NurseClick J U LY 2 0 16
A nurse or an angel in scrubs? A health consumer's story
Responding to and preventing elder abuse in Australia
The nursing grad experience: A reflective case study
Nurses advocating for human rights and freedom
In this edition
In focus @ACN
In focus @ACN
Corporate partner @ACN
Protecting the rights of older Australians from abuse
Vital Signs: Advocating for human rights and freedom
A nurse or an angel in scrubs? A health consumer's story
Your investment in a piece of Australia
In focus @ACN
In focus @ACN
Corporate partner @ACN
In focus @ACN
Climate & Health: Future disasters under new climate scenarios
The nursing graduate experience: A refelctive case study
Holding nurses to account: What to do when things go wrong
Nursing in the community: The bigger picture of patient care
In Memory @ACN
ACN voices â€“ meet our representatives
Aged care homes endorse new palliAGEDnurse app
In memory: Jeannie Ross Fraser FACN, 1923-2016
NMBA pleased to announce national health support service
Welcome Adjunct Professor Kylie Ward FACN, CEO of ACN
Publishing details Publisher Australian College of Nursing
Welcome to the July edition of NurseClick. We have some insightful articles this month that highlight the immense difference support and compassion can make to nurses and patients alike. In her reflective case study, Rachel Wardrop MACN shares her journey from struggling graduate with no support network to valued and confident nurse and educator, while a grateful health care consumer tells of her experience with the ‘best and the worst’ of the health care system in her thank you letter of sorts, ‘A nurse or an angel in scrubs?’ With compassion being synonymous with the nursing profession, it’s no surprise that we are wellpositioned to advocate for human rights. Inspired by a recent panel held by the Australian Human Rights Commission, ACN Nurse Educator Trish Lowe MACN discusses the importance of meaningful conversation in this space and how nurses can contribute in her regular column, Vital Signs. Described as ‘compassionate, courageous and committed’, Jeannie Ross Fraser FACN, who sadly died on May 30 this year, encapsulates the ethos of the nursing profession. With the help of Jeannie’s dear friend Eve Chappell, we pay tribute to the generous nurse and philanthropist, who will be greatly missed by the Glen Innes and nursing communities whom she gave so much to. Once again, it is a pleasure to profile one of our
member representatives. Tracy Kidd MACN is an exceptional nurse leader with a wealth of experience in emergency nursing and we are proud to have her representing ACN on the Australian Resuscitation Council. Following the recent release of the Australian Law Reform Commission Elder Abuse Issues Paper, the ACN Policy Team have put together an article on this global social issue. If you have any experience or expertise related to elder abuse, I encourage you to share your knowledge to help inform ACN’s response to the Elder Abuse Issues Paper. Following up her inaugural piece in the June edition of NurseClick, ACN’s Climate and Health Key Contact Dr Liz Hanna FACN shares her expertise once again in her Climate and Health column, as she explores the climate's effect on global health as it influences the intensity and frequency of disasters around the world. Finally, we feature a story from our Community and Primary Health Care Nursing Week: Nurses where you need them eBook. Vanessa Crossley's story is a captivating look into the role of an in-home care nurse — just one of the many forms a community and primary health care nurse can take. If you are a community nurse or know a community nurse, I encourage you to share your story with us and get involved in this year's Community and Primary Health Care Nursing Week.
Editors Karina Piddington Wendy Hooke Design Nina Vesala Emma Butz
TO RESEARCH REVIEW
MAKING EDUCATION EASY FOR NURSES www.researchreview.com.au
Enquiries t 02 6283 3400 email@example.com © Australian College of Nursing 2016 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 ‘file photo’ or credited to iStock are representative only and do not depict the actual subjects and events described in the articles. Cover image: iStock/Emma Butz ACN publishes The Hive, NurseClick and the ACN Weekly eNewsletter.
Read the latest in nursing research and practice in ACN’s digital journal, Collegian. Access to the peer-reviewed publication is free for all ACN Members via the My ACN member portal, members.acn. edu.au
In the news Nat ional More Victorians to be able to die at home under government plan
Study shows an increase in post-birth hysterectomies
More Victorians would be able to die at home under an ambitious government plan to overhaul the state's strained and fragmented palliative care system within two years. About 800 people and 40 organisations were consulted for the plan, many of whom stressed that people want access to palliative care in their homes and local areas.
The number of women who have had potentially life-saving peripartum hysterectomies in Australia has increased. New research on this rare, emergency surgery has found the increase is strongly associated with increased rates of caesarean sections in Australia. Read more
Epileptic NSW children to trial cannabis Decrease in neural tube defects since folic acid added to bread The introduction of the mandatory fortification of bread with folic acid (in Australia) and iodine (in Australia and New Zealand) in 2009 has resulted in improved health outcomes, particularly for teenagers and Aboriginal and Torres Strait Islander women, according to a new report from the Australian Institute of Health and Welfare (AIHW).
NSW children suffering severe, debilitating and treatment-resistant epilepsy will soon be able to access medicinal cannabis as part of an Australianfirst clinical trial. The experimental, cannabis-based Epidiolex drug will be delivered through the Sydney Children's Hospital to an initial group of 40 NSW families in need, with the hope of expanding the trial to hundreds within the next 12 months. Read more
Irregular heartbeat a cause of stroke Health Tracker report card The Australian Health Policy Collaboration has released Australiaâ€™s Health Tracker, a report card that provides a comprehensive assessment of the health of Australians in relation to chronic disease and their risk factors. The report card will track progress towards the targets for a healthier Australia by 2025. Read more
Hundreds of thousands of Australians may be living with an undetected killer that is putting them at serious risk of stroke, experts warn. Around 460,000 Aussies have atrial fibrillation, an irregular heartbeat which can be fatal if left untreated. Read more
Cancer risk linked to skin cells exposed to high temperatures Scientists have found that skin cells exposed to UV light and a temperature of 39 degrees Celsius show significant DNA damage, which increases a person's risk of illness. They say the findings could be of particular importance to people who work outdoors, in warm climates.
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High health care costs for obese preschoolers Obesity even at a very young age is costing the health system money, with obese pre-schoolers two to three times more likely to be admitted to hospital, a study has found. The study by the University of Sydney's School of Public Health examined the total health care costs of 350 pre-school aged children over a three-year period and found those who were obese had 60 per cent higher costs than healthy weight children. Read more
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World Mother's DNA is key to healthy ageing, study finds A tiny repository of DNA inherited only from one's mother may be key for healthy ageing, according to researchers who swapped out mouse genes to prove the point. The research team created two sets of lab mice identical but for their mitochondrial DNA (mtDNA) â€“ and found that one group was much healthier and more sprightly in old age.
Hospitals on alert for global emergence of deadly, drugresistant yeast infection Health authorities in the United States and the United Kingdom are alerting hospitals to be on the lookout for an emerging multidrug-resistant yeast in patients that is causing potentially lethal, invasive infections in healthcare settings. Read more
Womb scratch may double the chance of having a baby A cheap and simple technique that involves scratching the lining of the womb could double fertility rates in women, research suggests. A global study found that women who underwent the procedure during natural or assisted conception had birth rates 2.2 times higher than those who did not. Read more
New genetic test can spot aggressive prostate cancer
Scientists are homing in on the secrets of limb regeneration
Artificial pancreas for diabetes patients could be available within a year
In recent research, scientists from Mount Desert Island Biological Laboratory and the University of Maine found that three evolutionary distant species have important similarities in their microRNA â€“ small RNA molecules that regulate elements of gene expression â€“ which may be vital to their regenerative abilities.
People living with type 1 diabetes could soon be free of regular insulin injections, after researchers said an artificial pancreas could become available within a year. Those diagnosed with the autoimmune condition need regular insulin injections, sometimes up to six times a day, to compensate for a pancreas that produces little or no insulin.
Unmasking Alzheimer's risk in young adults
New 3D printing technique helps create jaw prosthesis for cancer survivor
For decades, doctors have been able to easily identify women who have a higher risk of developing breast cancer because of their genes. Now researchers have recognized a similar set of genes that can distinguish aggressive prostate cancer.
The risk for developing devastating Alzheimer's disease may be detectable in healthy adults younger than expected, and new studies reveal how. A study published in the journal Neurology suggests that the risk factors for sporadic Alzheimer's can be detected early in adulthood and might make a person more susceptible to cognitive decline.
The life of a cancer survivor has been changed forever, thanks to a novel 3D printing technique developed by scientists at Indiana University. The revolutionary technique uses 3D modeling and printing to create incredibly lifelike prosthetics faster than conventional methods. Read more
C all for nominations for Policy Innovation and Impac t Award The International Council of Nurses (ICN) is calling for nominations for the first Kim Mo Im Policy Innovation and Impact Award. The recipient of this award will receive a grant for advancing an innovative policy project focused on a key global issue. The award will be presented during the ICN Congress Opening Ceremony on Saturday 27 May 2017 in Barcelona, Spain. A nominee may be an individual nurse or a group of nurses who have worked together on the same project. Nominations must be received at ICN headquarters by Friday 30 September 2016. Click here for more information about this award.
New C Nnec t improves user experience In 2010, the Australian College of Nursing (ACN) launched its online education portal CNnect. This was a significant leap forward into the digitally delivered education world. Since then thousands of students have completed graduate certificate and speciality nursing courses, as well as registered training organisation accredited nursing courses such as the Advanced Diploma in Nursing, Certificate IV Training and Assessment and CPD courses using CNnect. Technology changes rapidly and ACN’s commitment to improving educational products, services and systems remains remains strong. We are determined to ensure a high level of excellence for our students. Against this background, ACN proudly launched an improved and contemporary version of CNnect on 1 July 2016. Not only has the look changed, there has been significant changes to CNnect functions which will enhance the student experience and aid learning.
