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NurseClick J U NE 2 0 16

Ending the aged care ‘lottery’

Climate change: Time for nurses to step up

Using social media to lead, lobby and inform

When reassurance goes a long way

In this edition







Policy @ACN

Events @ACN

Adjunct Professor Kylie Ward FACN, CEO of ACN

The latest health care news

Ending the aged care 'lottery'

Answering the call for ‘stories from the field’




15 THE

In focus @ACN

Events @ACN

In focus @ACN

Events @ACN

Vital Signs: Using social media to lobby, lead and inform

Over 200 breakfasts and 9,000 nurses!

Climate change: Time for nurses to step up

It’s time to secure your early bird registration before June 30





Representation @ACN

Professional development @ACN

In focus @ACN

NMBA update

ACN voices – meet our representatives

CPD short courses @ACN July–August

When reassurance goes a long way

Renew your registration by 31 May


26–28 October 2016



Welcome Adjunct Professor Kylie Ward FACN, CEO of ACN

Publishing details Publisher Australian College of Nursing

It is my pleasure to welcome you to the June edition of NurseClick. The National Aged Care Alliance, of which the Australian College of Nursing (ACN) is a member, recently relaunched the Australians Deserve to Age Well campaign, which advocates for important aged care reforms. In the article, ‘Ending the aged care lottery’, our policy team outlines the current shortfalls in the system and why ongoing reform is so vital for the future of older Australians. Following on from her inaugural piece in last month’s NurseClick, our wonderful nurse educator and member Trish Lowe MACN continues to highlight the innovation and leadership in nursing and midwifery in her column, Vital Signs. This month, Trish explores the value of, and potential in, social media as a tool for nurses to communicate, lead and inform. I am excited to welcome another regular commentary, which comes from ACN’s Climate and Health Community of Interest Key Contact, Dr Liz Hanna FACN. As the President of the Climate and Health Alliance, of which ACN is a member, Liz will be keeping us up to date with developments in the climate space and what we, as nurses and health professionals, can do to protect and promote health through climate action. Experience and personal reflection are powerful learning tools. In her article, ‘When reassurance

goes a long way’, Jenny Cavanagh MACN writes of her challenging experience going from registered nurse to patient and the immense difference it made to have support and respect from the health professionals caring for her. As well as understanding serotonin syndrome, we can all take Jenny's experiences into our own hearts, reflections and practice. Thank you for your honesty, Jenny, and for sharing your story. This invaluable conversation via our publications is just one of the many reasons our members are so amazing. Whether it is through ACN’s representation, policy, networking or learning activities, our members are constantly proving their passion and commitment to their profession. One such member is Tracey McDonald FACN, who has been an outstanding representative for ACN for many decades. Tracey has kindly summarised her incredible work in this month’s representation profile. I am extremely proud to be able to give back to our valued members with the unveiling of our first wave of new member benefits this month. ACN Members and Fellows can now access three new initiatives – a new online portal, three free CPD courses and discounts off all ACN courses. This offer value is greater than the annual cost of ACN membership. I am committed to ensuring our members enjoy substantial benefits as a way to say thank you for the knowledge and experience you bring to ACN.

Editors Karina Piddington Wendy Hooke Designers Nina Vesala Emma Butz Enquiries t 02 6283 3400 publications@acn.edu.au © 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 photo ACN publishes The Hive, NurseClick and the ACN Weekly eNewsletter.

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In the news Nat ional Ketamine could treat chronic pain Ketamine, a drug mainly used as an anaesthetic, could double up as an effective treatment for longterm pain following surgery – with the potential of saving billions in healthcare costs. A review of studies found that ketamine was the safest and most effective option available. Read more

NSW emergency department presentations soar in summer months Demand on NSW hospitals continues to rise significantly, with more emergency department presentations than ever before over the 2016 summer months. Hospital admissions increased to nearly 459,000 this quarter – 14,100 (or three per cent) more than the same time last year. Read more

Key to long-term malaria vaccine unlocked Brain scans could be used to diagnose depression and tailor treatments for it Brain scans can reveal whether someone suffers from depression and show what kind of depression they have, according to a breakthrough new study. The findings, published in Psychological Medicine, showed that medical imaging techniques show distinct differences in the brains of people suffering different types of depression. Read more

New device offers blood-free glucose testing for diabetes patients A new device is promising to revolutionise the way diabetes sufferers manage their condition on a daily basis, by offering a pain-free alternative to the standard blood sampling technique. Insulin users can now scan their arm to read glucose levels using a specially devised sensor the size of a 20 cent coin. Read more

Queensland researchers believe they might have found the key to developing a long-term malaria vaccine. Scientists at the QIMR Berghofer Medical Research Institute announced the results of a study that looked into utilising immune cells known as CD8+ to help increase the life of malaria vaccines. Read more

Gum an unlikely ally in stopping blindness Researchers from the University of Sydney's Save Sight Institute say they've discovered a simple chewing gum test, which could hold the key to identifying and treating Giant Cell Arteritis (GCA). The condition is caused by the inflammation of the lining of arteries in the head, restricting blood flow. Read more

The link between chronic pain and depression: which comes first? It’s easy to imagine that people with persistent pain have cause to become depressed. After all, it’s a problem that affects every part of life, not just the bit that got injured. But like so much to do with persistent pain, it becomes harder to unravel exactly what the relationship is when one digs a little further. Read more

Simple approach to buckle fractures eases strain on EDs A streamlined pathway for a common childhood fracture that utilises removable splints rather than traditional plaster casts is leading to faster and simpler outcomes for families and hospitals. The pathway is designed to provide a more efficient treatment to patients, speed up treatment times in the ED and reduce demand on outpatient services. Read more

Postgraduate Certificate courses The Australian College of Nursing’s postgraduate courses are designed specifically for nurses and midwives by nurse educators. We offer a range of accredited graduate certificate courses that deliver advanced knowledge and clinical expertise. Our graduate certificate courses are available online, studied over four terms of ten weeks each. They have a strong clinical focus and include leadership subjects that help you prepare for a leadership position in your chosen specialty.

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US to establish 'superbug' response lab network after detecting antibiotic-resistant strain US authorities have announced plans to establish a network of laboratories that can quickly respond to antibiotic-resistant "superbugs", following the nation's first human case of a dangerous strain of E. coli.

India hospital transfusions infect thousands with HIV

Alzheimer’s disease may stem from infections

At least 2,234 Indians have contracted HIV while receiving blood transfusions in hospitals in the past 17 months alone, say officials. The information was revealed by the country's National Aids Control Organisation in response to a petition filed by information activist Chetan Kothari.

