NurseClick SEP T EMBER 2 0 16
“For everything there is a season…”
When all is said and done – receiving and providing nursing care
Have you considered being a nurse entrepreneur?
Community nursing – a reflection of one passionate community nurse
What nursing the dying has taught me about life
In this edition
In focus @ACN
Adjunct Professor Kylie Ward FACN, CEO of ACN
In the news
When all is said and done â€“ receiving and providing nursing care
In focus @ACN
Leadership is a mindset that needs to be developed and nurtured
Have you considered being a nurse entrepreneur?
Community Nursing â€“ a reflection of one passionate community nurse
Community and Primary Health Care Nursing Week
In focus @ACN
In focus @ACN
Home visiting enhances maternal, child health and developmental outcomes
What nursing the dying has taught me about life
Nursing that takes you places
Registration standard: continuing professional development
Welcome Adjunct Professor Kylie Ward FACN, CEO of ACN
Publishing details Publisher Australian College of Nursing
Welcome to the September edition of NurseClick. With September signaling the changing of seasons and spring bringing the promise of new beginnings, this month’s edition of NurseClick features some insightful articles that highlight the importance of hope, change and innovation in nursing care. Embracing change and innovation was a key step in Gary Bain’s MACN inspiring journey into business and private practice following thirty years in the acute hospital sector. In his article, Have you considered being a nurse entrepreneur?, Gary encourages nurses to build upon their passion and expertise in an effort to improve the community’s wellbeing while also broadening their own professional experience. Reflecting on her experiences working in palliative care, one of our exceptional nurse educator’s Musette Healey MACN writes of finding new life in death in her article, What nursing the dying has taught me about life. Musette offers an uplifting perspective on chronic disease by highlighting the importance of hope, support and compassion in nursing care. As a health care consumer and clinical nurse working in community palliative care, Mandy Cleaver MACN has experienced many pivotal moments in her professional and personal life that provide hope for the future of our profession. In her article, When all is said and done – receiving and providing nursing care, Mandy reflects on moments when nurses impact the lives of their patients.
We also feature a story from our Community and Primary Health Care Nursing Week 2015 eBook. Karen Sergeev’s story is a capturing look into the changing role of the community nurse and the transformational nature of our dynamic profession. If you are a community nurse or know a community nurse, I encourage you to share your story and get involved in Community and Primary Health Care Nursing Week coming up later this month. Following on from her article in last month’s NurseClick, our wonderful nurse educator Trish Lowe MACN continues to highlight innovation in nursing and health care delivery in her regular column, Vital Signs. This month, Trish explores a new model of care aimed at developing parenting skills to combat barriers to effective parenting in vulnerable families. As an organisation not only committed to cultivating an entrepreneurial nursing culture but to fostering the next generation of nurse leaders, the Australian College of Nursing (ACN) has recently launched two new membership options for undergraduate RN and EN students. In her article, Leadership is a mindset - it needs to be developed and nurtured as early in a nurse’s career as possible, our newly appointed Leadership Director Dr Elise Sullivan FACN outlines ACN’s commitment to supporting emerging nurse leaders through a variety of exciting new initiatives, including our enhanced Emerging Nurse Leader Program.
Editors Sally Coen Wendy Hooke Design Nina Vesala Emma Butz Enquiries t 02 6283 3400 firstname.lastname@example.org Advertise with ACN Send your enquiries to email@example.com © Australian College of Nursing 2016 The opinions expressed within are the authors’ and not necessarily those of ACN or the editor. No part of this publication can be reproduced without permission from ACN. Information is correct at time of print. All files marked ‘file photo’ or credited to iStock are representative only and do not depict the actual subjects and events described in the articles. Cover image: Emma Butz/Raye Sommers Design ACN publishes The Hive, NurseClick and the ACN Weekly eNewsletter.
13 October 2–3pm AEST
Stop for Clots
Who should we protect? In Australia, Venous Thromboembolism (VTE) events kill more people than breast cancer, road traffic accidents and HIV/AIDS combined. It is the most common cause of preventable deaths in hospitalised patients.