New course openings for ACN's Breast Care Nurse Practicum A few places have become available in our September Breast Care Nurse Practicum, which will run from Monday 19 – Friday 23 September.
Have Your Say Are you a nurse working in advance care planning? Researchers from The University of Sydney and The Royal Melbourne Hospital are conducting a survey to better understand health professionals’ knowledge, attitudes and practice behaviours regarding advance care planning. Respiratory, practice or palliative care nurses are invited to complete a 15-minute survey that will take you to only those questions relevant to your discipline. Key features include: • Menu driven functionality that provides a one-stop-shop for navigation • Improved access to learning content and material • Contemporary design that works significantly better on mobile devices • Improved student support resources
This five-day program is designed for registered nurses who are currently caring for patients diagnosed with breast cancer. Attendance is free and open to all nurses currently working as breast care nurses, particularly in rural and remote Australia. Spaces are strictly limited and will fill fast – so make sure you secure your place by filling out an enrolment form today! If you are interested in participating in this program in 2017, email us on firstname.lastname@example.org.
ACN prides itself as a learning organisation that is responsive to student and member needs. After seeking student feedback and ideas on CNnect functionality, we spent some time making sure the new CNnect addressed student needs. We hope this new version of CNnect provides a fertile environment for online learning and engagement for thousands more nurses who choose to study with ACN in the future.
Click here for more information and to complete the survey.
Calling renal nurses to inform study on complementary therapy during haemodialysis A study exploring the views of renal nurses towards the design of a yoga program for haemodialysis related fatigue is seeking participants for a short survey. This study forms one of the initial research phases being conducted as part of a larger sequential multiphase mixed methods research project, forming the basis of a doctorate of philosophy at Western Sydney University. Consultation with renal nurses will ensure the development of clinically relevant yoga components for these domains, explicitly addressing the protocol and research design limitations identified in previous yoga studies. Click here for more information and to complete the survey.
In focus@ACN Policy @ACN
Responding to and preventing elder abuse in Australia By Stefan Wythes, Anita Pak and Carolyn Stapleton FACN
There has been significant media coverage about the issue of elder abuse as it is a growing problem in Australia and worldwide and with an ageing population is likely to worsen (Davey 2016, Wynne 2016). Elder abuse is defined as any type of abuse which can be one or more of either physical, emotional, sexual and financial, or involve neglect of people aged 65 years or over, either in a residential aged care facility (RACF), in private care, or living independently. It can be a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person (World Health Organization 2008). The global population of people aged over 60 years and older will more than double, from 542 million in 1995 to about 1.2 billion in 2025 (World Health Organization 2016). Already around four to six per cent of elderly people have experienced some form of maltreatment at home, and it is estimated that 1 in 10 older people experience abuse each month (World Health Organization 2015). According to the World Health Organization (WHO) (World Health Organization 2015) this is likely to be a gross underestimation, as only 1 in 24 cases of elder abuse is reported, in part because older people are unwilling to report cases of abuse to family, friends, service providers or authorities. In 2015, the Australian College of Nursing (ACN) made a submission to the New South Wales Legislative Council General Standing Committee No. 2 Inquiry into Elder Abuse (Parliament of New South Wales 2015). Some of the main arguments made by ACN in its submission include:
• The [need for the] development of a comprehensive statewide regulatory framework for preventing, detecting and responding to elder abuse. • The creation of a single authority dedicated to the prevention, investigation of and intervention in elder abuse. This authority should be well promoted to enable people concerned about or affected by elder abuse to contact relevant services in a streamlined manner. • The expansion of mandated reporting of suspected and actual elder abuse by aged care workers, health professionals and community workers beyond the residential aged care sector. Mandatory reporting would improve the detection of and response to elder abuse. • The undertaking of mandated training of aged care workers, health professionals and community workers about the prevention and detection of and response to elder abuse. This training should take into account Australia’s culturally and linguistically diverse elderly population. • The NSW government supporting the development of a coordinated national approach to addressing elder abuse to streamline current protections and address service gaps. • The NSW Government to advocate with the Federal Government through appropriate bodies for the development of an international Convention on the Rights of Older People. Similarly to the United Nations Convention on the Rights of Children, this convention would frame for governments, their institutions and NGOs to ensure the key conditions are met ensure peoples’ healthy ageing.
Policy @ACN To view ACN’s submission in full, please visit the Parliament of New South Wales website. ACN’s recommendations in its submission to the New South Wales Legislative Council General Standing Committee No. 2 Inquiry into Elder Abuse drew numerous parallels with the New South Wales Legislative Council General Standing Committee No. 2 report, submitted on 24 June 2016 to the NSW Government with 11 recommendations (General Purpose Standing Committee No. 2 2016). Some of the recommendations include: “That the NSW Government embrace a comprehensive, coordinated and ambitious approach to elder abuse with the following elements: • A rights based framework that empowers older people and upholds their autonomy, dignity and right to self-determination. • A major focus on prevention and community engagement. • Legislative reform to better safeguard enduring powers of attorney and to establish a Public Advocate with powers of investigation. • An ambitious training plan to enable service providers to identify and respond appropriately to abuse. • An enhanced role for the NSW Elder Abuse Helpline and Resource Unit.” The overarching key recommendation to the NSW Government by the Committee is to invest additional resources in the prevention of elder abuse. This ought to involve the development and funding of a new prevention framework that provides for: • Substantially enhanced primary prevention, community education, awareness and engagement, carer support and later life planning initiatives.
• Specific resources for strategies targeting culturally and linguistically diverse and Indigenous communities and engagement with Multicultural NSW and Aboriginal Affairs NSW. The NSW Government’s response to the Committee’s report is due for release in January 2017. Around Australia numerous measures have been adopted to address elder abuse. The Office of the Public Advocate in Western Australia provides “training, education and information sessions for community members and service providers on preventing, recognising and responding to elder abuse” (Government of Western Australia 2015). The office is a member of the WA Alliance for the Prevention of Elder Abuse (APEA) which includes government, non-government and voluntary organisations working towards the prevention of elder abuse. Furthermore, the Western Australian Department of Local and Government Communities, provides information for elder abuse victims and support services which can be readily accessed remotely (Department of Local Government and Communities Western Australia, 2015) In Western Australia, the agency Advocare, has been operating an elder abuse hotline since September 2014, with the organisation’s Chief Executive, Greg Mahney, revealing that the number of calls made to the hotline was more than the organisation had anticipated (O’Leary 2016). Mahney says the helpline’s staff “can offer general advice but sometimes we might need to refer them to a lawyer or the police” (O’Leary 2016). In April this year, in Victoria, the President of the Australian Human Rights Commission, Gillian Triggs, was speaking at the launch of a health justice partnership placing lawyers within health practices, such as GPs and physiotherapists’ offices, with the intention of preventing elder abuse. Elder abuse victims are more likely to seek assistance and report
“Already around four to six per cent of elderly people have experienced some form of maltreatment at home, and it is estimated that 1 in 10 older people experience abuse each month.” abuse to their health practitioner than their lawyer, so this initiative makes it easier for elder abuse victims to speak out in a safe environment, often while their abusers are waiting in the waiting rooms (O’Leary 2016). Preventing elder abuse requires a concerted effort from multiple sectors. Health care workers play a key role in detecting and treating victims of elder abuse and in some countries the health sector has taken a leading role in raising public concern about elder abuse, while in others the social welfare sector has had greater involvement (World Health Organization 2015). In Australia, the health sector has been proactive in raising concerns about elder abuse but it is evident that Australia’s laws must be reviewed to handle incidences of elder abuse. From 1 July 2007 Compulsory Reporting obligations came into effect under the Aged Care Act 1997 (The Act). The amendments to The Act relate to alleged physical and sexual assault inflicted on seniors living in Australian Government subsidised Aged Care Homes (Aged Care Advocacy Service Inc., 2016). There still remains a number of people who live in the community who experience elderly abuse but do not have the same reporting ability. Furthermore, there is no central database in any state or territory for recording incidents of abuse in the community sector (O’Keeffee 2014).
In other incidences of alleged abuse (psychological, social and financial), the law assumes that adults are able to report incidences of abuse they experience. The law does not differentiate an older person from any other adult (Aged Care Advocacy Service Inc., 2016). As elder abuse is multifaceted, current legislation does not offer protection to older people. Reporting of elderly abuse outside of the residential aged care environment, falls upon each state and territories’ individual criminal jurisdiction (O’Keeffee 2014). The Victorian Government has been responsive to the issue of elder abuse. In 2006, the Victorian Government commenced work on the Elder Abuse Prevention Initiative which highlighted the prevalence of elder abuse in the community and guided older people to where to seek information and advice and know their rights. The initiative included the introduction of “professional education and capacity building, the implementation of policies, protocols and referral pathways, and cross-sector cooperation” (Victoria State Government 2016). In addition, the government established the Elder Abuse Prevention Advisory Group to provide advice to the Elder Abuse Prevention Initiative with representatives from government agencies and key sectors. Since 2008, the Victorian Government has funded Seniors Rights Victoria to provide information, support and advice to older people experiencing elder abuse and includes a free helpline which older people may contact (Victoria State Government 2016).
