NurseClick DECADES OF LEADERSHIP COGNITIVE IMPAIRMENT NURSES AT WORK
Breast care nurses
IN THIS EDITION
IN FOCUS @ACN
In the news
Australian College of Nursing update
Breast care nurses
Adjunct Professor Kylie Ward FACN, ACN CEO
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IN FOCUS @ACN
IN FOCUS @ACN
Primary health care
Nurses at work
Decades of leadership
Mini field of women
Interview with an ENL
New codes of conduct for nurses and midwives
Adjunct Professor Kylie Ward FACN, CEO of ACN
Welcome to the October edition of NurseClick. Breast cancer is the most common cancer among Australian women. To coincide with Breast Cancer Awareness Month this October, we feature a number of insightful articles in NurseClick that explore the vital role nurses play in providing essential care, compassion and support to patients diagnosed with this debilitating disease. At the Australian College of Nursing (ACN), we offer a Graduate Certificate in Breast Cancer Nursing that fosters the clinical knowledge and expertise of the nursing workforce to ensure the provision of high-quality, evidence-based breast cancer care. Through critical analysis and reflection, our postgraduate course aims to enhance professional and ethical understanding of clinical practice development for the improvement of patient outcomes. Breast cancer nursing is an extremely rewarding and fulfilling career path that presents numerous opportunities for personal and professional growth. In our feature article this month, we asked some of our dedicated tutors and students to reflect on their experiences studying and working in this growing area of nursing practice. In another interview with one of our passionate Emerging Nurse Leaders, Hollie Jaggard MACN, we explore the diverse possibilities available for early career nurses within our profession. Reflecting on her studies and practice, Hollie encourages nurses to embrace continuous learning and consider pursuing a career in clinical nursing research.
In an intriguing doctoral study on a new conceptual framework, Dr Irwyn Shepherd FACN, perfectly outlines the importance of nursing research to enhance health care delivery. Through a detailed analysis of the design and outcomes of his study, Irgyn ascertains that conceptual frameworks are an essential tool for the design, development and delivery of simulation-based activities in health care education. A second new care model and framework is thoroughly explored in an engaging research report written by Brendan Zornig MACN and Angelka Opie MACN. With a view to reduce the incidence and duration of in-hospital delirium, Brendan and Angela examine an alternative model of care for elderly patients experiencing cognitive impairment.
Publisher Australian College of Nursing Editors Sally Coen Olivia Congdon Karen Watts Design Nina Vesala Emma Butz Enquiries email@example.com Advertising firstname.lastname@example.org
© Australian College of Nursing 2017 The opinions expressed within are the authors’ and not necessarily those of ACN or the editor. No part of this publication can be reproduced without permission from ACN. Information is correct at time of print.
Dr Tracey McDonald AM FACN is a nurse leader who has made a significant contribution to aged care, education and health throughout the course of her distinguished career. In a tribute to Tracey upon her retirement, we celebrate her decades of leadership and extensive contributions to our organisation, before and after unification.
All files marked ‘Stock photo’ or credited to iStock or ThinkStock are representative only and do not depict the actual subjects and events described in the articles.
Nancy Bundle AM FACN is another one of our talented Fellows who has shown remarkable leadership in her field of study. In an informative review and extract from her recently published book, Nurses at Work: A history of industrial and occupational health nurses in New South Wales, we celebrate and acknowledge Nancy’s dedication to preserving our professional history.
ACN publishes The Hive, NurseClick and the ACN Weekly eNewsletter.
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In the news national Australian governments urged to act on UN report
Scientists discover a strong link between Alzheimer’s and eye disease A team of Sydney scientists have discovered a strong link between Alzheimer's disease and glaucoma, which causes blindness. This new-found link may help researchers develop tests for early diagnosis and better treatments. Read more
Mum's asthma and allergies linked to autism Australian researchers have found a link between chronic asthma or allergies during pregnancy and the severity of autism symptoms in children. A retrospective study of 220 children published in Molecular Psychiatry, explored the relationship between a mother's immune history and autism spectrum disorder, led by researchers at the University of Sydney in partnership with the Telethon Kids Institute. Read more
'Revolutionary' super glue could treat wounds in car crashes and war zones Australian researchers have developed a new superglue-like substance that can be squirted onto wounds — even internal ones — to seal them within seconds, potentially revolutionising treatment in war zones and at the site of car crashes.
The Close the Gap Campaign urges all governments to prioritise Aboriginal and Torres Strait Islander health with long-term and sustainable commitments that address the endemic challenges to health equality.
The Close the Gap Campaign has recently urged Australian governments to act on the recommendations of the United Nations Special Rapporteur on the Rights of Indigenous Peoples.
Gardasil vaccine soon to be free for 12 and 13 year olds Prime Minister The Hon Malcolm Turnbull MP has announced that an improved version of the cervical cancer vaccine will be free to all 12 and 13-year-old students from next year.
The gel works like the regular bathroom sealant commonly used for tiling, but is made from a natural elastic protein.
The Gardasil vaccine was first introduced to students in 2007 to help protect against some strains of the human papillomavirus.
ACN Fellow and Member awarded Fellowship for the American Academy of Nursing
Professor Sandy Middleton FACN and Professor Wendy Chaboyer MACN were recently inducted as Fellows of the American Academy of Nursing in a ceremony held on Saturday 7 October in Washington DC.
Tech Connect supports elders in aged care to stay meaningfully connected
For overseas applicants, one of the criteria for Fellowship is membership of your national peak professional body. ACN would like to take this opportunity to congratulate Sandy and Wendy on this significant professional achievement that acknowledges nurse leaders in education, management, practice and research.
Imbruvica for leukaemia patients to be added to the PBS The Federal Government will subsidise costs of a new cancer-fighting medicine to help ease the financial strain for leukaemia patients in Australia. Imbruvica is a tablet for patients living with the most common form of leukaemia, chronic lymphocytic leukaemia, and will be added to the Pharmaceutical Benefits Scheme (PBS) from December 1. Read more
A new guide for aged care organisations was recently launched by Meaningful Ageing Australia. Tech Connect: Staying Meaningfully Connected in Aged Care, supports aged care residents’ spiritual wellbeing by connecting them with loved ones using technology and social media. Read more
Morning sickness a worry for dads too Morning sickness is not only debilitating for many pregnant women, but can also make expectant dads more anxious, researchers have found. A survey of 300 Australian dads-to-be showed anxiety levels were significantly higher among those whose partners battled moderate morning sickness, or the more severe hyperemesis gravidarum. Read more
In the news world Sequencing test enables precise identification of drug-resistant TB
Two recent studies have documented how a new advanced genetic sequencing approach can help thwart the growing worldwide threat posed by drug-resistant mutations of tuberculosis (TB).
Gene test 'narrows down breast cancer risk'
Bananas, and avocados could reduce heart disease
Vitamin D â&#x20AC;&#x2DC;could ease asthma attack riskâ&#x20AC;&#x2122;
A gene test informing women how likely they are to develop breast cancer could soon be used on high-risk groups.