In the news Nat ional
Strong association found between drug treatment and homelessness in Australia Almost 40,000 Australians received drug treatment and specialist homelessness services over a three-year period, according to a recent report by the Australian Institute of Health and Welfare (AIHW). The report, Exploring drug treatment and homelessness in Australia: 1 July 2011 to 30 June 2014, examines the overlap between the use of homelessness services and alcohol and drug treatment. Read more
Suicide rate for young Indigenous men highest in world, report finds The rate of suicide amongst young Aboriginal and Torres Strait Islander men is the highest in the world, a new report has found. The report, Australian Youth Development Index 2016, also found that health outcomes for all young Australians - particularly the disadvantaged - are falling. Read more
New tool compares heart-related hospital admissions across Australia
Creatine levels in pregnant women could affect baby birth size
The National Heart Foundation of Australia has developed a new tool that monitors hospital admission rates for heart-related conditions at a national, state, regional and where possible, at a local government level.
The level of the nutrient creatine in a pregnant woman could affect the size of their baby, a early study by the Hudson Institute of Medical Research in Melbourne has found. The study showed that women who had less of the naturally occurring acid in their urine had significantly smaller babies.
The Heart Maps tool is an extremely valuable resource that can be used to establish health related strategies, to plan for health services and to develop/ implement targeted prevention initiatives. Read more
ACN Fellow awarded Australian Museum Eureka Prize In a first for nursing, Professor Patricia Davidson RN, BA, Med, PhD, FACN was awarded the 2016 University of Technology Sydney Eureka Prize for Outstanding Mentor of Young Researchers on Wednesday 31 August.
Click to download free eMag
New research examines online engagement of older Australians The level of online engagement of older Australians has been assessed in a recent research snapshot by the Australian Communications and Media Authority. The research snapshot, Digital Lives of older Australians, reveals that older Australians are embracing digital life, with 71% of research participants accessing the internet within a three month period.
Spring Issue out now
Australians spend more time looking at their digital devices than engaging with family and friends Australians spend an average of 46 hours of their weekly down-time looking at their digital devices, compared to an average of six hours engaging with family and friends, a new survey by suicide prevention charity, R U OK?, has found. Read more
More Australians are turning to Dr. Google for medical advice Three in five Australians will sometimes or always look up information about health conditions on the internet to avoid going to see a health professional, a new survey by NPS MedicineWise has found. These new figures show a significant increase from a 2012 NPS MedicineWise survey that reported that only one in three people were likely to search the internet for information about their symptoms before visiting a doctor. Read more
More people in health and community services choose HESTA for their super Find out more
World Night surgery doubles risk of death, study finds Canadian research presented at the World Congress of Anaesthesiologists in Hong Kong suggests people who have overnight surgery are more likely to die. The study also found that those operated on later in the working day or in the early evening were at a higher risk of dying post-surgery compared with those who undergo surgery during regular working hours. Read more
International Council of Nurses condemns Syrian attacks on health personnel in joint statement In a joint statement, The International Council of Nurses (ICN) and the World Medical Association (WMA) have said that the persistent and targeted attacks on doctors, nurses, emergency medical personnel and other health workers in Syria have reached unprecedented levels that should alarm the world. The two organisations confirmed their support of the UN resolution (2268) which calls for a cessation of hostilities in Syria, and ceasefires of sufficient periods for the provision of humanitarian aid. Read more
Diabetes linked to memory decline in older adults
International Society for Burn Injuries issues practice guidelines on burn care Following the formulation of practice guidelines that addressed the care and management of burn injuries in developed countries, the International Society for Burn Injuries (ISBI) has updated these recommendations to guide the improvement of care of burn patients in resource-limited settings. Given the modesty of service, as well as lack of access to scientific publications and critical appraisal expertise among burn care givers in developing countries, ISBI proposed practice guidelines in an endeavor to standardise burn care worldwide. Read more
Parkinson's could potentially be detected by an eye test
University of South Florida researchers have found that older adults with poorly controlled diabetes are more likely to struggle with the ability to recall specific events experienced recently or long ago.