Key messages • Abuse may be physical, emotional, sexual or financial and may include neglect. It can occur in an aged care facility, or in the community. • Risk factors for elder abuse can be related to the individual, the perpetrator, relationships and the wider environment. • Elder abuse needs to be considered by any health practitioner seeing elderly patients, as they have a pivotal role in the recognition, assessment, understanding and management of elder abuse and neglect. • If confronted with elder abuse, establish the patient’s capacity to make decisions. Help may need to be sought from the person legally responsible for giving consent for their healthcare. If this person is the abuser, then seek help from the appropriate advocacy source in your state or territory. The Victorian Government also released the With Respect to Age guidelines in 2009. These practice guidelines are aimed at community agencies and health services, and focus upon a multi-sector and multidisciplinary approach to elder abuse (Victoria State Government 2016). The complexities of elder abuse are further illustrated when considering those from culturally and linguistically diverse (CALD) backgrounds. A number of risk factors may prevent a person from a CALD background from seeking help. This includes dependency and isolation, cultural factors, a lack of English language skills, smaller family networks and an inability to seek support (Seniors Rights Victoria 2016). Elder abuse is also prevalent in Aboriginal and Torres Strait Islander (ATSI) communities. For example, the term ‘elder’ may refer to a respected member of the community irrespective of age. Therefore,
some organisations may use the term ‘family violence against aunties and uncles’ to distinguish this difference. A number of factors may influence the incidence of abuse in older people in Aboriginal communities. These include historical influences such as the disposition of the land and the destruction of the traditional Aboriginal life coupled with poverty, high unemployment, high numbers of incarceration and substance abuse (Seniors Rights Victoria 2016). Elder abuse is a global social issue which affects the health and human rights of millions of older persons around the world, and an issue which deserves the attention of the international community. ACN believes that a coordinated response is required to address elder abuse in the national and international community.
References: Aged Care Advocacy Service Inc. 2016, Mandatory Reporting, viewed 7 July 2016 <http://www.sa.agedrights.asn.au/residential_care/preventing_elder_abuse/elder_ abuse_and_the_law/mandatory_reporting>. Davey, M. 2016, Gillian Triggs: older people subject to ‘abuse, violence and manipulation’, The Guardian Australia edition, viewed 7 July 2016, <https://www. theguardian.com/australia-news/2016/apr/22/gillian-triggs-older-people-subject-toabuse-violence-and-manipulation>. Department of Local Government and Communities Western Australia 2015, Seniors: Major funded services, viewed 11 July 2016 <https://www.dlgc.wa.gov.au/ GrantsFunding/Pages/Seniors.aspx>. General Purpose Standing Committee No. 2, Summary of recommendations, Elder abuse in New South Wales inquiry, viewed 7 July 2016, <https://www. parliament.nsw.gov.au/committees/DBAssets/InquiryReport/ReportAcrobat/6063/ summary%20of%20recommendations.pdf>. Government of Western Australia 2015, Preventing Elder Abuse, viewed 11 July 2016 <http://www.publicadvocate.wa.gov.au/E/elder_abuse.aspx> Johannesen, M. & LoGiudice, D. 2013, ‘Elder abuse: a systematic review of risk factors in community-dwelling elders’, Age Ageing, vol. 42, no. 3, pp. 292–8. O’Keeffee, D. 2014, Expert calls for legal reform on elder abuse, Australia Ageing Agenda, viewed 7 July 2016 <http://www.australianageingagenda.com. au/2014/11/28/expert-calls-legal-reform-elder-abuse/>. O’Leary, C. 2016, Hotline reveals elder abuse, The West Australian, viewed 7 July 2016, <https://au.news.yahoo.com/thewest/wa/a/30585434/hotline-reveals-elderabuse/>. Parliament of New South Wales 2015, Australian College of Nursing Submission to the Inquiry into Elder Abuse, Submission Number 76, Parliament of New South Wales, viewed 7 July 2016, <https://www.parliament.nsw.gov.au/committees/ DBAssets/InquirySubmission/Summary/53924/0076%20Australian%20College%20 of%20Nursing%20.pdf>.
Post, L., Page, C., Conner, T., Prokhorov, A., Fang, Y. & Biroscak, B.J., 2010, ‘Elder abuse in long-term care: types, patterns, and risk factors’, Research on Aging, vol. 32, no. 3, pp. 323–48. Seniors Rights Victoria 2016, Working with people from culturally diverse backgrounds, viewed 11 July 2016 <http://www.seniorsrights.org.au/toolkit/toolkit/ working-with-different-cultures-languages-and-communities/>. Victoria State Government 2016, Elder Abuse Prevention, viewed 11 July 2016 <https://www2.health.vic.gov.au/ageing-and-aged-care/wellbeing-and-participation/ preventing-elder-abuse>. World Health Organization, 2008, A Global Response to Elder Abuse and Neglect: Building Primary Health Care Capacity to Deal with the Problem Worldwide: Main Report, World Health Organization, Geneva, viewed 7 July 2016, http://www.who.int/ ageing/publications/ELDER_DocAugust08.pdf. World Health Organization 2015, Elder abuse Fact sheet No. 357, World Health Organization, viewed 7 July 2016, <http://www.who.int/mediacentre/factsheets/ fs357/en/>. World Health Organization 2016, World Elder Abuse Awareness Day, World Health Organization, viewed 7 July 2016, <http://www.who.int/life-course/news/elderabuse-awareness-day/en/>. Wynne, E. 2016, When elder abuse happens in plain sight families still feel powerless to stop it, Australian Broadcasting Corporation News, viewed 7 July 2016, <http:// www.abc.net.au/news/2016-06-15/family-feels-powerless-to-stop-financial-abuseof-grandmother/7513556>.
The Attorney-General, Senator the Hon George Brandis QC announced a new Inquiry for the Australian Law Reform Commission (ALRC) on 'Protecting the Rights of Older Australians from Abuse' on 24 February 2016. The ALRC has now released an Issues Paper and is calling for public submissions. The ALRC will inquire into and report on: • existing Commonwealth laws and frameworks which seek to safeguard and protect older persons from misuse or abuse by formal and informal carers, supporters, representatives and others including the regulation of living and care arrangement and health; and • the interaction and relationship of these laws with state and territory laws. ACN is making a submission to this inquiry and members are encouraged to share their experiences and expertise in relation to elder abuse to inform ACN’s response to the inquiry. To ensure your say, please respond to the ACN survey by 17 July 2016.
In focus @ACN
Advocating for human rights and freedom
ACN has launched new member benefits
By Trish Lowe MACN
Trish Lowe MACN
On a cold and wet, June night, 1500 people made their way to Sydney’s majestic Town Hall, motivated by an opportunity to hear Julia Baird host a panel discussion, featuring Australian of the Year Alumni: David Morrison AO, Nic Marchesi, Elizabeth Broderick AO and Julian McMahon.
“Nurses and midwives are an articulate and powerful group, capable of contributing to this debate, with genuine authority”
The event was organised by the Australian Human Rights Commission, in partnership with the National Australia Day Council. Throughout the evening, Professor Gillian Triggs commended the Australians of the Year for their impressive leadership and inspiring work.
It was heart-warming to recognise how well-positioned nurses and midwives are to inform public opinion in this space. Since equity and fairness are two of the core ethical principles guiding us, these concerns are not new, nor the solutions foreign. Nurses and midwives are an articulate and powerful group, capable of contributing to this debate, with genuine authority.
As the discussion continued, speakers addressed a range of human rights issues. Homelessness, gender inequality, indigenous health, capital punishment and the treatment of refugees and asylum seekers, were considered. The importance of meaningful conversation, valuing diversity and engaging with respect and dignity, were all proposed as potential solutions.
The Australian College of Nursing’s policy team have recently engaged in discourse pertaining to children in detention, aged care health reform and the fiscally conservative 2016-17 health care budget. These contributions are welcomed and timely. For, as so eloquently suggested by American civil rights activist, John E. Lewis, “If not us, then who? If not now, then when?”
MY ACN A new online portal where members can access all of their details, benefits and services. Members can update their profile and preferences, and specify the publications they wish to receive.
1, 2, 3 CPD COURSES FOR FREE
DISCOUNTS ON ALL ACN COURSES
Members can now access three free CPD courses each registration year (1 June to 31 May).
Members and Fellows can now receive a 10% discount on full fees for all ACN Courses.
Visit www.acn.edu.au for more information or contact ACN Membership on 1800 061 660 or email@example.com
In focus @ACN
A nurse or an angel in scrubs? are covered with open sores, becoming ulcerated and scarred. There is also a risk of complications that include fistulas, abscesses, fulminant colitis, toxic megacolon, bowel obstructions and perforation, and colorectal cancer. As if those symptoms and complications aren’t enough, Crohn’s can impact on many other parts of the body, including the joints, eyes, mouth and skin, causing them to become inflamed. During the past 30 years of living with the disease, I have had painful sacroiliitis (inflammation and arthritis of the joints where the lower spine and the pelvis connect), in addition to regular eye problems, including increased pressure in the eyes, uveitis and episcleritis.
By a health care consumer
In the early 1980s, upon my return from a dream six-week holiday in Asia, the “tummy bug” that I had picked up in the Philippines still had not abated. Yes, I unthinkingly drank several large glasses of iced water after a day trip to the Devils's Cave behind the Pagsanjan Falls and shooting its rapids in a dugout canoe. Much to my alarm, it got rapidly worse when
I started to pass large amounts of blood and I was eventually diagnosed with Crohn's Disease.
it or ulcerative colitis, and numbers expected to increase to more than 100,000 by 2022”.