Alzheimer’s disease may be the result of byproduct that builds up in the brain when it fights infections, according to a new study. The new study, if proven, could change the way the medical community thinks about the disease, and the development of drugs to treat it.

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Cancer vaccine moves a step closer

Statins could stop breast cancer returning

Scientists may be closer to developing a cancer vaccine after discovering a way to trigger the immune system to fight the disease just like it would a virus. They've developed a vaccine that is based on a type of genetic material – RNA – that helps cells create proteins. Read more

Breast cancer survivors could benefit from taking statins, scientists believe, after discovering that lowering cholesterol halves the chance of the disease returning in 10 years. A new study from the Institute of Cancer Research has shown that breast cancers use cholesterol to produce a molecule which has the same impact as oestrogen. Read more

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Heart disease linked to women's migraines Scientists discover an inherited gene for MS Scientists say they have found a gene that causes a rare but inherited form of multiple sclerosis. It affects about one in every thousand MS patients and, according to the Canadian researchers, is proof that the disease is passed down generations.

Women who experience migraines are also more likely to suffer from major heart problems, a new study has found. Experts examined data on more than 110,000 nurses taking part in the American Nurses' Health Study. Of these almost 18,000 were reported to suffer migraines when they were initially examined.

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Study links child obesity to bowel cancer Children who struggle to stay at a healthy weight run an increased risk of developing bowel cancer in later life, research suggests. A Danish study of more than 250,000 individuals found young people with higher body mass index (BMI) had an increased likelihood of suffering from the illness in adulthood. Read more

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E xciting new benefit s now available for AC N’s Member s and Fellows The first wave of new benefits for Australian College of Nursing (ACN) members has arrived! ACN values its Members and Fellows. Not only do they inform our response to policy and contribute knowledge and experience to help us shape health care debate, they are the lifeblood of our preeminent nursing organisation. There are three new initiatives that will streamline the member experience and provide significant value that is greater than the annual cost of our membership fees:

My ACN My ACN is 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. My ACN is a practical information hub that will ultimately put everything members need in one place, with the convenience of a single login. We're delighted to start to deliver these changes and will continue to improve the services available in the My ACN hub. If you are a current member and have forgotten your username or password, simply enter the email address that you currently receive your ACN correspondence to, to reset your login. If you have any questions or issues with this process please contact ACN Membership on 1800 061 660 or membership@acn.edu.au.

1, 2, 3 CPD courses for free

Discounts off all ACN courses

Members can now access three free CPD courses each registration year (1 June to 31 May). The courses that will be available are:

Members and Fellows, you now receive a 10% discount off full fees for all ACN Courses.

Abdominal Assessment Cardiac Assessment Deteriorating Patients Musculoskeletal and Neurovascular Assessment of the Lower Limbs Musculoskeletal and Neurovascular Assessment of the Upper Limbs Neurological Assessment Physical Assessment

As an example: if you enrol in a graduate certificate course, your discount represents a saving of between $790 and $1120. If you don’t have the time or resources to study a graduate certificate course, you can enrol in a postgraduate unit of study, which will provide you with a Statement of Attainment. The discount will save you up to $327 on the cost of a single unit of study, depending on the subject fee. For a full list of courses offered by ACN please visit our education page or contact our Customer Services team on 1800 265 534 or customerservices@acn.edu.au.

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When you fill out the application form for your unit or course, please quote your member number as your special offer discount code.

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If you have any questions or issues with this process please contact ACN Membership on 1800 061 660 or membership@acn.edu.au.

4. Offer subject to change without notice. If you are not already a member of ACN, you can sign up now to take advantage of these benefits and services.

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Attend the Expo to expand your nursing or health career! Sunday 19 June 2016 8.30am – 1.30pm Perth Convention & Exhibition Centre With thanks to the support of

In focus@ACN Policy @ACN


Ending the aged care ‘lot ter y’: T he National Aged C are A lliance work ing towards the future of A us tr alia’s aged care sys tem

By Anita Pak, Stefan Wythes and Stacie Murphy MACN

Australian College of Nursing (ACN) encourages anyone concerned about access to quality aged care to back the relaunched National Aged Care Alliance (the Alliance) Australians Deserve to Age Well Campaign. The campaign outlines the need for ongoing aged care reform, including the need to end the capping of aged care places, otherwise known as the “aged care lottery”. ACN is a member of the Alliance, a collaborative of peak national aged care organisations which includes consumer groups, providers, unions and health professionals working together to determine a more positive future for aged care in Australia. The Alliance supports a vision for aged care in Australia that enables access to quality aged care services that are planned, resourced and integrated. The Alliance also upholds that services are flexible and equitable, and also recognise diversity and promote choice and respect for users and workers (National Aged Care Alliance (NACA), 2007). At the inaugural meeting of the Alliance in 2000, representatives identified a number of issues at the forefront of aged care health policy, which included consumer rights, quality of care, workforce planning and the short and long term financing of aged care. These issues became the cornerstones of the Alliance’s united policy agenda aiming to improve outcomes in the care of older Australians (NACA n.d.).

Australians Deserve to Age Well campaign The impact of Australia’s ageing population is evident with an estimated 3.5 million Australians predicted to utilise aged care services by 2020 (NACA 2016a), with the changing nature of Australia’s ageing population highly published.

On 23 May 2016, the Alliance relaunched its Australians Deserve to Age Well campaign, which targets all political parties, seeking reform to ensure that older people do not have to wait months on waiting lists to receive aged care services as there are not enough aged care packages available (NACA & COTA 2016a).

With the election campaign in full swing, the Alliance is sending a clear message to all parties to end what they call the “aged care lottery”. The “aged care lottery” is essentially a process of rationing aged care places. For example, at the moment, the government only funds 112 services for every 1000 Australians over 70 years (NACA & COTA 2016a).

Policy @ACN

The current system means that if you are number 113, you may miss out (NACA & COTA 2016b). Under the current system, an older person may be assessed as requiring a certain level of care, however, due to the imposed caps, the necessary care may not be immediately available and they may need to wait for services. Some people may only get a portion of the care they really need or they may never get the care even though they have been assessed as requiring it (NACA & COTA 2016a). A weakness of the current system is that the funding structures prevent providers from tailoring care to individual requirements. It is therefore important that there is a move towards individualised funding for consumers to allow for greater flexibility, supporting clients to choose from services offered within the private and public sector and the general community (NACA & COTA 2016b). The Alliance has also developed its Position Statement for the 2016 Federal Election (the Position Statement). In addition to ending the “aged care lottery”, this key statement highlights reforms the Australian Parliament should adopt to further improve aged services to better cater for the diverse needs of older Australians (NACA 2016b). The Position Statement builds on the proposals outlined in the Alliance’s 2015 Blueprint II, forming a series of documents stemming from the Alliance’s first Blueprint for Aged Care Reform published in 2012. The Position Statement also revisits reforms already undertaken or committed to by Australian governments following the release of the Productivity Commission’s seminal report, Caring for Older Australians (NACA 2016b).