Bananas and avocados may bolster your arteries and protect against heart disease, research suggests.
A new study has revealed Vitamin D could help reduce the risk of asthma attacks.
The Manchester researchers behind the test said it could reduce the number of women having surgery to remove their breasts, by narrowing down their risk.
Both may prevent hardening and narrowing of the arteries, a condition known as atherosclerosis, because they are rich in potassium, scientists believe.
Taking the common supplement on top of standard medication led to a 30% reduction in the rate of asthma attacks requiring treatment, the review conducted by British scientists and published in The Lacet Respiratory Medicine found. Read more
Skipping breakfast linked to poorer heart health, research reveals
Researchers to test universal flu vaccine they hope will provide better and longer-lasting protection
Bright light therapy at midday may help patients with bipolar depression
New research has found foregoing a decent feed first thing in the morning is associated with poorer heart health.
A seasonal flu vaccine that would be the world's first to fight all types of the virus is to be tested in a two-year clinical trial involving more than 2,000 patients by researchers in England.
Daily exposure to bright white light at midday significantly decreases symptoms of depression and increases functioning in people with bipolar disorder, a recent study found.
The so-called universal vaccine was developed by Oxford University's Jenner Institute and Vaccitech, a spin-out biotech company founded by Jenner scientists.
More than 68% of patients who received midday bright light achieved a normal level of mood, compared to 22.2% of patients who received a dim placebo light.
The overseas study of more than 4,000 adults found those who skipped breakfast were 2.5 times more likely to have plaque build-up in the arteries. Read more
The threat of TB is increasing in some places as mutant versions of the disease become more and more resistant to current drug treatments. Read more
First study to find link between testosterone and stock market instability New evidence suggests biology strongly influences the behaviour of professional stock market traders. According to a new US study, this could be a significant contributor to fluctuations in the market, as high testosterone levels can cause traders to overestimate future stock values and change their behavior, leading to dangerous price bubbles and subsequent crashes. Read more
Home-brewed poppy seed tea can be lethal A home-brewing technique used to extract morphine from unwashed poppy seeds can produce lethal doses of the drug, according to research at Sam Houston State University. Read more
Australian College of Nursing update Cover doesn’t always mean protection. Find out more Nurses support equality On World Mental Health Day, ACN acknowledged the impact that the current debate on marriage equality has on the mental health of the lesbian, gay, bisexual, transgender, queer or questioning, and intersex (LGBTQI) community. “ACN strongly supports equality for all. It is a fundamental human right and we condemn any kind of discrimination, be it on the basis of race, religion, ethnicity, sexual orientation, gender or disability,” said ACN CEO Adjunct Professor Kylie Ward FACN. There is a clear link between mental health and equality. People who identify as LGBTQI have the highest rates of suicide and significantly poorer mental health outcomes than the wider population. It has been shown that implementation of same-sex marriage policies is associated with a significant decrease in the proportion of high school students attempting suicide, as well as improving overall health outcomes and reducing health costs of the LGBTQI community. Read our media release.
ACN CEO recognised for contribution to nursing
Inaugural National Regulation Seminar
On Friday 29 September, ACN CEO Adjunct Professor Kylie Ward FACN was presented with the 2017 Australian Capital Territory Telstra Business Women’s Award for the Purpose and Social Enterprise Category.
On Wednesday 15 November, the inaugural National Regulation Seminar and Dinner will be hosted by ACN and the Nursing and Midwifery Board of Australia (NMBA).
Kylie received this award as recognition for her invaluable contribution to our profession and tireless commitment to our organisation. This award was very well deserved and a tribute to all that she has achieved for nurses throughout her distinguished career. The Purpose and Social Enterprise award acknowledges female business leaders who strive to bring positive social or environmental change within our society. Kylie was named the Purpose and Social Enterprise state-category winner because of her determination to drive change across the Australian health care system. We would like to take this opportunity to congratulate Kylie on this significant professional achievement.
The seminar will feature a keynote presentation by the United States National Council of State Boards of Nursing (NCSBN) Chief Executive Officer Dr David Benton. Dr David Benton will be joined by NMBA Chair Associate Professor Lynette Cusack MACN, ACN President Professor Christine Duffield FACN, Australian Health Practitioner Regulation Agency (AHPRA) Chief Executive Officer Martin Fletcher and Commonwealth Chief Nursing and Midwifery Officer Adjunct Professor Debra Thoms FACN (DLF) for a panel discussion. This event will provide all those in attendance with an opportunity to have their say on nursing regulation and enjoy networking with nurse leaders from around the country. Watch this space for photos and an overview of the seminar in the next edition of NurseClick.
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Breast care nurses During Breast Cancer Awareness Month, we asked one of our tutors and some of our students about their experiences in this field of nursing practice…
MICHELLE ROSANO, MCGRATH AND BREAST CANCER INSTITUTE BREAST CARE NURSE, NSW
MELISSA GOSPER, MCGRATH BREAST CARE NURSE, VICTORIA How did you get started as a breast care nurse (BCN)? I had been working as a registered nurse for over 20 years and an opportunity presented itself to provide roster relief for our breast care nurses. At first, I was a little apprehensive about taking on the role but after a week on the job, I knew this was going to become a future career for me. What do BCNs do? Our role involves planning, coordinating and providing advanced breast care knowledge, education and support to those diagnosed with breast disease as well as their families and carers.
What do you enjoy about your role? Being able to minimise the stress and trauma of a breast cancer diagnosis through education and support. As a McGrath nurse, I am very passionate about increasing the awareness of the importance of early detection. What is the one thing you wish you knew before you started working as a BCN? I wish I had known that being a breast care nurse is an incredibly special role and regret not becoming one sooner! How has studying with ACN helped you? Completing the breast care course through ACN has helped me to be a wonderful support to those under my care, as I am able to provide them with up-to-date, relevant, evidence-based information. The course allows you to interact with fellow students and share knowledge and experiences.
I have met some amazing, like-minded nurses as a result. Returning to formal study after many years was a little daunting but the staff at ACN are incredibly supportive and always there to lend a hand when needed. What would be your advice to someone wanting to work as a BCN? Just enrol! I am currently working as a McGrath breast care nurse in rural Victoria as a result of completing the course! I remember reading words of encouragement in one of the text books that stated, “As breast care nurses, we have the power to save a person from giving in to the disease with our encouragement, patience and support,” and those words have stayed with me. Being a breast care nurse is a privilege and an extremely rewarding career.
I am the McGrath and Breast Cancer Institute (BCI) BCN for the Blacktown and Mt Druitt area in Western Sydney. I work out of both hospitals and cover patients through BreastScreen assessment, diagnosis, surgery, chemotherapy, radiotherapy, survivorship and palliative care. I work with patients who have early breast cancer, as well as those with a metastatic diagnosis. It is a challenging but also very rewarding role. How did you get started as a BCN? I actually fell into the BCN role. I have always worked in oncology nursing but originally started in paediatric oncology. I loved it but found shift work difficult to juggle after having my own children. There was a position advertised at the Breast Cancer Institute, so I thought I would apply and I was lucky enough to get the position!
