin-Crine S et al 2011, ‘European Surveillance of Antimicrobial Consumption (ESAC): disease-specific quality indicators for outpatient antibiotic prescribing’, BMJ Quality and Safety, 20: 764–72 Australian Commission on Safety and Quality in Health Care (ACSQHC) 2016, AURA 2016: first Australian report on antimicrobial use and resistance in human health, Sydney ACSQHC & National Health Performance Authority (NHPA) 2015, Australian atlas of healthcare variation, Sydney ACSQHC & National Centre for Antimicrobial Stewardship 2016, Aged Care National Antimicrobial Prescribing Survey 2015, viewed 16 January 2017, https://ncascre.files.wordpress.com/2015/08/acnaps-print-copy.pdf Drug Utilisation Sub-Committee 2015, Antibiotics: Pharmaceutical Benefits Scheme/Repatriation Pharmaceutical Benefits Scheme utilisation: October 2014 and February 2015, Canberra McGeer A, Campbell B, Emori TG, et al 1991, ‘Definitions of infection for surveillance in long-term care facilities’, American Journal of Infection Control, 19: 1–7.1 NPS MedicineWise 2015, MedicineInsight post market review report 3: antibiotics (unpublished), Sydney 7Organisation for Economic Co-operation and Development (OECD) 2015, Health at a glance 2015, Paris: OECD Publishing,
Join us in supporting a diverse nursing culture
ACN is looking for motivated registered nurses to provide clinical facilitation for our Entry Program for Internationally Qualified Nurses/Return to the Register (EPIQ/RTR) program. This program is conducted eight times per year in NSW, predominantly in Sydney. The program consists of a five week theoretical component and six weeks of clinical placement. Clinical placement can take place in public or private facilities in acute and aged care specialities. The students undertake two clinical
assessments and must be successful to be recommended for registration with the Nursing and Midwifery Board of Australia (NMBA). We require clinical facilitator primarily for the clinical placement component of the program but there are also opportunities to facilitate some on campus sessions. BENEFITS INCLUDE: • Flexible working arrangements that you can fit around your life. • Travel allowance and parking reimbursement • Opportunities to attend in house education sessions
APPLICANTS MUST PROVIDE: • Certificate of registration with the NMBA • Evidence of clinical facilitation experience • Current criminal record check • Current immunisation status compliant with NSW Health DESIRABLE QUALIFICATIONS: • Certificate IV TAE • Postgraduate specialty qualifications Please forward a current CV, copies of your qualifications and evidence to support the essential criterion via email to firstname.lastname@example.org or call 02 9745 7500 for further information.
Would you like to work for Australia’s peak professional nursing body where nurse leaders are valued and developed?
Are you passionate about the nursing profession? Would you like to work for Australia’s peak professional nursing body where nurse leaders are valued and developed?
What’s happening in 2017? The Nursing and Midwifery Board of Australia (NMBA) wishes all nurses and midwives around Australia a very happy new year. In 2017, the NMBA will continue to ask for your input into key projects, including public consultation on the revised codes of conduct for nurses and midwives and the new Midwife standards for practice.
“This nationwide support service will offer 24/7 professional, confidential advice and referral about health issues for nurses and midwives, via telephone and online.”
The NMBA, supported by the Australian Health Practitioner Regulation Agency (AHPRA), is continuing to improve the registration process for nurses and midwives each year, making it easier than ever to renew online in 2017. We will also continue to support nurses and midwives to practice safely, with the launch of Nurse and Midwife Support, the national health support service for nurses and midwives which will provide around the clock advice, anywhere in Australia.
Nurse and midwife support March 2017 will see the commencement of Nurse and Midwife Support – the national health support service for nurses, midwives, students and employers. This nationwide support service will offer 24/7 professional, confidential advice and referral about health issues for nurses and midwives, via telephone and online.
Code of conduct: public consultation and launch in 2017
Internationally qualified nurses and midwives
In February 2017, all nurses and midwives will receive an invitation from the NMBA to give their feedback on the draft codes of conduct for their professions, as part of the public consultation before the codes are finalised. The new codes of conduct will be launched later in 2017.
In 2017, the NMBA is developing a model for outcomes-based assessment for internationally qualified nurses and midwives (IQNMs).
The codes of conduct set out the legal requirements, professional behaviour and conduct expectations for all nurses and midwives in all practice settings in Australia. The draft codes are research-based and have been through extensive consultation with the professions and other stakeholders. The NMBA looks forward to hearing your thoughts on the draft codes next month.
Midwife standards for practice Deakin University is developing the new Midwife standards for practice, on behalf of the NMBA, and the public consultation on the draft standards is expected to open in May 2017. The project includes a review of the existing National competency standards for the midwife (2006) and is expected to be completed later this year.
This model will allow a more consistent and robust assessment of IQNMs, and align with international best practice standards.
Registration renewal Registration renewal will open in March 2017 and it’s easier than ever to renew online. Registration fees fund all of the costs of regulating around 380,000 nurses, midwives and students of nursing and midwifery in every Australian state and territory. These fees cover the costs of setting and administering evidence-based registration standards as well as professional codes, standards and guidelines. These fees also contribute to the cost of the Australian Nursing and Midwifery Accreditation Council (ANMAC). ANMAC is responsible for accrediting and monitoring more than 400 nursing and midwifery programs of study that lead to registration or endorsement: an essential component of the National Scheme. Some of the work the NMBA does for safer health care is communicated to nurses and midwives in our regular newsletters and bulletins, but you can also visit our website to find out more.
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