Reform principles The key principles underlying the reforms that the Alliance highlights are consumer choice and control.


“Representatives identified a number of issues at the forefront of aged care health policy, which included consumer rights, quality of care, workforce planning and the short and long term financing of aged care.”

The Alliance states reform must “move beyond the specific meaning of individualised funding that the implementation of Consumer Directed Care (CDC) Home Care Packages has attached to the term CDC. The focus is on ensuring that care is available which is responsive to people’s level of ability, life goals and strengths, by providing tailored service options across the service systems” (NACA 2016b). Importantly, the Alliance suggests that governments and service providers must, in consultation with the consumer, ensure support to “individuals who may struggle to receive equal access to the services they require under an individualised, market-based model” (NACA 2016b).

Key proposals of the campaign The Alliance has put forward a number of proposals in the Australians Deserve to Age Well campaign which aim to improve the services that older Australians are receiving. These include: • Giving the consumer the right to choose where their residential care funding will be allocated and the choice to move services if they are not satisfied. • Uncapping aged care supply to better allow care to be provided where and when it is needed. • That the government and the aged care sector work together to identify the risks (financial and other risks) associated with proposed reforms to move to consumer led and demand driven aged care.

• A commitment to an independent “cost of care” study so informed decisions can be made on how aged care will be funded in the future. • The campaign encourages political parties to adopt the Alliance’s Election Positions to progress aged care reform (NACA & COTA 2016b). The Alliance encourages everyone to sign the Australians Deserve to Age Well petition, addressed to the Prime Minister, the Opposition Leader and Leader of the Greens, to end the “aged care lottery”. The Alliance believes by removing the current restrictions on the level, quantity and distribution of services that providers can deliver, Australia can develop an aged care system that is more responsive to each older person’s individual needs. ACN members and non-members are encouraged to sign the petition here and to visit the Alliance’s website for further information.

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References: National Aged Care Alliance 2007, National Aged Care Alliance, NACA, Canberra, viewed 24 May 2016, <http://www.naca.asn.au/index. html>. National Aged Care Alliance n.d., About NACA, NACA, Canberra, viewed 24 May 2016, <http://www.naca.asn.au/about.html>. National Aged Care Alliance 2016a, Australians Deserve to Age Well, viewed 25 May 2016 National Aged Care Alliance 2016b, Position Statement for the 2016 Federal Election, viewed 27 May 2016 < http://agewellcampaign. com.au/wp-content/uploads/2016/05/NACA_Blueprint_Election_ Campaign_2016.pdf> National Aged Care Alliance & Council on the Ageing 2016a, What is the problem in aged care today?, viewed 26 May 2016 < http:// agewellcampaign.com.au/reforms/problem-aged-care-today/> National Aged Care Alliance & Council on the Ageing 2016b, How can we improve aged care, viewed 26 May 2016 < http://agewellcampaign. com.au/reforms/can-improve-aged-care/>

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Answering the call for ‘stories from the field’ By Ruth Sheahan

Ruth Sheahan (right) with one of her patients

My primary health story is a tale of passion and compassion. I feel very lucky to have been selected to work within the NSW Refugee Health Service as a member of the NSW Refugee Health Nurse Program (RHNP), which commenced service in October 2012. This recent and innovative NSW Health initiative aims to address the health needs of this marginalised population group whom arrive in our country often in poor health, with meagre health literacy and, more often than not, no English language skills to speak of. The RHNP focuses upon newly arrived refugees holding a valid Australian Humanitarian Entry Visa. It aims to settle them into our complex health system by linking them with a local general practitioner

and other area health services such as dietetics, oral health, early childhood and women’s health clinics as required. We do our best to link those that need psychological healing into trauma counselling (STARTTS) as soon as possible. The RHNP also offers in-house services such as immunisation, treatment of vitamin D deficiency and QUIT smoking programs. Those whom arrive with more urgent and complex health issues are managed as a priority. My position requires that I operate in an often autonomous role, drawing on a broad spectrum of nursing knowledge and experience. The ability to advocate on behalf of my clients is especially pertinent as a great deal of my time is spent assisting them gain access to services such as disability and aged support, access to specialist outpatient clinics and sourcing professionals and services that will provide pro-bono or bulk billing services. I am based at the Refugee Health Service Head Office in Liverpool. The Liverpool district hosts a large proportion of Arabic speaking refugees whom have arrived fleeing conflict and persecution in Iraq and more recently Syria. I find it very important to be culturally informed in regard to my client’s respective customs and beliefs, and sensitive toward the situations they have fled. Iraq was once a very cultural and diverse country with peoples from many faiths and ethnicities living in relative harmony. During the recent civil upheaval this ethnically cohesive society has been torn to shreds, Muslim sects turned

against each other, ethnic minorities such as the Mandean peoples have been particularly victimised, prominent Christian communities such as the Assyrian and Chaldean peoples have also suffered persecution. People of secular and liberal Muslim views came under threat of attack as did anyone who ran a profitable businesses. Many have suffered torture, kidnap and witnessed unspeakable atrocities. Nonetheless, the strength and resilience of our refugee individuals and families never ceases to amaze me and it is such a great privilege to welcome and care for these folk on behalf of NSW Health and the greater Australian public. Our service aims to strengthen the community as a whole by providing the most optimal health pathways possible to assist these new members of our society make Australia home.

Community & Primary Health Care Nursing Week

Nurses where you need them 19–25 SEPTEMBER 2016

How to get involved: The ACN Community and Primary Health Care Nursing Week: Nurses where you need them national campaign will take place from  19–25 September 2016. Here’s how you can get involved this year: • 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 submit your story. SUBMIT YOUR STORY

• 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. • 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

Ruth’s inspiring 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’ their 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!

• 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 With thanks to the support of our official sponsor

In focus @ACN


Vital Signs

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Using social media to communicate, lobby, lead and inform By Trish Lowe MACN


MAKING EDUCATION EASY FOR NURSES www.researchreview.com.au

Sitting on a crowded train, surrounded by fellow commuters, it is hard to imagine a time when portable access to the internet and social media, did not exist. Yet, it is estimated that since the first generation of smartphones Trish Lowe MACN were released in 2007, ownership has expanded to over 80% of the Australian population. Ownership confers the capacity to complete a range of tasks, including monitoring social media and listening to podcasts, music or newsfeeds at any time. Nurses and midwives have embraced social media as a means of communicating and engaging with each other, lobbying, informing and leading the way.