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That was at the end of 2014 and I haven’t looked back. It was definitely a challenge going from paediatric to adult nursing and from a ward to a clinic environment, but I have really enjoyed it. I have now moved into the role of McGrath BCN for the Blacktown/Mt Druitt area and love the challenge of setting up a new role in a relatively new cancer center. What do BCN’s do? In short we provide physical, emotional and psychosocial support to women and men with a breast cancer diagnosis, as well as their families, but it is so much more than that. We educate and empower our patients to make treatment decisions. We encourage them throughout the treatment trajectory. We ensure the multidisciplinary team (MDT) are aware of each individual’s needs and do our best to ensure these are met. We translate the information so it is easily understood by all involved. We are a familiar face in a foreign environment. We also provide education and leadership to other staff around the care of our patients. What do you enjoy about your role? I enjoy the variety my role gives me. It isn’t just about those with a cancer diagnosis. My role starts at a BreastScreen assessment clinic, so I am involved in the diagnostic process, which requires a different skill set. Not everyone who comes through the BreastScreen door will be given a cancer diagnosis, but they all come through with the same high levels of anxiety and fear. I then follow patients through their treatment and guide them into survivorship or support them through the metastatic phase. I also do some breast awareness with local community groups, which I really enjoy. The thing I enjoy most about my role is the rapport I build with my patients and their families. I meet them at a highly vulnerable time in their lives and it is a privilege to be a part of this.
What is the one thing you wish you knew before you started working as a BCN? How different every BCN role is! I came into my current role with an idea based on what I had done at the BCI and it is very different. Location-wise there is not a huge difference, but the needs of my patients and the service is different to those at the BCI. The BCN role is one that needs to be flexible and adaptable. The basic principles are the same, but it is how these principles are applied to the specific service and patient population that changes. Why do you work with ACN as a tutor? I have been involved in nursing education for several years as a clinical nurse educator and then as a casual academic at the University of Technology, Sydney. When I took on the McGrath BCN role, I was unable to continue teaching in the formal sense. I jumped at the chance to work with ACN because it allows me to combine two of my passions – oncology nursing and nursing education. It also means I have to keep up-to-date with current research. I believe you never stop learning and as nurses, whether it is as a BCN or any other nurse, it is important that we ensure we actively pursue education opportunities at every chance we get. We owe it to ourselves and those we care for. What would be your advice to someone wanting to work as a BCN? Meet with your local BCN and have a chat. Look at doing some relief when they are on leave to get a feel for what is involved and if it is something you can see yourself doing. If you are in a surgical or medical oncology field, see if you can care for some breast cancer patients to help get an understanding of the different treatment options and the implications these can have. Do some study in the field (at ACN!). Give it a go. If it is something you are interested in you have nothing to lose!
ERIN PRIMMER, MCGRATH BREAST CARE NURSE, VICTORIA I am a McGrath Breast Care Nurse in Albury/Wodonga. In this role, I support men and women through their diagnosis, surgery and treatments of breast cancer. We are a free service for which patients and families can self-refer and we are available for information and guidance as well as referrals. How did you get started as a BCN? I was looking for a change in my career after working in the operating theatre. I was watching an interview with the McGrath Foundation at the cricket, when I decided to do some enquiries and enrolled into the introduction course for breast care through LaTrobe University. After this, I gained employment as a breast care nurse at my local AHS. What do BCNs do? BCNs play a supportive role, assisting women, men and their families through a breast cancer
diagnosis and the relevant treatments. They offer support, information and referrals to relevant services along the way. What do you enjoy about your role? I have really enjoyed getting to know so many amazing people and their families; their strength and resilience is incredible. I feel very privileged to be a part of their life journey which just happens to include breast cancer. How has studying with ACN helped you? Undertaking the graduate certificate with ACN has been seamless; all the behind the scenes work they do to make the course run so well is great. It meant I could focus on the course work without the extra hassles that often go with tertiary institutions. Support from tutors is always available and the flexibility of studying online really suited me being a regional student; it meant I could continue to work and be at home with my young family. What would be your advice to someone wanting to work as a BCN? Make the enquiry, you won't regret it; it is a very rewarding career.
“Support from tutors is always available and the flexibility of studying online really suited me being a regional student; it meant I could continue to work and be at home with my young family.”
Specialise with ACN Graduate Certificate in Breast Cancer Nursing
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ACN’s Graduate Certificate in Breast Cancer Nursing instils a professional and ethical understanding of clinical practice development into our students, resulting in improved outcomes for patients. It responds to industry requirements by preparing graduates for specialist breast cancer nursing roles within the wide scope of breast cancer care. The ability to choose electives allows students to further explore a specific area of interest related to breast cancer nursing. ACN has proudly been providing education to McGrath Foundation nurses since 2013 through this course. Career opportunities may include: • Clinical education roles • Management roles • Specialist nursing roles COURSE OVERVIEW The course aligns with the Specialist Breast Nurse Competency Standards, associated educational requirements and the National Educational Framework for Cancer Nurses. The Graduate Certificate in Breast Cancer Nursing focuses on the continuum of breast cancer care, evidence-based practice, future trends and the impact of breast cancer on individuals, their families and communities.
LEARNING OUTCOMES This course enables students to:
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• Demonstrate a specialist knowledge base within breast cancer nursing • Develop specialist clinical practice and advance their clinical decision making skills
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• Engage in and maintain effective therapeutic relationships • Implement professional, educational and leadership skills to provide support for other clinicians and contribute to patient care
to draw on the knowledge of an experienced, high calibre nurse leader.
• Critically analyse current literature and nursing practice to provide evidence-based contemporary care • Reflect on personal and professional values and attitudes in relation to the care of patients with breast cancer and their families and carers.
Further information, including the units offered and key dates, can be found on our website.