It’s now known that certain types of stomach bugs can trigger a Crohn’s episode. But at that time, not much was known about Crohn’s. According to the website of Crohn’s & Colitis Australia (formerly the Australian Crohn’s and Colitis Association), “Crohn’s disease now an emerging global disease, with Australia having one of the highest prevalence in the world. More than 75,000 Australians live with
Needless to say, at 19 years old, my education was about to begin the hard way. For those not familiar with Crohn’s, it is a hideous, chronic inflammatory condition of the gastrointestinal (GI) tract, causing fever, nausea, stomach pain and cramping, inflammation, diarrhoea, malnutrition and bleeding that can result in anaemia. It affects the deepest layers of the intestinal walls. Parts of the bowel lining
There is no cure for Crohn's; the cause is unknown. It is thought that genetics are involved – in my case Crohn’s is evident in my maternal grandfather's family. The treatment relies on suppressing the immune system so it stops attacking the GI tract and suppressing the inflammation that silently sent the immune system into hyper-drive in the first place. The treatment for a flare up is usually high doses of steroids, oral or intravenous, in my case both (hello weight gain and serious and bizarre infections as a result of the steroid’s actions). For me, maintaining a remission has been achieved with azathioprine (an immunosuppressive drug used for organ transplants and autoimmune diseases) plus a fortnightly self-injected dose of a new and powerful TNF inhibitor medication (adalimumab, known as Humira). Both of them have fairly scary side effects such as a high risk of melanoma, lymphoma and other delightful conditions. If they stop being effective then there’s the prospect of colorectal surgery, stoma and a colostomy bag. I’m reminded of that old saying of the treatment being worse than the cause.
In focus @ACN
“To all the nurses who go beyond their job description, like the dedicated dark-haired angel who cared for me – thank you” At 19, I had to confront the fact that the rest of my life would revolve around doctors, medication and blood tests, and I had to become knowledgeable about what medication and food I could not have – certain antibiotics could trigger a flare up. Ibuprofen, hot cross buns, spices and fruit cake were also on the “no” list. A tiny piece of my wedding cake triggered a flare up that resulted in a fortnight in hospital and two blood transfusions, and stubborn symptoms that took a year to abate. Not only did I think my life was over before it had really begun, but that initial diagnosis started me on a journey of the best and worst of the health care system and it has brought some of the most special and wonderful people into my life: the doctors and nurses who have cared for me and gotten me well. The best have undoubtedly been my gastroenterologist and my GP, who have done a brilliant job of managing my condition, limiting the number and severity of flare ups that I experience and getting me well as fast as possible afterwards. However, despite their excellent management and care, I have ended up in hospital several times in a fairly serious condition, as a result of a debilitating flare up that has come out of nowhere and hit me extremely hard and fast. I can recall losing 25kg in less than five weeks at the onset of severe flare up. Another “best” has undoubtedly been the nursing care I have been fortunate to receive, some of whom I can only describe as angels on earth. They are the inspiration for me putting pen to paper now.
As a result of the actions of the steroids, I have also been hospitalised after becoming so ill from infections that I have succumbed to long after I recovered from the flare up that necessitated the steroids in the first place. In the late 1990s, I was recovering from a bout of Crohn’s that, while not as bad as ones I have subsequently experienced, put me into Concord Repatriation General Hospital for five days (my wonderful specialist is a VMO there). I went home on oral steroids and insulin to control the very high blood sugar spikes caused by the steroids, but that is a story for another time. Several months later, and off the steroids, but with an immune system still suppressed, I contracted an obscure bacterial infection that delighted in feasting on the cartilage in my ear. I was away in Melbourne at a team building conference when my ear blew up to what seemed to be 10 times its usual size, was extremely hot, red and so incredibly painful that I cannot describe it. I went to a medical centre near the hotel we were staying and came away with a prescription for Keflex. By the next morning I knew I was in serious trouble despite the antibiotics. I was nauseous, vomiting, had chills and was as white as a sheet. My ear was so sore and inflamed that every nerve ending in it was screaming at me. I got myself onto the earliest flight back to Sydney and then into a taxi to my GP, who took one look at me and immediately phoned an ear, nose and throat (ENT) specialist.
Looking back, I'm sure it was not very wise to get on a plane with my ear in the state that it was in, but I didn't want to be stuck in Melbourne and possibly die in a hospital so far away from home and family. The ENT saw me as soon as I arrived at his rooms and sent me across the road to Hornsby Ku-ring-gai Hospital’s ER for an emergency admission.
say thank you. But, much to my dismay, no one knew her name or which ward she was from and I never got to thank her for what she did for me. The care she gave me was not only to the best of her professional ability, it was also way beyond her duty. It still touches me that she came back to visit and check on my progress.
I have never forgotten the lovely nurse who took care of me when I arrived in a ward in the Lumby building. She stayed with me through the night, constantly checking on me and administering a cocktail of powerful antibiotics including gentamicin, plus an assortment of IV fluids.
To that amazing and caring nurse, I really hope you read this. Thank you so much for what you did for me. “Thank you” is hardly adequate but I am certain that the reason I am still here today is entirely due to you and I will never forget how you fought for me and kept me here to see another day.
There were times when I was drifting away and she persisted in talking to me and pulling me back to consciousness as the antibiotics slowly got into my system and started to fight the infection.
To all the nurses who go beyond their job description, like the dedicated dark-haired angel who cared for me – thank you. You are truly inspiring and wonderful people for whom nursing is more than an occupation – it is a passion that can literally tip the scales in your patient’s favour. You are angels in scrubs, you personify “care” and you are the very best of our health care system.
In addition to the doctor’s aggressive therapeutic approach, I have no doubt that it was her care, diligence and dedication that saved my life. The ENT specialist later told me that he didn’t think I’d live through that first night, such was the severity of the infection and his fears about sepsis and septic shock. That wonderful nurse stayed with me, even though her shift had ended, making sure that, when I was moved into another ward in the main part of the hospital the next morning, the nurses there were fully briefed on the heavy-duty antibiotic regime. She finally left when she was satisfied that she had provided an adequate handover and that I was settled in the new ward. After a couple of days, and still on IV antibiotics, I was taken to surgery to get my ear drained (it ended up being done twice). When I returned from surgery, I was told that there had been a visitor for me – the nurse who had taken care of me that first night, popped in on her break to see how I was doing. I had often thought about her and I desperately wanted
Editor’s note: This is a reflective piece, written by a person with Crohn’s disease. She is not a health care professional, the views, definitions and explanations are based on her experiences and her understanding of her illness. If you are a nurse working in a gastroenterology ward or with patients with inflammatory bowel disease, you may benefit from studying ACN’s Graduate Certificate in Stomal Therapy Nursing, or a Wound Management unit of study. The next intake is in January 2017.
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The benefits of collaboration With one of our longstanding infrastructure managers, Industry Funds Management (IFM), we joined with fellow industry super funds — AustralianSuper, Cbus and HOSTPLUS — on the bid.
Our latest port investments are 80% owned by industry super funds — established leaders in infrastructure investing. The long-term returns from these investments help build the super of an estimated five million Australians, like you. Our investments also support jobs and the economy. The NSW Government has indicated some of the funds from the sale of the leases will go to meeting the State’s future infrastructure needs. You may regularly use an infrastructure asset we’ve invested in on your behalf. You might fly into Perth, Melbourne or Adelaide airports, or use a key road, like Sydney’s M5.
The role of infrastructure investments Infrastructure investments have both growth and defensive characteristics, as earnings are generated from ongoing income and capital growth.
A port asset, for example, can provide a stable and growing source of revenue from its ongoing operation. Higher revenues and, usually, higher capital growth can provide important protection from inflation. Although inflation protection isn’t always guaranteed. That’s because the value of a port asset can also be influenced by broader economic conditions — such as the quantity of goods being imported or exported. Long-term infrastructure investment managers, like IFM, can further enhance the value of an asset through skilful management. This usually includes having positions on the boards of organisations that operate the assets they invest in.
Want to learn more about investing? Visit hesta.com.au/investments or if you’re a HESTA member, call 1800 813 327 to make an appointment with an adviser. With more than 25 years of experience and $33 billion in assets, more people in health and community services choose HESTA for their super.
Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL 235249, the Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. This information is of a general nature. It does not take into account your objectives, financial situation or specific needs so you should look at your own financial position and requirements before making a decision. You may wish to consult an adviser when doing this. Before making a decision about HESTA products you should read the relevant Product Disclosure Statement (call 1800 813 327 or visit hesta.com.au for a copy), and consider all relevant risks (hesta.com.au/understandingrisk).