“Nurses and midwives have embraced social media as a means of communicating and engaging with each other, lobbying, informing and leading the way.”

In 2014, The Australian Institute of Health and Welfare, estimated that 40% of nurses and midwives, were 50 years of age, or older. These health professionals have consequently witnessed significant social, economic and political change throughout their lives whilst simultaneously enjoying the personal and professional benefits, associated

Whilst personal communication is undoubtedly considered the least authoritative source of information within the ‘hierarchy of evidence’, opinions expressed via social media offer insights into the realities of life for nurses and midwives, have a useful role in expanding professional networks and may initiate critical enquiry.

with technological advancement. Notwithstanding the geographic, cultural and age related diversity of Australia’s nursing and midwifery workforce, requirements for rapid distribution and assimilation of knowledge remain, with social media providing a means of achieving this. Some useful examples of nursing and midwifery related social media sites include the Australian College of Nursing Facebook, Twitter and Instagram pages.

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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

Visit www.collegianjournal.com

Events @ACN


Over 200 break fasts and 9,000 nurses!

We would like to sincerely thank all our members who got involved in the 2016 ACN National Nurses Breakfast. We hope you enjoyed spending International Nurses Day with your colleagues and friends and celebrating the invaluable contribution nurses make to the health of our society. 240 breakfasts were held across the country with over 9,000 individuals taking part. It was wonderful to see so many groups involved and sharing their celebrations on social media.

Hedland Health Campus

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Griffith University

Click here to see all the #ACNBreakfast posts from breakfast hosts and supporters across Australia.

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Best care at fingertips with palliAGEDnurse app Suite of two palliAGED apps The positive response from GPs to the palliAGED app has led Decision Assist to produce this second app for nurses, with the two apps being marketed through app stores as a suite of two apps – one for GPs and one for nurses. CareSearch Director and 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.

Nurses caring for older people near the end of life are now able to access current clinical advice at the point of care, thanks to the development of a new smartphone app. Available free through Google Play and the Apple Store, the app – palliAGEDnurse – has been developed as part of the Decision Assist program for aged care staff in residential and community settings.

“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. “Web based resources that are constantly updated 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.”

It provides clinical advice based around three key areas – advance care planning, case conferencing and terminal care.

The locations in which nurses are providing care to older people are increasingly varied, which raises the need for portable resources for nurses to consult at the point of care.

The app was developed by the CareSearch Project Team at Flinders University, following the production last year of the palliAGED app for General Practitioners (GPs).

to live at home through the provision of Australian Government Home Care Packages and many are spending some or all of the last year of their life

For example, increasingly older people are enabled

at home. Nurses will therefore need to be able to recognise and address their palliative care needs. Whatever the location for care, nurses usually need similar information, as well as some setting-specific ideas which are provided through the app.

A palliative 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

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. Nurses working out of internet range can use the app as it holds a version locally in the phone.

In focus @ACN


Climate & Health

Climate change: Time for nurses to step up By Dr Liz Hanna FACN, Key Contact ACN Climate and Health Community of Interest

Liz Hanna FACN

Climate deniers are a dying breed. Their voices are increasingly fading under the overwhelming evidence that climate change is scientifically valid (IPCC 2013) and evidence of climate mayhem unfolding all over the world (WHO & UNFCCC 2015 ).

Similarly, the evidence is overwhelming that fossil fuel industries were funding the leading groups working to disseminate the seeds of doubt (Oreskes & Conway 2010; Klein 2014). They have failed. Nations are moving towards renewable energy sources and away from fossil fuels. In 2015, global investment in renewables was double that of fossil fuels (McCrone et al. 2016). Coal prices have plummeted, such that the world’s largest coal company declared bankruptcy in April (Kary et al. 2016).

Those of us who are concerned about climate change and studying these trends have been warning banks, universities and superannuation funds that the end is nigh for the fossil fuel industries, urging them to ‘divest’, that is, to protect their investment portfolio and sell all shares in fossil fuel companies. It was inevitable that shares in those companies would become ‘stranded assets’, meaning they will lose their value as alert nations shift their economies towards clean energies. International coal prices have collapsed, hence the bankruptcy. You may ask why has the health sector been involved in these campaigns? It seems a long way from our “core business”. To the contrary, collectively, the health sector works to optimise human health and wellbeing. Some of us work in curative health, restoring health, many others are involved in preventing ill health, working to ensure that health determinants are optimised to enable opportunities for people to enjoy good health and remove the barriers to good health (such as redressing situations where high-fat, high-sugar foods are cheaper than healthy options). Others are involved in research, policy, training the next generation of health workers and administration.

We are all working towards the same goal – keeping Australia healthy. How climate change fits into all this is through our global energy usage. Our past habit of burning of fossil fuels has released gigatonnes of greenhouse gases into the atmosphere, to such an extent that

we have now altered atmospheric chemistry and warmed the planet. 2014 was the world’s hottest year, then 2015 quickly passed that by a very long margin, and January to April 2016 have continued breaking global heat records, by increasingly large margins (WMO 2016a; WMO 2016b).

In focus @ACN


“We, as nurses have an important role to play… we all need to know the climate change risks for our part of the world and how that will impact our professional activities.”

Psychology Society, the Pope, the World Health Organization, World Bank, and even the Australian Government Department of Defence are all on board. I am a member of an International group of nurses who are engaging with climate change. It is time for Australian nurses to come out and lend their support and energies into: • Cutting greenhouse gas emissions from their private lives and professional arena

The average annual global temperature is now more than one degree higher than pre-industrial times (WMO 2016b). So, using long term data, we are halfway towards the arbitrary 2oC limit, and more importantly, two-thirds of the way towards the more sensible limit of 1.5oC of total warming. The short term data is even more concerning. Global average land temperatures between December 2015 to February 2016 were 1.95oC warmer than pre-industrial times, and was more than 2oC warmer for the entire month of April (NOAA 2016). The most intense El Niño on record is now receding, so these hyper extreme temperatures are expected to settle as a flip to La Niña is likely over the coming year (BOM 2016). Already, with a global averaged one degree of warming, 300,000 people die every year due to climate change alone. The numbers will increase exponentially as temperatures continue to rise and storms, droughts, floods, sea-level rise, heat and fires really ramp up. Global heat deaths have risen by a massive 2,300% (WMO 2013), and there is more to come. The Climate and Health Alliance (CAHA) was set up to provide a cohesive voice from the health sector to educate the public and policy makers that climate change was bad for health (see www.caha.org.au). I am President of CAHA, and the Australian College of Nursing (ACN) is a member.