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Cognitive impairment Making change happen for a new model of care By Brendan Zornig MACN and Angelka Opie MACN
Introduction Up to 50% of all elderly inpatients in Australian hospitals have some form of cognitive impairment, and these patients Brendan Zornig are at the greatest MACN and Angelka risk of developing Opie MACN in-hospital delirium. General medical ward patients in Australia are known to have delirium at the time of admission in 15â&#x20AC;&#x201C;20% of cases, and an additional 5â&#x20AC;&#x201C;40% of patients develop delirium during their hospital stay (Australian Commission on Safety and Quality in Health Care, 2016). Cognitively impaired patients, particularly those with delirium, are at significantly increased risk of adverse events whilst in hospital, including functional and cognitive decline, medical and surgical complications, and medication incidents. In many cases these events result in prolonged length of hospital stay, and in some cases mortality (Australian Commission on Safety and Quality in Health Care, 2016; National Institute
for Health and Care Excellence, 2014). Delirium can be prevented or shortened in duration by providing appropriate care of patients with cognitive impairment. The purpose of this paper is to describe a model of care change that aimed to improve the care provided to cognitively impaired patients in a general medical ward setting. Background The previous practice for caring for cognitively impaired patients in this particular ward was to provide a nurse special, which involved an assistant in nursing (AIN) or enrolled nurse (EN) staying one-on-one with each cognitively impaired patient. These nurse specials were in addition to the routine ward staffing. The rationale for this strategy was to prevent cognitively impaired patients from climbing out of bed, wandering and falling. Often, due to staffing limitations, up to four patients would be co-located in one room so that they could be specialled by one or two nurses, rather than a ratio of one-to-one. The strategy of co-locating patients for specialling required unnecessary bed moves, and contributed to a chaotic environment, which may cause
sensory overload for the cognitively impaired patients, and exacerbate delirium and agitation (Australian Commission on Safety and Quality in Health Care, 2016). There were no specific criteria for inclusion of patients into the specials model; it relied on the clinical judgement of the ward shift coordinators and the nurses caring for the patient. Often these decisions were made based on feedback from the AIN specialling the patient. The absence of specific criteria defining requirements for specials contributed to delays in specials being ceased, and potential overuse of specials. In general, patients that were specialled experienced cognitive impairment, impulsive behaviour, high risk of falling and were unable to use the nurse call bell system to request assistance prior to mobilising.
Analysis of the wardâ&#x20AC;&#x2122;s clinical incident data between January 2015 and July 2016 concurred with the widely-acknowledged evidence that cognitively impaired patients are at greater risk of adverse events whilst in hospital, and also indicated that the specialling model was not effective in reducing this risk. For example, of a total of 101 falls occurring in the in-patient ward between January 2015 and July 2016, 60 (59.4%) were patients being specialled (see Figure 1 on the next page). Additionally, during the same time period, a total of 10 patients had multiple in-hospital falls in the ward and eight (80%) of these patients were being specialled. Also in this ward during this time period, were a total of 87 hospital-acquired pressure injuries, of which 64 (73.6%) were being specialled (see Figure 2 on the next page). During this time period, a total of 37
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Figure 1: In-hospital falls, January 2015 – July 2016
patients in the ward had more than one pressure injury, and of these patients, 29 (78.4%) were being specialled. This analysis was supported in the literature (Australian Commission on Safety and Quality in Health Care, 2016; National Institute for Health and Care Excellence, 2014). The use of one-on-one specials was a very resource-intensive model. From January to July 2016 this ward used a monthly average of 13.1 FTE of nursing staff for specials (see Figure 3). These staff members were almost exclusively provided from the casual pool. Based on the cost of permanently-appointed enrolled nurses, monthly expenditure for specials in this ward averaged $93,902, and the total cost was $1,265,249 for the 2015-2016 financial year. As this estimate is based on permanently-appointed employees, it is an under-estimate of the actual cost, as a large proportion of casual staff members were used, which is a premium cost. Using such a large amount of casual staff members for routine care on a daily basis also had severe implications for the entire hospital, as there were
Figure 2: Hospital-acquired pressure injuries, January 2015 – July 2016
less casual staff members available to replace sick leave and fill gaps in areas of need. Use of casual staff members to care for this cohort of patients also had the disadvantage of exposing the patients to a large variety of unfamiliar people, which is known to contribute to delirium in cognitively impaired patients (Australian Commission on Safety and Quality in Health Care, 2016).
• Assessment and screening for delirium and risk factors
• Elimination strategies
This data demonstrated that the one-on-one model of care was not meeting the needs of the patients, and as a result the incidence of adverse events for those patients was alarmingly high. Therefore, with the intention of formulating a new model of care to improve outcomes for the large cohort of cognitively impaired patients, a review of contemporary literature was conducted. This literature review revealed a variety of strategies for caring for cognitively impaired patients and reducing delirium, which were not being consistently utilised in the specials model. These strategies included:
• Hydration and nutrition
• Activities for stimulating cognition • Mobilisation and exercises • Involvement of carers and family in care • Clear communication with the patient, family and carers
• Pressure injury prevention strategies (Australian Commission on Safety and Quality in Health Care, 2016; Avendano-Cespedes et al., 2016; Chong et al., 2011; Eeles et al., 2013; Godfrey et al., 2013; Holly et al., 2013; Mudge et al., 2012; National Institute for Health and Care Excellence, 2014; Royal College of Nursing, 2010; Siddiqi et al., 2016).
• Minimising infection risk
Considering these strategies, a new model for caring for cognitively impaired patients in the ward was developed and implemented. This new model involved the implementation of two new strategies:
• Reducing polypharmacy and medications that are risk factors for delirium
1. Criteria for patients requiring one-on-one special
• Ensuring adequate oxygenation
2. Cognitive impairment rounding.
• Sensory input and reduce sensory overload
As the provision of a one-on-one special was not achieving optimal outcomes for cognitively impaired patients, specials were limited to the following criteria:
• Fall prevention strategies
• Required under the Mental Health Act
• Pain assessment and pain relief • Regular reorientation and reassurance
• Required based on clinical acuity due to critical condition
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Figure 3: Total hours and FTE required for specials, per month
â&#x20AC;˘ Extreme cases of wandering, posing an immediate safety risk to themselves or others. Patients who would previously have been specialled who did not meet the new criteria were managed using cognitive impairment rounding. This involved one enrolled nurse per shift allocated to implement structured rounding on up to six patients identified to have or be at risk of having delirium. This resource was in addition to the normal workload allocation of the ward nursing staff, as the one-on-one specials model had been. The sole purpose of this model is to ensure these strategies are carried out with 100% reliability, as this was previously not occurring. To achieve the cognitive impairment rounding model, 4.42 FTE of enrolled nurses in addition to the existing ward roster was required. Staff members recruited to fulfil this role were absorbed into the ward roster to enable a large pool of approximately 10-15 nurses who could be rotated through being allocated for cognitive impairment rounding on a shift-by-shift basis. The purpose
of this rotation was to give all interested staff members the opportunity to participate in the model, as well as to prevent burnout and maintain the general nursing skillset by enabling staff members to provide care for all patients in the ward. All staff members were provided training on caring for patients with cognitive impairment via online modules, and the specific cohort of staff who would be conducting the rounding were invited to attend a cognitive impairment rounding workshop, which provided detailed education on the strategies for preventing delirium and the specifics of the new model of care. Outcomes Implementation of the cognitive impairment rounding model resulted in significant improvements in both patient outcomes and efficiency. Comparing the six months immediately prior to the intervention to the six months following, substantial improvements have been made in hospital acquired pressure injuries, falls and nursing hours per patient per day (HPPD).
Figure 4: Falls, hospital-acquired pressure injuries (HA PIs) and nursing hours per patient per day (HPPD), pre- and post-intervention
Hospital acquired pressure injuries were reduced by 58.98%, falls were reduced by 29.79%, and HPPD were reduced by 11.15% (see Figure 4). Conclusion In conclusion, this paper has described the development and implementation processes for an alternative model for caring for patients with cognitive impairment aiming to reduce the incidence and duration of delirium by implementing specific evidence-based strategies within a general medical ward setting. This model has resulted in significant improvements to clinical incident data, including reductions in hospital acquired pressure injuries and falls, and has also improved efficiency by reducing nursing HPPD. In addition, this project has reinforced the importance of constant review of clinical practice against the latest evidence, as historical practice may not always be the best for patients.