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Climate & Health
Future disasters expected due to erratic Australian climate By Dr Liz Hanna FACN, Key Contact ACN Climate and Health Community of Interest
Extreme climatic events result in disasters when the scale is massive and the effects on human health and societies are both profound and extensive. Developing countries are at heightened risk of catastrophic disasters Dr Liz Hanna FACN due their high exposure levels, high population numbers, limited preparedness, and response and recovery capacity. Yet Australia is also highly vulnerable due the erratic nature of Australia’s climate. Australia’s rainfall is more variable than any other nation (Love 2012) as the El Niño-La Niña cycle delivers periodic floods and droughts with potentially devastating effects on agricultural sectors and threatens water security. This factor is a major contributor to Australia’s relative low population carrying capacity. Additionally, Australia’s heat and propensity to heat waves presents major health
(Hanna and Tait 2015) and productivity threats (Hanna, Kjellstrom et al. 2011). The scorching summer of 2009 testified that Australia’s response capacity can be sorely tested. Amid the extreme heatwaves and catastrophic fires across the southern states, deluge flooding ravaged Queensland. Australia’s response systems struggled to cope with the contemporaneous surge demand for emergency responses and recovery management. The pattern of climate suggests that such unusual circumstances can not only reappear, but amplify. Real potential therefore exists that future climate disasters will stretch Australia’s response capacity to a state whereby we cannot promptly recover all the people involved and safely secure them from danger, re-establish telecommunications, and provide the required transport, health, social and emotional support. A massive East Coast Low (ECL) in June 2016 brought a different type of national climatic challenge. Many regions received the highest rainfall for June on record, and unprecedented
Flooded buildings can sustain further damage from mould, which can have severe health ramifications, including spikes in asthma and other respiratory tract symptoms, such as pneumonia.
daily totals for any month (BOM 2016). This event left a trail of destruction spanning Queensland to Tasmania, from floods and coastal erosion. There were several deaths in New South Wales and Canberra and two people went missing in Tasmania. Insured losses exceeded $235 million from 32,000 claims across Queensland, New South Wales, Victoria and Tasmania (Insurance Council of Australia 2016), and the uninsured cost will add to the damage and personal trauma, loss and grief. The relationship between disasters and human health follows several pathways. Direct influence is easily recognised, as the nightly news streams scenes and heartbreaking stories into living rooms across the country. Less apparent though are the
indirect pathways. These can linger for many years beyond the event, long after the news cameras have departed, and public empathy and donations have dwindled. Health impacts include loss of life, injuries, disease as well as costly repair bills, loss of homes and capacity to generate income. When occurring on a major scale, this delivers a major shock to communities. Resilient communities can bounce back, but even in such a positive scenario, many people find themselves unable to rebuild and recover (Reser, Bradley et al. 2012). Disasters can shift people and families from a normal life to one of dependency. Mental health issues can soar and bring multi-generational hardship (Hanna, McCubbin et al. 2010).
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“Expanding the presence of nursing in response and recovery teams must be a central plank to Australia’s climate preparedness.” It is common for the destruction of infrastructure in disasters to hit the hardest in areas of pre-existing low accessibility, making them even harder to access. Transporting relief supplies and rescue services to these areas is impossible or at best extremely difficult. Hotels, restaurants and grocery stores are forced to close. Relief workers, repair crews and loss adjusters must find accommodation outside the disaster areas and travel up to several hours a day to their places of assignment. Delays in relief supplies, loss adjustment and repairs are the result. After flooding, the surviving buildings can sustain further damage from mould, which can have terrible effects on their condition. Health ramifications include spikes in asthma and other upper respiratory tract symptoms, such as coughing and wheezing as well as lower respiratory tract infections such as pneumonia, Respiratory Syncytial Virus (RSV), and RSV pneumonia (Luber, Knowlton et al. 2014). Delays in repairs and rebuilding can arise due to insurance complications, and escalation in repair bills (up to 40%) due the surge demand for scarce labour and building materials (Munich Re 2016), and leave people in damp houses for extended periods. In moderate catastrophes, the transportation network is usually restored in just a few days. After
more serious events, however, it can be months before roads, railways, airports or ports are back in full operation. Access to essential utilities such as power, water and food, and vital services, such as schools, and health care can remain fractured for extended periods. Damage to the local environment and vital health supporting ecological services can further impact health through interruptions to water supply, water purification and sanitation, and cause infectious diseases to spike. Food security is harmed through protracted droughts, floods, and resultant health effects are exacerbated by both pre-existing and newly acquired poverty. When climate disasters affect wealthy countries, services are allocated and national response aims to ensure that housing and emergency needs are promptly provided. A suite of emergency response agencies, including ambulance, police and fire authorities, volunteers and State Emergency Services, and the military are often called upon to assist. Yet, when disasters befall developing countries, populations can be dependent upon foreign agencies and charities to provide those emergency needs. Not all disasters are sudden and short-lived. Some are lower key, yet protracted. A slow-disaster can unfold, such as the global food crises in 2008. Widespread hunger is a trigger for social unrest,
as history has repeatedly testified (De Châtel 2014, FAO 2016). Unrest can overturn governments and spill over to other countries, and hence the insecurity can adopt a political or international flavour (Levy and Sidel 2014). Climate change is increasingly generating fast and slow disasters across many parts of the globe. This prompted the Intergovernmental Panel on Climate Change (IPCC) to release a special report on disasters and climate change in 2012 (IPCC 2012). For the first time ever, the 5th Assessment Report of the IPCC devoted an entire chapter to human security (IPCC WGII, Adger WN et al. 2014). The 2014 US Department of Defense Adaptation Roadmap recognises the increased role for Defence and National Security Guard to respond to natural climate related disasters and urges the military to incorporate climate change into “broader strategic thinking about high-risk regions” (U.S. Department of Defense 2014). In 2015, the Australian Defence Force published The Longest Conflict: Australia’s Climate Security Challenge (Sturrock and Ferguson 2015), which argued on page 9, “Australia is underprepared and underpreparing for what is now a known security threat”. Margaret Chan, Director-General of the World Health Organization, in her address to Sixty-ninth World Health Assembly in June 2016 described climate change as a slow-motion disaster (Chan 2016). Australia needs to boost its climate change preparedness, as we can expect more weather disasters. For example, as a result of anthropogenic influences on the climate system, the additional heat and convective energy is predicted to increase the frequency and severity of cyclones and superstorms around the globe (Bouwer 2011, IPCC 2013).
11th Conference of the Australian College of Nurse Practitioners (Incorporating NursePrac ED)
The Centre of Care Alice Springs Convention Centre 30 August – 2 September 2016 INTER NATION AL KEY NOTE S PEAK ER Dr Tammy O’Rourke Assistant Professor, University of Alberta, Canada
E: firstname.lastname@example.org W: www.dcconferences.com.au/acnp2016
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The relatively infrequent nature of these severe events presents challenges for studies analysing trends, however, increasing intensity trends have been observed. Whereas the increase in cyclone frequency has not yet been recorded in Australia (Allen, Karoly et al. 2014), researchers advise caution in assuming that Australia will be spared. An increase in the length and the frequency of severe thunderstorm environments, particularly over the eastern parts of the continent, is projected. The overall frequency of potential severe thunderstorm days per year likely to rise over the major population centres of the east coast by 14% for Brisbane, 22% for Melbourne, and 30% for Sydney (Allen, Karoly et al. 2014). Such increases will bear significant potential health and societal implications. Also, small-scale cyclones are projected to extend further southward than historical patterns and East Coast Lows (ECLs) are likely to show a marked strengthening in warm season of between +17% to +29% (Pepler, Di Luca et al. 2016). The widespread system that flooded much of Australia’s eastern seaboard and extended into Canberra in June 2016 was a cool season ECL. The full human toll and damage bill will not be available for many months. Multi-sectoral action is required to achieve the health protection from climate change (Figueres 2016). Australia is facing increases in frequency and intensity of disasters, so a boost in preparedness is essential to reduce harmful effects. Nurses have a leadership role in delivering community education, helping people to prepare and protect themselves, to avoid risks. Community education can also boost community resilience by facilitating peer to peer support when response teams are delayed or unavailable. Expanding the presence of nursing in response and recovery teams must be a central plank to Australia’s climate preparedness. Direct service provision in the acute sector, as well as assisting
The frequency and length of severe thunderstorms is projected to increase, particularly over the eastern parts of the continent.
people and communities in their long recovery phase are also key nursing activities.
References: Allen, J. T., Karoly, D. J. and K. J. Walsh 2014, "Future Australian Severe Thunderstorm Environments. Part II: The Influence of a Strongly Warming Climate on Convective Environments", Journal of Climate, vol. 27, no. 10, pp. 3848-3868. BOM 2016, Extensive early June rainfall affecting the Australian east coast, Special Climate Statement 57, Melbourne, Australian Government Bureau of Meteorology, p. 24. Bouwer, L. M. 2011, "Have Disaster Losses Increased Due to Anthropogenic Climate Change?", Bulletin of the American Meteorological Society, vol. 92, no. 1, pp. 39-46. Chan, M. 2016, Address to the Sixty-ninth World Health Assembly, Geneva, Switzerland De Châtel, F. 2014, "The Role of Drought and Climate Change in the Syrian Uprising: Untangling the Triggers of the Revolution", Middle Eastern Studies, vol. 50, no. 4, pp. 521-535. FAO 2016, Peace, Conflict and Food Security: What do We Know about the Linkages? Technical Note. Rome, Food and Agriculture Organization of the United Nations 102. Figueres, C. 2016, Address to the Sixty-ninth World Health Assembly, Geneva, Switzerland. Hanna, E.G., Kjellstrom, T., Bennett, C. and Dear, K. 2011, "Climate change and rising heat: population health implications for working people in Australia", AsiaPacific Journal of Public Health, vol. 23, no. 2, pp. 14S-26S. Hanna, E.G., McCubbin, J., Horton, G. and Strazdins, L. 2010, "Australia, Lucky Country or Climate Change Canary: what future for her rural children?", International Public Health Journal, vol. 2, no. 4, pp. 501-512. Hanna, E.G. and Tait, P.W. 2015, "Limitations to thermoregulation and acclimatisation challenges human adaptation to global warming". International Journal of Environmental Research and Public Health, vol. 12, no. 7, pp. 80348074.