A recent study, commissioned by CAHA, calculated the health costs attributable to coal mining in the Hunter Valley from exposure to the very small particles of air pollution (PM2.5) amount to $65.3 million and the full annual social costs to $66 billion.

• Educating themselves on climate change and what needs to be done

So not only is coal causing global warming, it is also directly harming the health of Australians, especially those living nearby. This amount of illness and waste of money need not occur. Australia can already fully power itself through renewable energy sources, which do not kill, and can offer long term jobs (Jotzo & Kemp 2015).

• Be part of the global movement to urge for a cleaner, safer world to save lives and prevent ill health.

So we, as nurses have an important role to play. Firstly, we all need to know the climate change risks for our part of the world and how that will impact our professional activities. The health sector needs to be prepared and this includes education and training of our future workforce, plus professional development for the existing workforce. In the next issue I will expand further on preparedness, vulnerability assessments and adaptation which are all key to this planning. If any of you are still feeling trepidacious about whether nurses should be engaging in this space, you may ask who else is now on board. In 2009 The Lancet called climate change “the greatest health threat facing humanity”. The International Council of Nurses, the Royal Australian College of Physicians, the Australian Medical Association, the Australian

• Becoming a trusted source of education for the Australian community who seek expertise from nurses

• The ACN Climate and Health Community of Interest is now reforming. We are facing a brave new world; one that carries serious threats, and needs nurses to help protect current and future generations. I invite you to join. Nurses CAN make a difference! Let’s do it together!

Author details: Dr Liz Hanna is an environment, climate & health researcher at The Australian National University, President of the Climate and Health Alliance and Key Contact for ACN’s Climate and Health Community of Interest. Editor’s note: ACN is currently developing a position statement on the impact of climate upon nursing and health.

References BOM 2016, ENSO Wrap-Up: Current state of the Pacific and Indian Ocean, Bureau of Meteorology, Melbourne, viewed 5 May 2016 <www. bom.gov.au/climate/enso/wrap-up/archive/20160426.archive.shtml> IPCC 2013, Working Group I Contribution to the IPCC 5th Assessment Report "Climate Change 2013: The Physical Science Basis". Geneva, Switzerland: Intergovernmental Panel on Climate Change (IPCC), 2013. viewed 3 Dec 2014. <www.ipcc.ch/report/ar5/wg1/#.UudGWhB9Lcs> Jotzo F. & Kemp L. 2015, Australia can cut emissions deeply and the cost is low: Submission to the review of Australia’s post-2020 emissions reductions target, Centre for Climate Economics & Policy, Crawford School of Economics and Government, The Australian National University, Canberra, viewed 23 November 2015 <https:// ccep.crawford.anu.edu.au/files/uploads/ccep_crawford_anu_edu_ au/2015-05/australia_can_cut_emissions_and_the_cost_is_low-_ jotzo_and_kemp_april_2015_-_submission_to_dpmc.pdf> Kary, T., Loh, T. & Polson, J. 2016, "Coal Slump Sends Mining Giant Peabody Energy Into Bankruptcy", Bloomberg, 13 April 2016 <www. bloomberg.com/news/articles/2016-04-13/peabody-majority-of-its-us-entities-file-for-chapter-11> Klein N. 2014, This Changes Everything: Capitalism vs. the Climate, Simon & Schuster, New York. McCrone, A., Moslener, U., d’Estais, F., Usher, E. & Grüning, C. 2016, Global Trends in Renewable Energy Investment 2016, Frankfurt School UNEP Collaborating Centre for Climate & Sustainable Energy Finance, Frankfurt, viewed 20 May 2016 <http://fs-unep-centre.org/sites/default/files/publications/ globaltrendsinrenewableenergyinvestment2016lowres_0.pdf> NOAA NCEI 2016, Global Analysis – April 2016, National Oceanic and Atmospheric Administration National Centers for Environmental Information, viewed 20 May 2016 <www.ncdc.noaa.gov/sotc/ global/201604> Oreskes, N. & Conway, E. 2010, Merchants of Doubt, Bloomsbury Press, New York. WHO & UNFCCC 2015, Climate and Health Country Profiles - 2015: A Global Overview. Geneva: World Health Organization (WHO) and UN Framework Convention on Climate Change (UNFCCC), viewed 4 December 2015 <www.who.int/entity/globalchange/resources/ country-profiles/climatechange_global_overview.pdf?ua=1> WMO 2013, The Global Climate 2001-2010: A decade of climate extremes, World Meteorological Organization, Geneva, viewed 1 March 2015 <http://library.wmo.int/pmb_ged/wmo_1119_en.pdf> WMO 2016a, Monthly and seasonal temperature records smashed, World Meteorological Organization, Geneva, viewed 21 March 2016 <http://public.wmo.int/en/media/news/monthly-and-seasonaltemperature-records-smashed>. WMO 2016b, WMO Statement on the Status of the Global Climate in 2015, World Meteorological Organization, Geneva, viewed 21 March 2016 <http://library.wmo.int/pmb_ged/wmo_1167_en.pdf>

Events @ACN



26–28 October 2016

THE POWER OF NOW Melbourne Park Function Centre


Brian Dolan MACN (Associate) Director, Health Service 360

Adjunct Professor Debra Thoms FACN (DLF) Commonwealth Chief Nursing and Midwifery Officer, Australian Department of Health

Professor John Daly FACN The ACN team are busy working to develop an exciting and stimulating program for this year’s National Nursing Forum, The Power of Now. The program will include a host of influential thought leaders and inspiring nurses, high quality concurrent sessions, stimulating discussions and masterclasses, along with the opportunity to network and share ideas with colleagues and peers from across Australia. Several speakers have already been announced and are pictured. We are honoured to have each one contributing to our program this year. Keep an eye out for more speaker announcements coming soon! Click here to secure your early bird registration before the end of the financial year so that you can be a part of the nursing event of the year.

Dean, Faculty of Health and Head of the UTS/World Health Organization Collaborating Centre for Nursing, Midwifery and Health Development, University of Technology Sydney

Dr Louise Schaper

Dale Fisher

Professor Wendy Cross FACN

Chief Executive, Peter MacCallum Cancer Centre

Adjunct Associate Professor Lydia Dennett MACN Chief Nurse and Midwifery Officer, SA Health and Chair, Australian and New Zealand Council of Chief Nursing and Midwifery Officers

Chief Executive Officer, Health Informatics Society of Australia (HISA)

Associate Dean, Nursing and Allied Health, Monash University

Adjunct Professor David Plunkett MACN Executive Director – Acute Health and Chief Nursing and Midwifery Officer, Eastern Health

Representation @ACN


ACN voices â&#x20AC;&#x201C; 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 engagement@acn.edu.au

â&#x20AC;&#x153;The opportunity to be involved with the development of a private practice NP (nurse practitioner) service built naturally onto the past three decades of effort I have put into shaping policy and regulation."

issues by the government, related to feedback on the processes and outcomes of ACFI appraisals. Reviews of ACFI funding began February 2009 and I was appointed to the ACFI IRG from 2010 to 2014. However, it was disbanded and replaced by the ACFI Monitoring Group in 2012. Changes to the ACFI scoring and funding arrangements introduced in March 2008 and further refined in April 2012 generated concern among aged care providers and other stakeholders that funding would be reduced, compromising sustainability. The ACFI Monitoring Group was set up to monitor the effects of these changes over time and to advise the government on the impact of changes.