References Australian Commission on Safety and Quality in Health Care, 2016. Delirium Clinical Care Standard, Sydney: ACSQHC. Avendano-Cespedes, A. et al., 2016. Pilot study of a preventive multicomponent nurse intervention to reduce the incidence and severity of delirium in hospitalized older adults. Maturitas, Volume 86, pp. 86-94. Burns, K., Jayasinha, R., Tsang, R. & Brodaty, H., 2012. Behaviour management: a guide to good practice. University of New South Wales: Dementia Collaborative Research Centre - Assessment and Better Care (DCRC-ABC). Chong, M. et al., 2011. A new model of delirium care in the acute geriatric setting: Geriatric Monitoring Unit. BMC Geriatrics, 11(41). Eeles, E., Thompson, L., McCrow, J. & Pandy, S., 2013. Management of delirium in medicine: experience of a close observation unit. Australasian Journal on Ageing, 32(1), pp. 60-63. Godfrey, M. et al., 2013. Developing and implementing an integrated delirium prevention system of care: a theory driven, participatory research study. BMC Health Services Research, 13(341). Herr, K. et al., n.d. Pain assessment in the nonverbal patient: Position statement with clinical practice recommendations. American Society for Pain Management in Nursing. Holly, C., Cantwell, E. & Kamienski, M., 2013. Evidence-based practices for the identification, screening and prevention of acute delirium in the hospitalized elderly: an overview of systematic reviews. Current Translational Geriatrics and Gerontology Reports, Volume 2, pp. 7-15. Mudge, A., Maussen, C., Duncan, J. & Denaro, C., 2012. Improving quality of delirium care in a general medical service with established interdisciplinary care: a controlled trial. Internal Medicine Journal, 43(3), pp. 270-277. National Institute for Health and Care Excellence, 2014. Delirium in adults: quality standard. [Online] Available at: http://nice.org.uk/guidance/qs63 Royal College of Nursing, 2010. Improving quality of care for people with dementia in general hospitals. United Kingdom: Royal College of Nursing Publishing Company. Siddiqi, N. et al., 2016. Interventions for preventing delirium in hospitalised non-ICU patients (review). Cochrane Database of Systematic Reviews, Issue 3.
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Research outcomes A Conceptual Framework for Simulation in Healthcare Education Dr Irwyn Shepherd FACN Recipient of the 2014 Florence Nightingale Memorial Scholarship
Dr Irwyn Shepherd FACN
The following report outlines, the reasons for, and outcomes of, a doctoral study. The purpose of the research was the development of a Conceptual Framework for Simulation in Healthcare Education. The central tenet of
the study was that conceptual frameworks are an essential tool for the conceptualising, designing, developing and delivery of simulation-based activities in health care education. The research, inclusive of the rationale behind it, was about the design, strategies and processes that were undertaken to determine whether or not there was evidence of conceptual frameworks cited in the simulation literature. The study, in part, evolved from the researcherâ&#x20AC;&#x2122;s early identification of varying levels of atheoretical
simulation-based course development, along with the reinforcing requests by simulation leaders in the literature for further research into the underpinning education theories that support simulationbased education (Issenberg et al., 2011). Other publications supported the need for the study (Harris et al., 2013; Kaakinen & Arwood, 2009; Murdock, 2012; Rourke et al., 2010). The initial activity involved an extensive search, review and evaluation of the international simulation literature. This entailed the identification of the
current number of conceptual frameworks and theoretical models cited in the literature, which inform and guide simulation interventions; then identifying whether or not those conceptual frameworks and theoretical models actually did guide the design, delivery and evaluation of simulation interventions. The literature indicated that while a number of frameworks existed, evidence of their educational impact was not well demonstrated.
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Data gathering by a questionnaire targeting a random selection of simulation centres world-wide was subsequently undertaken to identify whether or not there was evidence of conceptual frameworks being currently employed in key simulation centres throughout the world. The review of the literature and the data demonstrated the need for such a conceptual framework and contributed to the design of a draft conceptual framework that required peer review. A modified Delphi technique was then employed to ascertain the views of a cohort of simulation experts about the structure and utility of a conceptual framework. The model that has emerged as a distillation of the findings of the study is the Conceptual Framework for Simulation in Healthcare Education. The study design produced rich data that answered the research questions and supported the aims of the study. There was enough information assembled from the literature, extracted from the questionnaires and collated from the expert critiques to prescribe that there was, and there remains a need for, a Conceptual Framework for Simulation in Healthcare Education.
The conceptual framework model, is web-based and can be accessed via personal computer, laptop, tablet or mobile phone. Using a recurring set of questions embedded in each theory presentation, it encourages the user to consider the use of a number and mix of education theories and models when designing, delivering and evaluating a simulation activity. Activity templates are also presented. Further research to extend the findings of this study is planned. First there will be a period of conceptual framework modification and development of application processes required, followed by a period of beta-testing to evaluate all aspects. Then there will be further ongoing research and development requirements to ensure this technology-driven tool will contribute to simulation-based education in health care – and beyond.
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Figure 1: C onceptual Framework for Simulation in Healthcare Education
References: Issenberg, B. S., Ringsted, C., Østergaard, D., & Dieckmann, P. 2011, Setting a research agenda for simulation-based healthcare education: A synthesis of the outcome from an Utstein style meeting. Simulation in Healthcare, 6, p.155–167.
Murdock, N.L. 2012, Systematic literature review: A best practices review of simulated education approaches to enhance collaborative healthcare, MSN Thesis, University of British Columbia, Okanagan, Canada.
Harris, K.R., Eccles, D.W., Ward, P., & Whyte, J. 2013, A theoretical framework for simulation in nursing: Answering Schiavenato’s call. Journal of Nursing Education, 52(1), p.1-16.
Rourke, L., Schmidt, M., & Garga, N. 2010, Theory-based research of high fidelity simulation use in nursing education: A review of the literature. Int J Nurs Educ Scholarsh, 7, Article11.
Kaakinen, J., & Arwood, E. 2009, Systematic review of nursing simulation literature for use of learning theory. Education faculty publications and presentations. Paper 6.
Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/20361859
Access free webinars to learn how to use some of the excellent research resources ACN membership offers. EBSCO Discovery Service Webinar recording and PowerPoint now available Nursing Reference Center Plus Register for the live webinar from 2.30pm–3.30pm on 8 November or access a recording at a later time Click here to find out more
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Primary health care The glue that binds communities together By Rebecca Rendalls MACN
As I looked at the nurses’ appointment book I knew that this was going to be a mixed day of adventure. From the phlebotomy collections, the driver’s licence renewal health assessment with an electrocardiography, chronic Rebecca Rendalls disease health assessments, MACN Aboriginal and Torres Strait Islander and age specific health assessments, spirometry, wound dressings, diabetes education and even to the first vaccinations for an eight week-old baby; a feeling of excitement washed over me. Today, I was going to work with and alongside the citizens, their families/carers and significant others from our local rural community and engage with them to offer continued support, guidance and services to promote their physical and mental health. As the day progressed and the dressing was removed from a chronic wound, signs of new granulation were a welcome sight. We both smiled and the elderly lady warmly squeezed my hand and said, “thank you”! We had been working together to get to this stage for weeks
now and not only was her body slowly healing; we had kept her from a hospital admission. Although the baby cried, her face soon filled with a toothless smile and her mother sighed with relief feeling reassured that the immunisations just administered would not only protect her daughter’s health but also that of her family and the wider community as a whole. As the practice door closed behind the last patient, I reflected on the positives of the day and realised again with pride that I had contributed as part of our small general practice team to the continuing improvement in health and welfare of our local community. Primary health care (PHC) is about having a genuine interest for each patient’s unique holistic health care needs and wants, and using innovation to utilise available resources to meet these; thus strengthening the ongoing bond-building with our patients and community as a whole. PHC is the glue that binds communities together and the foundational stone from which the physical and mental health and wellbeing of local populations can grow and flourish. For me, being a practice nurse isn’t just a job; it’s a privilege and my passion. EDITOR’S NOTE Rebecca’s story was originally published in our 2017 Community and Primary Health Care Nursing Week eBook. Visit our website to read the entire eBook.
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Nurses at Work
A history of industrial and occupational health nurses in New South Wales Occupational and industrial nursing has a fascinating history, as Nancy Bundle AM FACN and Jim Katay outline in their book, Nurses at Work: A history of industrial and occupational health nurses in New South Wales. It takes us through the history of nurses working from 1911 onwards, who were employed to protect and maintain workers’ health. “The role of the nurse in industry was markedly different to that of nurses engaged in hospitals, for three important reasons. First, a large percentage of the occupational health (OH) nurses were the only nurse on site. Second, in most cases there was not a medical officer at the workplace, rarely was there one full-time, sometimes one attended part-time such as one
hour a day or one day per week. Third, unlike hospitals, the primary objective of the OH nurse’s employer was the production of goods or services rather than providing health care. As discussed in earlier chapters, the OH nurse’s role was truly primary health care. It was unique, because the nurse, unlike most other nurses and doctors in society, could follow the course of the worker’s progress on a day-to-day basis. The nurse was in a position over time to know each worker and his or her work and social situation. Where the nurse was a sole practitioner her reputation was gained by her personal effectiveness and professionalism. Many nurses entered industry because they were attracted by the opportunity to manage their service.”
This extract is from pg. 139 of Nurses at Work by Nancy Bundle AM FACN and Jim Kitay
Published by NSW Nurses and Midwives Association, 2017: http://www.nswnma.asn.au/history-ofoccupational-health-nurses/
Decades of leadership Dr Tracey McDonald AM FACN
ACN would like to pay tribute to an exceptional leader in our profession, Dr Tracey Thérèse Anne McDONALD AM FACN GAICD RN., PhD., MSc(Hons)., BHA., Dip.N.Ed., RM, upon her retirement.
Dr Tracey McDonald AM FACN is a highly valued Fellow and extremely influential nurse leader who has made an enormous contribution to both our profession and organisation throughout her distinguished career spanning across the health, education, nursing and aged care industries.
Nurses’ Association. Tracey is a Professor of Ageing at the Australian Catholic University and Visiting Professor at the Wuhan University in China, focusing on older adults and life quality. This has seen her complete research and publish on Chinese issues around ageing, policy and practice.
Tracey has extensive professional qualifications and broad knowledge of health services, management, nursing, ageing and social issues, which have informed her influential work on clinical outcomes, management, and national and international policy relating to health concerns and late age. Through her work as a world expert with the United Nations on policy issues around social inclusion, human rights, equity and a global society for all ages, she has played a role in triggering the process of developing a UN convention on the Rights of Older People.
Tracey’s current role is as the Professor and RSL LifeCare Chair of Ageing. In this position, she has been working on clinical and management research in the broader field of ageing, exploring areas of interest involving clinical nursing outcomes, veteran health, quality management, mental health, dementia, mobility, wellness, informatics in aged care environments, and policy development around funding and quality for residential and community‐based aged care.
During the course of her career, Tracey has been an active member of the professional nursing community and held several senior leadership positions. She has worked across all levels of management, policy development and review, clinical nursing, midwifery, health services, professional education and clinical research. This has included working as the Manager of Research, Policy and Professional Services at the Aged Care Association, Australia, as the Management Consultant of the Australian Nursing Homes and Extended Care Association (NSW), and as the Manager of Professional Services for the NSW
Throughout her career, Tracey has led and contributed to numerous research and policy development projects, studies, reports, reviews and submissions. She has also delivered a large number of conference presentations, published work in copious academic journals and been actively involved in the development and review of curricula and management systems for nursing and health science fields to support high standards of teaching and assessment of clinical proficiency. Furthermore, Tracey has travelled extensively to share her knowledge and insights as an invited visiting scholar at numerous international universities and institutions around the world.
Tracey’s commitment to nursing has also been largely defined by her membership, leadership and contribution to a number of professional bodies, expert groups and networks nationally and globally. This includes a ministerial appointment to the National Lead Clinicians Group, as a research reviewer for the World Alliance for Patient Safety and an appointment to the NSW Ministerial Advisory Council on Ageing. She has also held several Board, editorial, advisory and honorary positions during her career. Tracey is currently a Director on the Salvation Army Board of Management, Honorary Treasurer of the Prince Henry Hospital Trained Nurses Association and a Justice of Peace in NSW, as well as a member of editorial boards for a number of highly positioned academic journals. In recognition of her significant professional accomplishments, Tracey has received various accolades and awards throughout her career. Most notably, in 2012, she was invested as a Member of the Order of Australia (AM) for her work in nursing, health and aged care, as well as national and international health and social policy. Tracey has a long and active history with ACN. She first joined the College of Nursing (TCoN) in 1977 and the Royal College of Nursing, Australia (RCNA) in 1984. She was a Fellow of both organisations before unification, and remains a Fellow of ACN to this day. Tracey has represented RCNA and ACN on a number of national and international professional bodies and
projects. This has included the International Council of Nurses 2009‐2013 Bank of Experts, the Australian Nursing and Midwifery Federation Staffing and Skills Mix Project, and the National Aged Care Alliance, for nearly two decades. Tracey has also made many other important contributions to our organisation, including collaborating with RCNA to set up a private practice model of nurse practitioner services for aged care in the ACT and delivering the Patricia Chomley Memorial Oration at the 2011 RCNA Annual Conference. Tracey has also been an assessor for the Department of Health and Ageing Aged Care Nursing Scholarships facilitated through RCNA, Chair for the RCNA Health and Wellbeing in Ageing Faculty, and Editor for ACN’s academic refereed journal, Collegian. Through her continued contributions, before and after unification, Tracey has played an integral role in establishing ACN as the national and pre-eminent leader of the nursing profession. We would like to thank her for playing such a key part in shaping the future of our organisation, look forward to her continued Fellowship and wish her all the best in the next stage of her life.