Insurance Council of Australia (2016). Insurance losses from east coast low soar as the storm clouds start to gather again. Media Release. Sydney. IPCC 2012, Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation (SREX) - Summary for Policymakers, IPCC WG II Technical Support Unit, Cambridge, UK and New York, USA, IPCC. IPCC 2013, Working Group I Contribution to the IPCC 5th Assessment Report "Climate Change 2013: The Physical Science Basis", Intergovernmental Panel on Climate Change, Geneva, Switzerland. IPCC WGII, Adger, W.N., Pulhin, J.M., Barnett, J., Dabelko, G.D., Hovelsrud, G.K., Levy, M., Spring, U.O., Vogel, C.H. and e. al. 2014, IPCC WG1 II AR5, Chapter 12, Human Security, Climate Change 2014: Impacts, Adaptation, and Vulnerability, Volume I: Global and Sectoral Aspects, Cambridge, UK, Cambridge University Press: pp. 755-791. Levy, B.S. and Sidel, V.W. 2014, "Collective Violence Caused by Climate Change and How It Threatens Health and Human Rights”, Health and Human Rights Journal, vol. 1, no. 16, pp. 32-40. Love, G. 2012, Impacts of Climate Variability on Regional Australia, Melbourne, Bureau oif Meteorology, pp 9. Luber, G., Knowlton, K., Balbus, J., Frumkin, H., Hayden, M., Hess, J., McGeehin, M., Sheats, N., Backer, L., Beard, C.B., Ebi, K.L., Maibach, E., Ostfeld, R.S., Wiedinmyer, C., Zielinski-Gutiérrez, E. and Ziska, L. 2014, Ch 9: Human Health, Climate Change Impacts in the United States: The Third National Climate Assessment, Melillo, J.M., Richmond, T.C. and Yohe, G.W., Washington DC, U.S. Global Change Research Program: 220-256. Munich Re 2016, Large loss amplification – Effects of tropical storms in Australia, Munich Re, Munich. Pepler, A.S., Di Luca, A., Alexander, L.V., Evans, J.P. and Sherwood, S.C. 2016, "Projected changes in east Australian midlatitude cyclones during the 21st century", Geophysical Research Letters, vol. 43, no. 1, pp. 334-340. Reser, J.P., Bradley, G.L., Glendon, A.I., Ellul, M.C. and Callaghan, R. 2012, Public Risk Perceptions, Understandings and Responses to Climate Change and Natural Disasters in Australia, 2010 and 2011, Gold Coast, Australia, National Climate Change Adaptation Research Facility, pp.246. Sturrock, R. and Ferguson, P. 2015, The Longest Conflict: Australia’s Climate Security Challenge, Sydney, Centre for Policy Development, pp 52. U.S. Department of Defense 2014, 2014 Climate Change Adaptation Roadmap, Washington, Office of the Deputy Under Secretary of Defense for Installations and Environment, pp 20.
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T he nur sing gr aduate experience: A reflec tive ca se s tudy By Rachel Wardrop MACN
The graduate registered nurse (RN) undergoes an assortment of challenges in their first year of practice (Bull et al. 2015). In response, countries have adapted various programs to provide support and direction for the graduate nurse within this fragile time of development. The role lacks general consensus regarding structure internationally and therefore retains within it flaws which impact on graduate nurse development. This article describes one nurse’s experience of her graduate year and highlights the difficulties associated with the transition. My first year as a graduate RN brought with it an assortment of feelings; excitement, fear and determination. I was educated for this role; I had the skills, what could possibly stop me? I was employed as a casual pool RN for my graduate transition year. I felt like I was sent from pillar to post wherever there was a deficit in staff. Nervous, I adapted to the clinical environment by asking questions and attempting to build relationships with staff. There were facilitators employed to work with and support the graduate nurses who would occasionally check on us. Unfortunately, the support was provided only once a month. After the first few months of employment the graduates were informed that funding had dried up and the facilitator positions had been made redundant. After losing the only support we had, my opinion of this new profession started to drastically change.
As we moved further into the graduate year, the expectations from other senior staff regarding our skill level began to change. Even during one of my very first shifts, I recall being placed in a situation which I had not been trained how to deal with. Apparently, permanent ward staff liked to utilise casual pool members to do what they call their ‘dirty work’. One shift, I was placed in a four-bed bay as a ‘special’ – a nurse who is required to monitor patients as they have a tendency to walk about. Three of these patients were high-care stroke patients with advanced dementia and Alzheimer’s who were known to be aggressive. The other was an alcoholic who was known to be both verbally and physically aggressive to nursing staff. I voiced my concerns at the beginning of the shift, stating that I was not comfortable with caring for these patients. My concerns were overlooked with the response, “You’ll be fine”. As I entered the four-bed bay, a feeling of dread passed over me. Two of the patients were still being fed and medicated via nasogastric tubes which just added to my workload. As I circled the room checking the charts, some of the patients started to rouse. I pulled out my shift planner and detailed the day’s events whilst waiting eagerly for the night duty nurse to handover these patients. After receiving handover and introducing myself to the patients, I started my morning medication rounds. Upon crushing medications for my first
"One shift in the emergency department awakened something in me."
patient, my alcoholic patient woke up in a fluster. He wanted to go outside and have a cigarette. I informed my patient that this was not permitted, trying to re-orientate him to where he was and why he was in hospital. Whilst his frustration grew, I informed another nurse that I needed help with this patient, she shrugged and walked away. I felt powerless as this patient grew even more impatient with me, now turning to verbal threats of physical harm if I was to refuse his request again. I started to panic. The textbooks said nothing about this. I mustered all of my courage to verbally de-escalate the patient with one hand and signal for
help with the other. The nurse in charge sighed at me and called security. I could hear the other nurses gossiping about me as I sobbed in the tea room. This experience was sobering for me. On initial employment, I viewed the nursing world as a child views the local candy store; heart aflutter and eyes wide open. It was this event and many like it that shocked me to my core; the profession was not what I had expected. The concept of nurses eating their young was not just a rumour, it was real. Yet, did my expectations of my graduate year taint my ability to cope? Were they too high? I started to question my career choices. If this was the norm, did it set the scene for the rest of my employable life?
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“If you made it through the shift without being attacked or spattered with some exciting form of bodily fluid then it was deemed to be a good shift. I finally felt needed and appreciated, not used and abused.” I moved through the months of graduate employment and noticed my personality started to harden. I could feel myself drifting into the realm of “this is as good as it gets, so don’t bother trying”. I even looked at other avenues of employment as I could feel the very essence of myself draining every time I went to work. In spite of the treatment I endured, mid-way through my graduate year, something wonderful began to happen. I was engaged in my Masters course at the time with the end hope that I would develop my skills and knowledge and become an advanced clinician. It was an interesting and challenging course which provided me with an understanding of complex patient conditions and other areas such as leadership and management. The more I immersed myself in education, the stronger my passion for self-development grew. So I thought, “How can I turn this into something different? How can I use this to my advantage?” One shift in the emergency department awakened something in me. One shift. That’s all it took and I was hooked. The adrenaline and the urgency of the emergency department coupled with a supportive team was enticing. After one shift and a recommendation from a senior clinical nurse, I was in. It was in this environment that I learnt advanced patient assessment, cannulation, interpretation of bloods and dysrhythmias, management of the psychotic patient and advanced resuscitation. And out of all of it, staff supported each other no matter how junior you were; there were no expectations. If you made it through the shift
without being attacked or spattered with some exciting form of bodily fluid then it was deemed to be a good shift. I finally felt needed and appreciated, not used and abused. Yet still, the longing for education and to make an impact lingered. As one of my core values, it has always been within my composition to be significant. To do something to be remembered for, something to be valued for or even more so, a legacy. A proposition to teach at a world-renown university was a chance to step up and prove myself. I now stand as an educator and an academic, knowing that my experience will help others. Knowing that what I do now is significant. Knowing that age, does not determine your quality or degree of contribution. Regardless of the role we are given, it is about making it your own. Sometimes the process of reflection reveals a lesson which can only be learnt over time. And sometimes, it requires a little leap of faith to find one’s own place in this world. References Bull, R., Shearer, T., Phillips, M. & Fallon, A. 2015, ‘Supporting Graduate Nurse Transition: Collaboration Between Practice and University’, The Journal of Continuing Education in Nursing, vol. 46, no. 9, pp. 409-415.
Editor’s note: If you are a nurse looking to gain more skills in providing care for patients during emergency situations, ACN offers online courses for registered and enrolled nurses. Click the links below to find out more: • Principles of Emergency Care For RNs • Principles of Emergency Care for ENs
26–28 October 2016
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Holding nurses to account: What to do when things go wrong Nursing is often referred to as a science and an art. A science in the sense that the nursing profession is based on research and an art because nursing is a profession grounded on caring for others and this entails building therapeutic relationships with patients. When things go wrong, however, nurses are held to account as professionals.
Notifications and complaints The Australian Health Practitioner Regulation Agency (AHPRA) receives notifications and complaints about nurses and midwives on behalf of the Nursing and Midwifery Board of Australia (NMBA). A notification can either be a voluntary notification or mandatory notification. Anyone can make a voluntary notification under the National Law about a registered nurse or registered midwife (‘Practitioner’) or nursing/ midwifery student (‘Student’). This includes other nurses, midwives, students, health practitioners and members of the public. The grounds for making a voluntary notification against Practitioners include that (among others): (a) The Practitioner’s professional conduct is or may be of a lesser standard than might be expected; (b) The Practitioner’s knowledge, skill or judgment may be below the standard reasonably expected of the practitioner; (c) The Practitioner is not a fit and proper person; (d) The Practitioner has an impairment; and (e) The Practitioner has contravened the National Law. Mandatory notifications are required to be made by a registered health practitioner (e.g. nurse, doctor, physiotherapist, pharmacist) where, in the course of practising their health profession they form a
reasonable belief that another registered health practitioner (e.g. nurse, doctor, physiotherapist, pharmacist) has behaved in a way that constitutes notifiable conduct or that a student has an impairment that in the course of undertaking clinical training causes the student to behave in way that constitutes notifiable conduct.