P r ofes sor Tr acey M cDonald A M FAC N Which working groups have you represented ACN on? Aged Care Funding Instrument (ACFI) Monitoring Group (from September 2012 to 2014): Since the aged care reforms commenced in 2002, we as a professional college have highlighted issues that we feel are of particular importance to older persons as well as difficulties facing the aged care system with financing, staffing and ensuring equitable access to services. Australian Government funding for provision of residential aged care services is paid as a basic subsidy determined by assessing residents and classifying them against the ACFI. I represented ACN on the ACFI Industry Reference Group (IRG), which was in place from 2009 following the identification of

ACFI Technical Reference Group (From March 2009 and then September 2012): The purpose of the ACFI Technical Reference Group is to provide advice to the ACFI Monitoring Group on possible changes to the ACFI from a technical perspective, including improving the evidence requirements such as assessment of residents, to support funding claims under the ACFI. The group is set up for a defined set of meetings and then called as necessary to consider further issues as they arise. National Aged Care Alliance (NACA): NACA was set up in 2002, bringing together national peak organisations representing key categories of professions, service providers, trade unions and consumers. NACA comprises 48 peak body organisations representing consumers and their families, informal carers, special needs groups, nursing, allied health and personal carers involved in the aged care sector, and private and not-for-profit aged care providers. Members meet

Recommend the flu and whooping cough vaccines to your pregnant patients. health.wa.gov.au WA Department of Health

Representation @ACN

quarterly to identify issues and collaborate on strategies that meet a consensus view of member organisations. I have been involved with NACA since its inception and have represented several of the key member categories. Currently I represent ACN in the ‘professional organisations’ category. As the ACN representative I have been actively involved with the following NACA working groups: • Specified Care and Services Advisory Group (Scheduled implementation 1 July 2015) • Gateway Advisory Group (Staged implementation commencing July 2013 • Home support Advisory Group (Scheduled to commence on 1 July 2015) • Complaints Management Scheme (Ongoing since 2011) As a member of NACA I have been able to ensure that ACN’s positions on a variety of issues have been heard and, where required, adopted by NACA in position statements and responses to various reviews and inquiries. The aged care reforms are progressing since the passing of five Bills in 2013 to address finding, quality and service scope. These are: • Aged Care (Living Longer Living Better) 2013 • Aged Care (Bond Security) Amendment 2013 • Aged Care (Bond Security) Levy Amendment 2013 • The Aged Care Quality Agency 2013 • The Aged Care Quality Agency (Transitional Provisions) 2013 International Council of Nurses (ICN) expert panels: I was nominated in 2010 by ACN to be the ICN representative on the expert panels for Ageing, Human Rights and Patient Safety.


I have since responded to reviews of position statements and ICN policy in all of these areas. Aged Care Nurse Practitioner in Private Practice Project: In 2010 I was approached by ACN to participate in an application for funding from the Department of Health and Ageing under the Nurse Practitioner in Aged Care Models of Practice program. We were successful in our application for funding to set up and evaluate a nurse practitioner in private practice model which continued until late 2014. I chair the steering committee for this project and this involves ensuring that the nurse practitioner (NP), Lyn Day, has access to guidance and that the funding under the program grant is managed appropriately, and that ACN and stakeholders in the project are provided with timely and accurate reports on the management of the grant. In the early 1980s, I heard about nurse practitioners in USA and decided Australia needed to be thinking about NPs here. I was teaching in universities at that time and began to seed ideas into the final year students about independent nursing and advanced practice, including assessments such as envisioning being a nurse practitioner and questions such as ‘would you employ yourself’ in private practice. As part of my work in introducing NPs to Australia, I have been involved with the NSW NP projects; regulation of NP practice and eligibility pathways; clinical guidelines for NP processes towards endorsement; negotiations and advice related to industrial frameworks to set up relativities between NPs and medical practitioners; negotiations related to access to the Pharmaceutical Benefits Scheme; review of NP competencies, and discussions with employers in aged care on roles for NPs in aged care. The opportunity to be involved with the development

of a private practice NP service built naturally onto the past three decades of effort I have put into shaping policy and regulation and building widespread acceptance of NPs in Australia. Faculty of Health and Wellbeing in Ageing: From August 2009 to mid 2013 I acted as the elected chair for this group of expert nurses with an interest in aged care issues and practice. The purpose of the faculty was to facilitate the exchange of information and advice on health and wellbeing in ageing issues as required between the Royal College of Nursing Australia (RCNA) and key nursing experts. With the amalgamation of RCNA with the College of Nursing to become ACN the faculty structure was disbanded. (Editor's note: ACN's Healthy Ageing Community of Interest now serves this function.) I am also involved with ACN as an assessor for the Nursing and Allied Health Scholarship and Support Scheme and aged care nursing scholarships.

What led to your interest in these areas? My background in nursing, management, health economics, nurse practitioner development in policy and practice and commitment to the success of ACN and the nursing profession.

If you are a nurse working in a general practice setting, the Nursing in General Practice (NiGP) Handbook is essential reading, and it’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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Can you highlight any issues and/or benefits arising for the profession as a result of these working groups? Having a nurse involved with these high-level committees who is aware of policy, economics and demographics associated with developments in these aspects of government and social change, delivers for ACN a high profile and credibility within these forums that would otherwise not be possible.

Order your FREE printed copy or download a PDF version.

Advertorial @ACN


Nursing that takes you places Back in Australia, Katrina is currently the officer in charge at the Soldier Recovery Centre in Darwin. The centre works collaboratively with health professionals to assist wounded, injured or ill soldiers with a wide range of complex needs. Katrina said the work changes on a daily basis and it’s very rewarding. “What I like most is the ability to influence the stigma of injury and mental health; and assisting soldiers to get from point A to point B in a really positive environment.” Katrina said her Army career has also enabled her to expand her qualifications. She has completed a Graduate Certificate in Emergency Nursing; will complete a Masters (Nurse Practitioner) this year; and is currently studying for an additional Graduate Certificate in Rural and Remote Nursing.