Mini field of Women Messages of love, support and solidarity Every day 42 Australian women learn they have breast cancer and seven will lose their lives to the disease. On Tuesday 31 October, we showed our support for the many Australians affected by breast cancer and the dedicated nurses who care for them, by holding a Breast Cancer Network Australia Mini-Field of Women event in our Canberra and Sydney offices. Mini-Field of Women events centre on an exhibition of 100 pink lady silhouettes planted in the ground or on display, and often include a simple ceremony. The 100 silhouettes symbolise the more than 15,000 Australian women diagnosed with breast cancer and the more than 3,000 women who die from breast cancer each year. Across both of our events, we displayed 200 silhouettes inscribed with messages of love and solidarity from our staff, Fellows, Members and the broader nursing community. Staff dressed up in pink and shared pink-coloured tasty treats in support of this important cause. Together, we raised awareness about breast cancer and paid tribute to the thousands of people in our profession and community affected by this debilitating disease.
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Breast cancer nursing – the nurse educator perspective By Musette Healey MACN This year in Australia, breast cancer is expected to be the most commonly diagnosed cancer affecting 17,586 women and 144 males (Cancer Australia, 2017). This equates to Musette Healey MACN 13% of all new cancer cases diagnosed and 28.4% of all new cancers in females (Cancer Australia, 2017). Australians have some of the highest survival rates in the world with a 90% chance of surviving at least five years post diagnosis. This means that the number of people in our communities who are living with a current or previous diagnosis of breast cancer is increasing; in fact, at the end of 2012 there were 193,730 people who had been diagnosed with breast cancer between 1982 and 2012 (Cancer Australia, 2017). In Australia, we are very lucky to have such high survival rates for breast cancer. Breast cancer is not the death sentence it once was. With the increase in survival rates however we have seen the development of a phenomenon known as the “survivor”. This has significant implications for the whole health care system because even though they are cancer free, their treatment can leave them with
multiple long term health issues, such as fear and anxiety, neuropathies, lymphedema, physical and mental scars. It can also have significant long term impacts on their families and carers. Breast care nurses (BCN) in Australia have a broad scope of practice which is influenced by where they are working and the needs of the community. But there is one thing that is consistent, the support that is provided to the patient and their family. The support takes a variety of forms; it could just be the reassurance of having a phone number they can call with questions, it may be practical support about what sort of bras they will need and where to get them from. It might be someone to talk to who is not emotionally involved, where they don’t need to censor themselves or worry about upsetting someone. It’s someone who understands that there will be good days and bad days, and that is ok. It might be someone to explain for the hundredth time what the doctors said last week or to give you tips on how to manage the nausea and fatigue you're experiencing, someone to hold your hand while you wait to have that first scan post treatment or hug you as you cry after your five year follow up scan is clear. Being able to provide this support requires a strong knowledge base because breast cancer is a hetrogenous disease; there are many subtypes and variations to treatments. Breast cancer treatment
is individualised to each patient, so while there are guidelines for treatments, changes are made to consider not only the pathology of the cancer but also the women’s physical and mental wellbeing, support systems, ability to attend treatments and preference. BCNs have an integral role in our health care system and many women benefit from the care and support they receive during treatment. BCNs work with people who are highly emotional and stressed, who are facing treatments which can make them sicker to get them better, who are exploring existential issues such as their own mortality or the mortality of someone they love. They deal with people during one of the most vulnerable times of their lives, but ask any BCN and they will tell you that they love the role and that it is a privilege to support the patients and their families.
My role as a nurse educator is to provide education and support to nurses who are not only caring for people with a current diagnosis receiving treatment but to also educate and support nurses who are caring for women and ensuring they have the skills and knowledge to talk to women about breast health because the research shows that early detection has a significant impact on survival and treatment outcomes. I am also there to educate and support nurses who may come into contact with survivors and their significant carers. A breast cancer diagnosis affects more than just the person diagnosed, it affects their whole support network. References Cancer Australia, 2017, Breast Cancer Statistics, accessed 25 October 2017, <https://cnnect.acn.edu.au/mod/wiki/view.php?id=59322>
Interview with an ENL Get to know one of our exceptional Emerging Nurse Leaders (ENL) Hollie Jaggard MACN and learn about her experiences with early career nursing research…
Why did you decide to become a nurse? I came to nursing as a mature age student. No one in my family has worked in health care, so I had never even looked at nursing until I saw an advert for a traineeship at St Vincent’s Private. I remember looking at it and all of a sudden I thought, you know what? I could do that. I need to do that. And the more I started googling and looking into it, the more I thought – this is what I need to be doing. Nursing has all the things that I love. I used to love retail because I loved serving people; I loved it when I found the thing they were after or I could help them find the thing that they wanted. And when I looked at nursing, I thought – that’s what nursing is. It’s all of that. This was my favorite aspect of all the different kinds of jobs that I had done in the past. But I was looking for more. All of a sudden, it was like this door had opened and there was this amazing future that I had never seen before. I was 30 at the time and I jumped on it.
Can you tell us a little bit about the research you were involved in while completing your Honours Degree? For my Honours Degree, I chose to do primary research. I came up with a research project, implemented it, got ethics approval, carried out the project and then analysed it myself. Part of the reason I wanted to do this, was that I already had a research topic in mind, which came to me in my second year. I wanted to know why some nurses don’t engage in CPD, or why some don’t engage as much as I do. Of course there’s people like me; I can’t be the only person who gets excited by learning new things, and so when the chance came up to do my Honours, I really wanted to look at that issue – I really wanted to understand it. It’s something that I was very curious about. It was also something that there isn’t really much Australian or international literature on. So it was a really good niche to look into, and it’s something that I’m really quite passionate about; it ticked all the boxes for me.
Why do you have an interest in nursing research? I’ve never not been at school; I’ve always studied something. So, during the last six years that I’ve been in nursing, I’ve been studying the whole time. I think learning new things is something I love to do. It’s part of what defines me; I need to define myself by what I’m studying next. It is probably a bit of an addiction. Do you think it’s important for all nurses to be involved and be passionate about continuous learning? I don’t think that everyone needs to be going out and doing the big postgraduate thing but I think every nurse should be practicing as a professional. We hold an individual license, we are legally obliged and our qualifications are recognised because they carry with them a certain level of practice. So, if you’re going to take yourself seriously and be recognised as an independent practitioner with a professional license, then you need to maintain some kind of engagement in learning. It doesn’t have to be anything big, it doesn’t have to be formal, it doesn’t have to be external to
your workplace but you should engage in those internal activities that are going on around you. Whether there’s new machines or new CPD practice guidelines, you should get on board and understand the changes that are going on in your workplace. That should be enough, because if you understand what’s going on in your workplace, then you are going to be keeping up with best practice in your area. I think, at minimum, we need to be doing that. Otherwise, you’re not engaged. How would you encourage another nurse to get involved in early career research? Do you have any advice? The first thing to do is to find yourself a good mentor. Ask around, talk to people, find someone who inspires you, and has a passion and drive that they can share with you. And if you’re really, really nervous about getting going or you feel that you haven’t got enough support – get on board with a research project that’s already started to give yourself some exposure. This will give you some understanding and an eye into what kind of research you’d like to do.