Researchers from the University College of London (UCL) may have discovered a method of detecting changes in the eye which could identify Parkinson's disease before symptoms develop. This discovery could lead to a cheap and non-invasive way to spot the disease.
Healthy older adults experience a decrease in brain blood flow after stopping their regular exercise routine, study finds Using MRI brain imaging techniques, University of Maryland School of Public Health researchers have found that physically fit older adults (ages 50-80 years) experience a significant decrease in blood flow to several brain regions, including the hippocampus, after stopping their regular exercise routine for a 10-day period. The study participants were all people who had at least a 15 year history of participating in endurance exercise.
TO RESEARCH REVIEW
MAKING EDUCATION EASY FOR NURSES www.researchreview.com.au
Research shows links between obesity and eight additional cancers Researchers from the World Health Organizationâ€™s International Agency for Research on Cancer (IARC) looked at more than 1,000 epidemiological studies and found that excess body fat is linked to the risk of developing gastric, liver, gallbladder, pancreatic, ovarian, thyroid, blood (multiple myeloma) and brain (meningioma) cancers. Read more
Study finds gene that could curb coffee consumption People with a DNA variation in a gene called PDSS2 tend to drink fewer cups of coffee, a study carried out at the University of Edinburgh has found. Results from the study suggest that the gene reduces cell ability to break down caffeine. This causes it to stay in the body for longer and means those with the gene get the same caffeine hit through less coffee. Read more
Read the latest in nursing research and practice in ACNâ€™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
Aus tr alian C ollege of Nur sing update ACN launches new Cosmetic Nursing COI ACN is proud to announce the introduction of a new Cosmetic Nursing COI to our suite of special interest groups. We will be working towards launching a code of conduct for cosmetic nurses as part of the work of this special interest group at the inaugural National Cosmetic Medicine Summit taking place in March next year in Sydney. If you would like to contribute to the development of the code or this innovative area of nursing practice, please contact us at firstname.lastname@example.org to join the Cosmetic Nursing COI.
ACN member presentation on nursing informatics In collaboration with Elsevier Australia, ACN held a member presentation on nursing informatics in our Sydney office on Thursday 1 September. Chief Professional Practice Officer of Elsevier Clinical Solutions, Michelle Troseth MSN RN DPNAP FAAN gave the presentation, reflecting on her wealth of knowledge and experience in digital health. Michelle is a world-renowned leader in nursing informatics with over 25 years’ experience in co-designing and implementing evidence-based practice and technology infrastructures to support patient-centered care and interprofessional integration at the point of care across hundreds of health care settings.
Have Your Say
This presentation was a great opportunity for Members and Fellows to learn more about the importance of nursing informatics, usability and clinical application.
Health Care Homes a positive move for patients but funding commitment critical ACN welcomes the Australian Government’s announcement of the 10 Primary Health Network regions across Australia involved in stage one of the Health Care Homes (HCH) model. We are in strong support of this important initiative that will use an alternative to the fee-for-service service model and focus on reforming how health care is provided to people with chronic and complex health care needs.
Participate in a study investigating how nurses keep children safe from abuse and neglect
It is essential that the trial of HCHs is given every chance of success and is not undermined by inadequate resourcing. In addition to adequate funding, its successful implementation will depend on the active engagement of consumers and all relevant health and allied health professionals.
Researchers from Flinders University are conducting a study exploring how nurses’ keep children safe from abuse and neglect. The study will seek to identify how the nursing workforce can be supported and empowered to improve outcomes for children.
ACN is well positioned to work with the Health Care Homes Implementation Advisory Group and the Government to provide strategies on how to best design a HCH model that makes maximum use of the nursing profession in the provision of the highest quality care to the Australian community.
Participants will be invited to attend a face-to-face or telephone interview with the primary researcher. The interview would last approximately 60-90 minutes.
Read the full media release.
If you would like to participate in this study or require further information, please contact the primary researcher Lauren Lines on email@example.com.