Captain Katrina Kelly

Nursing in the Army has given Captain Katrina Kelly opportunities not available in a civilian career. Katrina has trained as an aviation nurse and practiced her skill from helicopters and ships; she’s deployed on operations; undertaken graduate study; and even undertaken training roles. She said her deployment to Afghanistan in 2014–15, in a United Kingdom led mentoring mission, was her most satisfying role so far. Deployments test individuals’ professional, mental and physical capabilities. Nurses in a deployed environment play a role in primary health care, pre-hospital emergency care, evacuation of casualties, and surgical support.

Katrina demonstrated that she has what it takes, receiving a commendation for ‘distinguished performance of duties in warlike operations’ for her work in Afghanistan. “I was there for seven months and my work focused on health and well-being management, primary health care, emergency and working with soldiers,” Katrina said. During that deployment there was a mass casualty from an insider attack at a Defence University. Katrina’s citation states that her level-headed actions following this attack had a “force multiplying effect that aided the critical treatment and extraction of 14 casualties”.

The Army has also provided her with the opportunity to develop her leadership skills. Army Nursing Officers take on management, administrative and command positions. These roles develop their skills and professional opportunities beyond the purely clinical. It is a career that offers variety, challenges, travel and the means to gain experience and skills that are in high demand. The Army recruits Nursing Officers from most specialisations, and is especially seeking nurses with postgraduate, general, emergency, perioperative and intensive care qualifications.

NURSING OFFICER IT’S NOT YOUR GENERAL PRACTICE As a Nursing Officer in the Navy, Army or Air Force, you’ll have opportunities that you won’t get in the private sector. For instance, your patients will be your co-workers, as well as civilians on deployment. You’ll also have the chance to lead a team of health professionals and provide humanitarian aid, all while receiving a favourable salary and benefits. If you’re a registered nurse, contact us today for more information.


To find out more visit defencejobs.gov.au/army or call 13 19 01.

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Professional development @ACN


CPD short courses @ACN July–August NSW

These courses attract no fees for employees of NSW Health.

27–28 JULY Chronic and complex care for nurses RN | 2 days | 14 CPD hours | Wollongong


30–31 AUGUST Wound management RN/EN | 2 days | 14 CPD hours | Perth



28 JULY Immunisation update RN | 1 day | 7 CPD hours | Canberra

2–3 AUGUST Wound management RN/EN | 2 days | 14 CPD hours | Parramatta 11–12 AUGUST Diabetes management and current guidelines RN/EN | 2 days | 14 CPD hours | Goulburn 12 AUGUST ECG: introduction RN/EN | 1 day | 7 CPD hours | Coffs Harbour


12 AUGUST Building resilience: self-care strategies for nurses RN/EN | 1 day | 7 CPD hours | Melbourne


17 AUGUST Infection prevention and control in residential care RN/EN | 1 day | 7 CPD hours | Adelaide

18–19 AUGUST Orthopaedic update RN/EN | 2 days | 14 CPD hours | Newcastle 19 AUGUST Building resilience: self-care strategies for nurses RN/EN | 1 day | 7 CPD hours | Parramatta



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23–24 AUGUST Team dynamics and clinical leadership RN/EN | 2 days | 14 CPD hours | Wollongong

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11–12 AUGUST Wound management RN/EN | 2 days | 14 CPD hours | Launceston

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25–26 AUGUST Rehabilitation nursing RN/EN | 2 days | 14 CPD hours | Albury

29 JULY Perioperative anaesthetic nursing RN | 1 day | 7 CPD hours | Brisbane

18–19 AUGUST Wound management RN/EN | 2 days | 14 CPD hours | Hobart

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26 AUGUST Assessing and managing vascular access devices RN/EN | 1 day | 7 CPD hours | Orange 26 AUGUST Organ and tissue donation awareness RN | 1 day | 7 CPD hours | Tweed Heads

9–10 AUGUST Wound management  RN/EN | 2 days | 14 CPD hours | Toowoomba

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Advancing nurse leadership www.acn.edu.au

In focus @ACN


W hen rea ssur ance goes a long way By Jenny Cavanagh MACN

A recent routine hospitalisation for me went, as they say, “pear shaped”. As a registered nurse for more than 25 years who has worked in a wide variety of settings, I was in the situation of having a frightening episode that brought challenges not only to the professionals caring for me – but, most of all to me. When I heard the surgeon say, as we both looked at the MRI of my right knee, “There is no other option but replacement”, I just sat there. I filled in my paperwork for the admission and headed back to my workplace to let them know. It was here that I broke down in tears, frightened of what would come and daunted by the recovery I knew I would have to undergo. But what was to come almost two weeks after the surgery was one of the most taxing and wearing experiences of my life to date. Serotonin syndrome or serotonin toxicity as it is known, is something that I had never heard of but is “characterised by the presence of a triad of clinical features: neuromuscular excitation, autonomic stimulation and changes in mental state”(Isbister et al. 2007). I write this brief note to let others know and to plead with my colleagues to understand just how frightening this really is. Also to ask them just “to be there” and understand. I was diagnosed with depression many years ago and have been successfully managed with Paroxetine and cognitive behaviour therapy.

At the pre-admission clinic, I confirmed all of my medications with the medical personnel in attendance. Post-op, I awoke to find myself quite groggy as expected (I had been through many surgeries before). My chronic arthritis pain was gone and I was only experiencing mild discomfort. Through the post-op night, however, the block and epidural anaesthesia wore off. I was commenced on a routine course of medications which included Endone, Paracetamol and Palexia. Several days later, I moved along to the gym in the facility (I had been receiving physiotherapy in my room post-op until then) and commenced my rehabilitation. I was feeling what I can best describe as fuzzy, “not present” and fragile. The physiotherapists were fantastic. Most nurses too were terrific. I hit a hiccup six days after leaving hospital when I was back for outpatient therapy. All was fine except for when I hit the hydrotherapy pool. After 15 minutes I apparently went white as a sheet and was pulled out quickly. Vasovagal? Who knows? But the rehabilitation specialist then started talking about a syndrome that I had never heard of. I was experiencing periods of hypertension, pallor and a general feeling of “blankness”. Nonetheless, I was discharged the next day to return for further rehabilitation. Another day passed at home. Mid-afternoon I began to feel quite, what I can best describe as, skittish; no longer in control of things that were happening. I felt a little nauseous, I was getting diarrhoea and generally really unwell. I spoke to family who were