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For the purposes of mandatory notifications, notifiable conduct means: (a) Practising while intoxicated by alcohol or drugs; (b) Engaging in sexual misconduct in connection with the Practitioner’s practice; (c) Placing the public at risk of harm because of an impairment; (d) Placing the public at risk of harm through practising the profession in a way which is a significant departure from accepted professional standards. It is important to note that mandatory notification provisions apply to nurses individually and the NMBA may take action against a nurse who fails to notify it of notifiable conduct. The Health Services Commission in each State and Territory may also refer matters to the NMBA.
What should nurses do when faced with a notification? A notification to AHPRA and the subsequent investigation process is stressful. This process involves preparing statements and may also involve having to appear personally before a panel or Tribunal. All notifications made to AHPRA should be taken seriously. Even if you consider that the allegations are baseless, they may in fact still result in you being cautioned by the NMBA.
If you are the subject of a notification, at first instance you should seek assistance from your professional indemnity insurer. Given the potentially serious outcomes of an AHPRA investigation, it is important that you give serious consideration to taking out your own policy for professional indemnity insurance. You should consider doing so, even if you are an employee as your employer’s insurance does not usually provide legal assistance to employees in connection with disciplinary (and coronial) investigations. There may also be the need for separate representation from your colleagues at the place of employment, and having your own legal representation can provide much needed reassurance. This article was written by Jayr Teng, legal practitioner, and kellie Dell’oro, principal of Meridian Lawyers. Meridian lawyers works closely with guild insurance, which offers insurance to nurses and nurse practitioners. This information is current as of May 2016. This update does not constitute legal advice. It does not give rise to any solicitor/client relationship between Meridian Lawyers and the reader. Professional legal advice should be sought before acting or relying upon the content of this update.
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Nursing in the communit y: The bigger picture of patient care
Community & Primary Health Care Nursing Week
Nurses where you need them 19–25 SEPTEMBER
By Vanessa Crossley
The role of the community nurse differs greatly from the role of the ward nurse, the emergency nurse, the theatre nurse or the midwife.
Away from the bleeping monitors, the sterility and the bustle of the wards, you often discover the real person that lies beneath the patient.
It goes without saying that we ask the hard questions to our patients when they lie in a hospital bed. We enquire about pain levels, bowels that have opened (or not), allergies, medications, previous medical history and what the home environment is like that they will soon return to. However, until you stand in that home environment with them, you do not get a true picture of their life outside the walls of the hospital. Like an onion, they have layers that you often discover when they are able to relax in the comfort of their home. The concept of total patient care and problem solving changes from the model we know when the safety net of the hospital is left behind. As nurses, in all areas of practice, we are trained to look beyond “the man with the ulcer”, “the lady with the breast drain” or “the child with the burn” and discover other issues they may have.
“The concept of total patient care and problem solving changes from the model we know when the safety net of the hospital is left behind.” In the home setting, that journey of discovery takes on a whole new meaning and even though the medical side of our practice may be our number one priority, the little things we discover help to make up the big picture of community nursing. The elderly man who lost his wife many years ago, who has no family in this country and who cannot remember the last time he had a home-cooked cake, is not just the old man with the leg ulcer; he is the man who smiles and hugs you when you bring him a plate of cupcakes. The 92-year-old man with the swollen legs is the man who is overjoyed when you help him tune in his television so he can watch the cricket. The 80-year-old lady with the skin tear is the lady who thanks you for finding the number and calling someone to come and wash her dog as she no longer can. The lady who has just lost her husband, who cries with you and thanks you over and over for helping her to re-frame her wedding photo. The 45-year-old man who fought (and lost) against the roadway when he fell from his bike is the same man who is grateful when you run to take his sheets from the line as the rain starts to fall.
The sweet old man who fell in his driveway and broke his hand will grasp your hand and thank you when you help him with the “wretched fitted sheet” on his bed. The 90-year-old lady who lives alone in a double-storey house with a steep driveway will be pleased to see you drag her bin up that driveway for her and bring her mail up the stairs. She is the same lady whose husband was your school principal many years ago. After six long months it is hard to know if the patient’s wife is happier about his ulcer finally healing or the fact that you have successfully removed a coffee pod stuck in their machine with a pair of forceps. She hasn’t been this happy since you helped her take a photo with her mobile phone on your last visit. The 68-year-old man who loves your visits because you make him laugh and his wife who loves your visits because you bought a tin of WD40 along and finally removed the grandkids crayon masterpieces from the kitchen cupboard door. The paraplegic man who has just lost his old dog and who sits and looks through the “dogologue” book you have bought him to think about the shape his new best friend will take.
The four-year-old boy with a burn who hates you at first sight but is smiling through his tears at the end of the visit when you successfully name all his Thomas the Tank engine trains. “She even knows the white one Mum.” The wheelchair-bound man who is ecstatic when you find, in your travels, a flag from his favourite football team to replace the one stolen from his chair. He takes your hand and says, “Mate, you have made a really rotten day so much better.” The lady with the breast drain is the lady who smiles when you bend to pat her cat. She is glad you like him as he is her world. There are many challenges in community nursing. The driving, the distance, the weather, the decision making, the animals, the driveways and the nursing itself. You need to think on your feet and be clinically skilled in many varied areas. You don’t need qualifications or knowledge in baking, cleaning, animal care, football teams or appliance repair, but it sure helps. Vanessa’s story features in the 2015 Community and Primary Health Care Nursing Week: Nurses where you need them eBook. This year, we’re asking nurses to share a story that describes a time ‘when’ your nursing care has impacted on the health and wellbeing of individuals and/or communities. Click here to find out more and submit your story for the 2016 eBook! See next page for more information.
Community & Primary Health Care Nursing Week The Australian College of Nursing (ACN) Community and Primary Health Care Nursing Week: Nurses where you need them national campaign will take place from 19–25 September 2016 and its intentions are to: • Raise awareness of the current and potential contribution of community and primary health care nursing and its impact on the health and wellbeing of individuals and communities; • Inform the general public in order to increase their health literacy about community based health care options; • Inform nurses of community and primary health care nursing roles and career opportunities; • Inform state and territory governments as funders of many community and primary health care services and drivers of state health reform of the capacity of community and primary health care nurses; • Inform the federal government as a funder of community and primary health care services and general practice based services and as a driver of national health reform of the capacity of community and primary health care nurses; and • Inform other health professions active in community and primary health care to raise their awareness of community and primary health care nursing services.
Nurses where you need them 19–25 SEPTEMBER 2016
How to get involved: There are a range of activities that ACN is encouraging nurses and the broader community to become involved in over the week. As part of the celebrations, ACN is seeking your interest in contributing to the Community and Primary Health Care: Nurses where you need them 2016 eBook, a collection of stories from Community and Primary Health Care Nurses. This year, the eBook stories focus on the 'when' which may refer to a phase in life such as prenatal, early childhood, adolescence, ageing or dying. Alternatively, the 'when' may relate to a point in time when nurses care for individuals – such as when there are drug and alcohol issues, settling as a refugee, transitioning home after hospitalisation, during incarceration and a myriad of other times. If you have an interest in sharing a story that describes a time ‘when’ your nursing care has impacted on the health and wellbeing of individuals and/or communities, then we encourage you to please submit your story. SUBMIT YOUR STORY
Here are some other ways to get involved: • Wear an orange scarf or t-shirt during the week of 19–25 September 2016 to show your support of Community and Primary Health Care Nurses.
With thanks to the support of our official sponsors
• Hold an event during the week to get your town or city on the virtual map of supporters across the country and to share readings from the eBook to promote and discuss the important roles in Community and Primary Health Care Nursing. Events you can host may include a social gathering, morning or afternoon teas, public lecture or informal networking function. REGISTER AN EVENT
• Nursing organisations can join ACN as a supporter of the week to raise awareness and the profile of Community and Primary Health Care Nurses. Supporters will be acknowledged on the ACN website and in the eBook. REGISTER AS A SUPPORTER
• Spread the word to your networks! #nurseswhereyouneedthem
Read the 2015 eBook
ACN voices â€“ meet our representatives Australian College of Nursing (ACN) representatives ensure the views of the nursing profession are at the forefront of health care decision making. We harness the expert knowledge, experience and insights of our members and through ACN representation activities we facilitate the vital conversations about health and aged care and the leading role that nurses play in designing health care models and giving care. Each month, we feature our valued member representatives who are making a difference through their active participation in ACN representation activities.
If you are interested in future representation opportunities with ACN, please email email@example.com
promote uniformity and standardisation of resuscitation and to act as a voluntary co-ordinating body. To meet the aims and objectives of the ARC, the council develops and publishes guidelines, reviews and updates guidelines by consultation with member bodies and other experts, reviews world literature and research in resuscitation and acts as a resource for anyone wanting authoritative material on resuscitation (ARC, 2016). Can you please highlight any issues/benefits arising for the profession as a result of this working group?
Tr acy K idd M AC N Which working group are you representing ACN on?
â€œThis ACN representation opportunity has given me the chance to sit on a council made up of members with a wealth of experience, knowledge and expertise from a number of different backgrounds."