“I think the Emerging Nurse Leader program is really important in supporting early career nurses to be engaged, exposed and learn from some of the amazing nurse leaders that Australia has to offer.” I highly recommend that early career nurses go and do Honours part-time. I think it’s a fantastic gateway degree; it’s not a three-year Masters, it’s not a specialty degree – you can take your Honours into anything you want to do. I think it’s just a good way to ease yourself into a specialty or an area of interest. Go and make yourself a master of that knowledge! How did you manage working as a graduate nurse and studying your Honours consecutively? It was crazy. Planning, planning, planning. I would schedule in specific days to study. If someone said, “Can I pop in?” or, “Can you do this?” – my answer would be, “No, I can’t, I’m studying that day.” I think by being really firm with the days that I had to study and proactive with my time was probably the only way to get through it. I developed really refined diary-keeping skills. I have never been one to keep a diary and last year, I actually had to get a paper diary and physically write things in it; making lists for myself, crossing things off and blocking out days. I think that this was a really good skill that I learnt, which I might not have otherwise mastered. If you find something that you’re passionate about – the want is there. I wanted to study; I wanted to get out there and do the research. I think that’s really key to finding something that inspires you; something that drives you to learn for yourself. I also think that’s where finding a mentor can help you; finding someone who’s also engaged in the same thing that you are passionate about can open
doors for you in terms of knowledge and directions to look at. I think that’s really inspiring. What are your future career aspirations and how do plan to achieve them? I have a five-year plan. I completed my graduate year in February and am currently studying a transition to specialty practice program, emergency stream, in my emergency department where I work. This will give me credit towards a Masters program and so does my Honours. This means I will actually get three out of the six units credited. I’ve applied for postgraduate study next year and then in 2019, I hope to start my PhD. I’m thinking that this will take me three years with a scholarship, or maybe six years, part-time. So, I hope to come out the other side with a doctorate, and go from there. I’d love to take what I’ve learned into clinical research. I’d especially love to be involved in clinical nursing research in emergency. Why do you think clinical nursing research is important and why do you want to be a part of it? We have a lot of medical-based research out there, and we need that. We need new breakthroughs, new procedures, new drugs, and new methods of treating chronic and acute conditions. But I think we also need nursing research to back this up. How do we deliver these new interventions? How do we make someone have a really good experience? How do we provide holistic care while being safe and meeting
the criteria we need to meet as professionals within an organisation? I think when you try to pull all of that together, nursing is quite a complicated job. So, I think we need more research in terms of nurses in a clinical environment, guidelines and best practice. Emergency departments are somewhere that we don’t have time to think about what we need to do next; we need to know. When someone comes in, acutely unwell, you need to know what your best practice is, you need to know what the current procedures are and you need to know how to get them if you don’t. Clinical research gives us those practices and guidelines, which we can then work by, and I think we need more of that for nurses. Why do you think nurse leadership in important? Nurse leadership is very important to grow the voice of the nursing profession. There are so many nurses. Where you see health care, you’re going to see a nurse, and you’re probably going to see a nurse first and foremost – they will probably provide most of your care. But behind that for us, as nurses, we need people who are driving our profession, holding us accountable in a good way, and helping us to create guidelines and standards for our profession that keep us one of the most trusted professions. I think that this is really important for the long term integrity of the nursing profession. So that we continue to be an honest and trusted profession that delivers really good quality care – always. To be able to rely on a nurse always is a big thing and we need to maintain that. How does the ENL program support nurse leadership and how has it supported you? I think the Emerging Nurse Leader program is really important in supporting early career nurses to be
engaged, exposed and learn from some of the amazing nurse leaders that Australia has to offer. The Emerging Nurse Leader program has allowed me to see nurse leaders in action. It has allowed me to see the change they can create, and the goals that they set and achieve for nurses, the nursing profession, patients and the community. I think that being able to be a part of that through the Emerging Nurse Leader program, has really allowed me to see what I can aim for and the change that I could potentially make down the track. I think that it’s really important that early career nurses see goals that they can set for themselves and that they see the kind of change that they can make. I think that really gets people engaged at an early point in their career; so that they can be a strong nurse who lifts themselves, their career and others up around them for the betterment of the profession. Any final words? As nurses, we touch people’s lives every day. I have a saying that I say to a lot of my theatre patients when they apologise for being really nervous. I say to them, “Don’t apologise. This, for you, is a really big day.” Nurses have a tendency to normalise what we do because we do it every day. However, I think it’s important that we recognise that, for our patients, this is their "one day". I think that by being engaging and up-to-date with best practice, we can make that person’s "one day", the best it can be. Usually, when someone’s seeing a nurse it’s because somethings not right; so we need to do the best we can to make that a positive experience. For me, I believe education, continuous learning and best practice is the way we do that.
Code of conduct for nurses domain two: practise safely, effectively and collaboratively
The Nursing and Midwifery Board of Australia (NMBA) has published the new Code of conduct for nurses (the code). The code will take effect for all nurses in Australia on 1 March 2018. Nurses need to know and abide by the NMBA code even if their employer also has a code of conduct. The new code is grouped into four domains • Practise legally • Practise safely, effectively and collaboratively • Act with professional integrity • Promote health and wellbeing
The second domain in the new Code of conduct for nurses is “practise safely, effectively and collaboratively”, and is underpinned by two principles and their value statements: • Person-centred practice: nurses provide safe, person-centred and evidence-based practice for the health and wellbeing of people and, in partnership with the person, promote shared decision-making and care delivery between the person, nominated partners, family, friends and health professionals. • Cultural practice and respectful relationships: nurses engage with people as individuals in a
culturally safe and respectful way, foster open and honest professional relationships, and adhere to their obligations about privacy and confidentiality.
a nurse’s own culture, values, attitudes, assumptions and beliefs influence their interactions with people and families, the community and colleagues.
The principle of person-centred practice gives guidance for nurses around person-centred decision-making, informed consent, adverse events and open disclosure.
The NMBA encourages nurses to get to know their new code before it takes effect next year. Over the coming months in NurseClick there will be a feature of the other domains to assist your understanding of the new code.
Cultural practice and respectful relationships sets out the expectations for nurses in relation to important issues such as bullying and harassment, so that we can all work towards safe care. Culturally safe and respectful practice requires having knowledge of how
For more information and to view the Code of conduct for nurses in full, please visit the NMBA website.