In focus @ACN


“I have learnt to trust my feelings about my body and ensure I do my best to remember the little things in nursing such as gentle reassurance and giving someone privacy and respect.” staying with me and came back to hospital via the emergency department. In emergency I began to shake, experienced neuromuscular twitching and the diarrhoea persisted. I was extremely scared. Thank goodness the registrar believed me when I mention my specialist had said probable serotonin syndrome the day before. I was readmitted to the local private hospital next door. I have nothing but praise for the two registered nurses who came to collect me from emergency. It was, however, the after-hours nurse manager who I could not believe was saying, “Settle down and you will have to behave”. It took me quite a while to absorb this as I didn’t trust myself with what I was hearing because of the toxicity. To add to my distress, I had been placed on an alternating mattress replacement which was rock hard beneath me and the staff did not seem to know how to operate it! Through that night and the following five days, I was subjected to a barrage of tests; cardiac monitoring, faecal testing, urine testing, an urgent CT scan of my brain and Doppler ultrasound of my lower legs. The reasoning for the Doppler was that a prior patient had exhibited similar symptoms and was found to have a DVT (deep vein thrombosis). My scans all came back clear. My orthopaedic rehab continued. Only three nurses took the time to really ask how I was doing! One, a new graduate closing my door for privacy, and the others just reassuring me quietly that all was going to be okay. The physiotherapists and occupational therapists were nothing short of fabulous and kept an eye on me consistently. These people I am eternally grateful for as they continued to treat me with respect.

I had hyperreflexia upon testing, tremor, persistent diarrhoea (faecal testing was clear) and extreme distress with diaphoresis for a few days yet. I was struggling with my temperature regulation. The specialist saw me regularly and decreased my Paroxetine slowly and then commenced me on another antidepressant. It was to be six days before I came home for good. I guess you could say I had experienced moderate seratonin toxicity. Now, at almost nine weeks post-op I am almost back to my old self. The thermoregulation problem is proving to be a little persistent but my rehabilitation as an outpatient is complete and I am back seeing my regular physiotherapist. My general practitioner is monitoring me and I will go and see a toxicity specialist. So, what have I learnt? • Trust my feelings about my body and ensure I do my best to remember the little things in nursing such as gentle reassurance and giving someone privacy and respect.

Clinical features of serotonin syndrome Altered mental status

Confusion, agitation, restlessness, excitement

Autonomic dysfunction

Tachycardia, hypertension, hyperthermia, sweating, mydriasis, flushing, shivering

Neuromuscular Excitation

Hyperreflexia, hypertonia, ataxia, tremor, clonus (spontaneous, inducible or ocular

Source: TGA

Drugs that may contribute to serotonin syndrome Antidepressants • SSRIs • MAOIs (reversible and irreversible) • tricylic antidepressants • SNRIs Opioids • tramadol • pethidine • dextromethorphan

• Encourage others to be aware of this syndrome as antidepressants are quite commonplace now in our medical environments.

• fentanyl

• That “awareness of the possibility and supportive care are the most important treatments of serotonin syndrome” (TGA 2015).

• amphetamines and derivatives such as MDMA (ecstasy)

References Isbister, G.K., Buckley, N.A. & Whyte, I.M. 2007, “Serotonin Toxicity: A practical approach to diagnosis and management”, Medical Journal of Australia, vol. 187, no. 6, pp. 361-365. TGA 2015, Medicines Safety Update Volume 6 Number 4, Therapeutic Goods Administration, Canberra, viewed 21 April 2016 <www.tga.gov.au/publication-issue/ medicines-safety-update-no6-2010#serotonin>

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CNS stimulants • cocaine

Other • lithium • St. John's Wort • Tryptophan Source:TGA

Autumn Issue out now

NMBA update


Revised NMB A regis tr ation s t andar ds, s t andar ds for pr ac tice and guidelines now in ef fec t A number of revised registration standards, standards for practice and guidelines from the Nursing and Midwifery Board of Australia (NMBA), for nurses and midwives across Australia, took effect from 1 June 2016. The NMBA regulates Australia’s over 370,300 enrolled nurses, registered nurses and midwives. NMBA Chair Dr Lynette Cusack, RN said, “The newly effective standards and guidelines are further important steps to improve how we protect the public. We have made changes to standards and guidelines to make the obligations for nurses and midwives clearer allowing them to be more effective in how they provide care to the public. This benefits the professions, their employers and is good for public protection. It is a testament to the work of the individuals and all the key stakeholder organisations involved, who contributed to our consultations.” The revised common registration standards1, guidelines and supporting documents now in effect for both nurses and midwives are: • Registration Standard: Continuing professional development (CPD), guideline, factsheet and Policy: Exemptions from continuing professional development for nurses and midwives • Registration Standard: Recency of practice and factsheet, and • Registration Standard: Professional indemnity insurance (PII) arrangements and factsheet.

These revised registration standards, guideline and supporting documents came into effect on 1 June 2016 and replace any existing versions that were in place. In addition, the revised Registration standard: Endorsement as a nurse practitioner, the new Registered nurse standards for practice and revised guidelines also came into effect on 1 June 2016, including: • Registration standard: Endorsement as a nurse practitioner and factsheet • Safety and quality guidelines for nurse practitioners • Guidelines: For nurses applying for endorsement as a nurse practitioner, and • Registered nurse standards for practice and factsheet. All nurses and midwives will need to meet the obligations of the revised registration standards by the next registration renewal period in May 2017. You can find the revised standards, guidelines and supporting documents on the Registration Standards and Professional Codes & Guidelines sections of www.nursingmidwiferyboard.gov.au. The NMBA would also like to remind midwives that the effective date for the Registration standard: Endorsement for scheduled medicines for midwives and the Safety and quality guidelines for privately practising midwives and supporting factsheets is 1 January 2017.

For more information see the Board’s news item’s which explain what these changes mean for nurses and midwives on the News section of www.nursingmidwiferyboard.gov.au. The standards and guidelines were revised after a scheduled review, which included public consultation. The NMBA has published consultation reports providing a summary of the consultation processes, rationale for any changes and proposed way forward, including areas where further work is planned. 1 Registration standards define the requirements that applicants and registrants in the regulated professions need to meet to be registered.

For more information Visit the NMBA website: www.nursingmidwiferyboard.gov.au For registration enquiries: 1300 419 495 (within Australia) +61 3 9275 9009 (overseas callers) For media enquiries: (03) 8708 9200

Profile for ACN Australian College of Nursing

NurseClick June 2016  

NurseClick is the Australian College of Nursing's monthly e-zine focusing on topical articles related to nursing practice, policy developmen...

NurseClick June 2016  

NurseClick is the Australian College of Nursing's monthly e-zine focusing on topical articles related to nursing practice, policy developmen...