I sit on the Australian Resuscitation Council (ARC) National Branch. ACN is one of four nursing organisations represented on the council. What led to your interest in this area? I have a 20-plus-year background in critical care/ emergency nursing and I am also an advanced life support educator for the region I work in. What is the most recent work out of the working group and what were the major items discussed? The aims of the ARC are to foster and co-ordinate the practice and teaching of resuscitation,
Being one of four nursing representatives on the council, membership gives me the opportunity to stay up to date with the latest research in the field of resuscitation. I also have the opportunity to contribute to the review of guidelines and to help disseminate the latest updates to the nursing profession locally and further afield in Australia. How important is this ACN representation opportunity to you or how has this opportunity benefitted you and/or your career? This ACN representation opportunity has given me the chance to sit on a council made up of members with a wealth of experience, knowledge and expertise from a number of different backgrounds. The opportunity to learn from these extraordinary men and women is truly a privilege. I also have the opportunity to share from my unique background and nursing experiences. It has given me insight into internationally generated research and an appreciation for the rigour involved in thorough reviews of the published literature.
If you are a nurse working in a general practice setting, the Nursing in General Practice (NiGP) Handbook is essential reading, and itâ€™s FREE. The handbook contains details about employing and supporting RNs and ENs, the current regulatory environment, how to maximise the benefits, including the Practice Nurse Incentive Program and the range of MBS items that support nursing services in general practice.
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Aged care homes endorse new palliAGEDnurse app Residential aged care organisations have started to endorse the recently released palliAGEDnurse app and advocate its use amongst nursing staff. Meanwhile more than 800 palliAGEDnurse apps were downloaded by nurses across Australia in less than four weeks following the mid-May launch of the app by Decision Assist, an Australian Government funded program to better resource palliative care throughout the nation. The free smartphone app is designed for nurses caring for older people near the end of life and enables them to access clinical advice at the point of care. Aged care provider, BaptistCare, has already incorporated the app into its internal Palliative Approach toolkit for senior nursing staff. Debbie Kable, Care Development Manager – Residential for BaptistCare said her team would be promoting the app across the 18 homes BaptistCare operates in New South Wales and the ACT. ‘’The app will be promoted by our care development unit – I see the app as another tool for our staff to help them make palliative care decisions,’’ she said. Available through Google Play and the Apple Store, the palliAGEDnurse app has been developed as part of the Decision Assist program for aged care staff in residential and community settings. It provides clinical advice based around three key areas – advance care planning, case conferencing, and terminal care. The app was developed by the CareSearch Project Team at Flinders University, following production last
year of the palliAGED app for General Practitioners (GPs). Decision Assist is marketing them as a suite of two apps – one for GPs and one for nurses.
App keeps up to date and works anywhere CareSearch has designed the app to constantly update the advice that it gives nurse users. Being web based, the app goes to the website – where new evidence is published – to read its content. The linked website has a responsive design so that if nurses are using older smartphones or want to view the content on a computer or tablet the app presentation will adjust to their particular devices. Nurses working out of internet range can use the app as it holds a version locally in the phone. CareSearch Director Associate Professor Jennifer Tieman, identifies several reasons for the palliAGEDnurse app development. “With the rapidly expanding knowledge base for clinical practice it can be challenging for health professionals – including nurses – to keep their knowledge and skills up to date,’’ she says. “While continuing professional development is an important professional responsibility to invest in new skills and knowledge, nurses also need to be able to access knowledge at the point of care, that is, where they practice. The locations in which nurses are providing care to older people are increasingly varied, which also raises the need for portable resources.
‘’The palliAGEDnurse app will be promoted by our care development unit,’’ Debbie Kable, Care Development Manager – Residential, BaptistCare “Web based resources are helpful for this, and the growing use of apps prompted Decision Assist to explore different ways to share clinical knowledge and encourage its use in practice.”
A free smartphone app for clinical advice about end of life care Available from
A palliative care approach Being able to recognise that an older patient may die within the next 12 months is an opportunity for nurses to plan for changing care needs. Using a palliative care approach, the palliAGEDnurse app provides four key sections: • Understanding a palliative approach (and identifying older people needing a palliative approach) • Advance care planning • Palliative care case conference • Terminal care planning
In Memory @ACN
In memor y: Jeannie Ross Fraser FAC N, 1923-2016 “Jeannie would never accept anything but the best for her small patients. She was a very practical and well organised nurse and always tried to pass on these skills to those who worked with her.” After completing four years of training, Jeannie graduated in 1948 and went on to complete midwifery studies at the Queen Victoria Hospital, Launceston. She later nursed at the Port Macquarie Base Hospital and the Western Suburbs Hospital in Croydon, Sydney. In 1951 Jeannie moved to London and worked at Westminster Hospital, which provided staff for Buckingham Palace. When King George VI died, Jeannie was one of the first nurses on duty at his lying in state in St Stephen's Hall, Westminster.
Jeannie Ross Fraser FACN was a devoted Christian, nurse and philanthropist who was caring, compassionate, consistent, courageous and committed to the nursing and Glen Innes communities. Born in Lillydale, just north of Glen Innes NSW, in 1923, Jeannie spent her first four years living in camps round Coolatai and Yetman where her father, David John Fraser, was a successful water boring contractor on such properties as “Myall Downs” and “Blue Nobby”. Their portable camp home was a large tent surrounded by a wooden frame covered by fly wire. In 1926, her family bought part of “Yallaroi Station” at Warialda and named it “Kerrowgair” after David’s mother’s home in Ross-shire in Scotland. Jeannie’s
early schooling was completed via correspondence lessons while she assisted her parents on the property. After completing her final four years of school at the New England Girls School in Armidale, Jeannie went on to follow the career path of her mother, Margaret Pearl Chaffey, who was the first nurse to graduate from Glen Innes Hospital and a matron of Inverell Hospital. Sadly, Jeannie’s father died in October 1942 and her mother 10 months later, just a few days before Jeannie’s 19th birthday. Her guardian, Gordon Fraser, supported her through her last two years at school before she graduated and began her nursing training at Royal Prince Alfred Hospital.
After returning to Sydney in 1954, Jeannie started working at the Royal Alexandra Hospital for Children (also known as The Children's Hospital at Westmead) and completed further study at the NSW College of Nursing (now ACN) in Operating Theatre Management and Research Methods. As Second in Charge of the operating theatres for many years, Jeannie was committed to the care of children in the operating rooms. No matter how busy, it is reported that she would leave other duties to comfort and console the small waiting patients. She clearly made an impression on one little boy – a frequent visitor to the hospital – who said, “I hope Sister Fraser is doing me today!” Jeannie would never accept anything but the best for her small patients. She was a very practical and well
organised nurse and always tried to pass on these skills to those who worked with her. She worked for 31 years at the Royal Alexandra Hospital for Children until her retirement in 1985. Upon her retirement, Jeannie returned to her hometown of Glen Innes where she continued to touch people with her generosity and kindness as a supporter of many organisations, including, but certainly not limited to, the Red Cross, the Church of England congregation, the Glen Innes Art Gallery, the Cemetery Trust, Meals on Wheels, the National Trust and the Glen Innes Writer’s Group. She was a patron and life member of the Glen Innes & District Historical Society and curator of the medical section at the museum, which is now known as The Jeannie Ross Fraser Memorial Medical Wing. Jeannie was also a devotee of music and opera and a Foundation Member of the Elizabethan Theatre Trust. She loved the beauty of music and said the artistic colour filled the imagination.
ACN would like to thank Eve Chappell, Manager and Research Coordinator at Glen Innes & District Historical Society and dear friend to Jeannie, for her contribution towards this article.
NMB A plea sed to announce national health suppor t ser vice for 2 017 The Nursing and Midwifery Board of Australia (NMBA) is pleased to announce to nurses and midwives that a national health support service will be available across Australia from 2017. The service will offer nurses, midwives and students confidential advice and referral for health issues related to their nursing and or midwifery practice. The Australian Health Practitioner Regulation Agency (AHPRA), on behalf of the NMBA, has appointed Turning Point to deliver the service.
“No matter where nurses and midwives are living, working or studying, they will be able to consult with a professional about a health impairment, particularly where it may affect their ability to practise, and get confidential advice and referral to specialist treatment. “As the regulator, the NMBA is continuing to engage with nurses and midwives to ensure they are supported to provide safe care to the public. The national health support service will be funded by the NMBA, but will be an independent service.”
The service will offer support for nurses and midwives with a health impairment or at risk of a health impairment regardless of where they work and live across Australia. In addition, the service will provide education and awareness about health impairment as defined in the National Law for nurses, midwives, students, educational providers and employers.
Over the coming months Turning Point will be developing the infrastructure to deliver the national health support service. It is expected that services will be offered from early 2017.
The NMBA Chair, Dr Lynette Cusack RN, said that the service would offer nurses and midwives greater access to support on health impairment issues.
Visit the NMBA website: www.nursingmidwiferyboard.gov.au
“It’s important that nurses, midwives, students and employers can access confidential advice on issues related to their health anywhere in Australia,” Dr Cusack said.
For more information
For registration enquiries: 1300 419 495 (within Australia) +61 3 9275 9009 (overseas callers) For media enquiries: (03) 8708 9200
“It’s important that nurses, midwives, students and employers can access confidential advice on issues related to their health anywhere in Australia.”
NurseClick is the Australian College of Nursing's monthly e-zine focusing on topical articles related to nursing practice, policy developmen...
Published on Jul 15, 2016
NurseClick is the Australian College of Nursing's monthly e-zine focusing on topical articles related to nursing practice, policy developmen...