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In focus @ACN
When all is said and done – receiving and providing nursing care By Mandy Cleaver MACN
‘When’. It’s such a small but important word. According to Google, ‘when’ means “at what time” and refers to “a time, circumstance or point (at which)” (2016). So if our lives are indeed a continuum, as we learnt Mandy Cleaver back in ‘Lifespan 101’, it makes sense that there must be multiple points along such a continuum, where we experience a ‘when’ moment. We may be the one experiencing it ourselves or we may be the one providing a ‘when’ moment to someone else, but nonetheless, life is littered with ‘whens’. I’m certain many nurses appreciate spirituality – not necessarily religion or a particular faith per se, but spirituality as an integral component of holistic care. In that vein, please allow me to reflect on some of my life’s ‘when’ moments, from both receiving and providing nursing care, structured by exerts from the following popular biblical passage: “There is a time for everything, and a season for every activity under the heavens: a time to be born and a time to die, a time to plant and a time to uproot, a time to kill and a time to heal, a time to tear down and a time to build, a time to weep and a time to laugh,
a time to mourn and a time to dance, a time to scatter stones and a time to gather them, a time to embrace and a time to refrain from embracing, a time to search and a time to give up, a time to keep and a time to throw away, a time to tear and a time to mend, a time to be silent and a time to speak, a time to love and a time to hate, a time for war and a time for peace.” (Ecclesiastes 3:1-8, New International Version) “…a time to be born and a time to die…” As a first time mum, I had immediate trust in my midwifes. How could these women be so humble, when they were so confident and amazing at what they did! The thought that these people, who literally help deliver life itself, could be the same people you might pass in the supermarket doing things that ordinary people do, astounded me. I think, as nurses, we can become blasé to what we actually do and the extent our care can impact someone’s life (for better or worse). That is a privilege as much as it is a responsibility. I remember walking out of the maternity ward, holding my precious and healthy firstborn baby girl and thinking – um, what if there’s a problem? What if I can’t get her on the breast correctly again? And then remembered the relief of knowing a community midwife was coming to my house daily for a few days, to check in on me and bub. Her
visits provided me with encouragement, education, reassurance and support ‘when’ I really needed it. Jump to the other end of the spectrum where there is a ‘when’ moment with dying. There can be multiple ‘when’ moments here. There’s sometimes a warning ‘when’ moment – as it is with terminal illnesses – not a specific time but a pretty certain guarantee normal life expectancy will be reduced.
There can also be a ‘when’ moment that is completely unforeseen. There can be a series of ‘when’ moments with each deterioration or acceptance of lost autonomy, as can occur in increasing age or frailty. These are only a few examples – there are countless more, seen by palliative, hospice and community nurses, through to those in intensive care or the emergency department, and everything in between. As nurses, we are often there in people’s final ‘when’ moment – and those that lead up to it.
In focus @ACN
“…a time to plant and a time to uproot…” I think the last minute April rush of ensuring enough CPD hours has been accrued, is humorous – because as nurses, I believe we have a ‘when’ moment and learn something new during every shift – we just have to prove that we’ve accredited enough learning hours by May each year. However, there does also need to be a certain amount of deliberate intent with our learning. Whether it’s formal, like a postgraduate course or workshop, or informal, such as researching a particular diagnosis your patient has that you’re unfamiliar with, it’s deliberately sowing seeds to improve professional practice in the future. However, there is also the skill of knowing ‘when’ to uproot - just because it’s a good thing to do, doesn’t always mean it’s the right thing for you to be doing right at this time. Sometimes, no matter your skill level or passion for a role, the timing may not be right. It may be time to reduce hours to be with family more – as I’ve recently just done. Or it may be time to leave the security of a home town to take a placement in a regional, remote or even international location. Whatever the reason behind it, as nurses we need to recognise ‘when’ a season should end. “…a time to kill and a time to heal…” Obviously there is not a time to kill someone, but there is definitely a place for killing some things. From nurses supporting their patient’s having radiation, through to nurses checking PIVAS scores prior to administering IV antibiotics, there’s a time when we as nurses, play a part in trying to kill off those organisms which are trying to harm our patients. However, there is also many a time when we are there to promote the healing – emotionally, psychologically, spiritually or physically. I remember being in the home of a patient recently discharged from hospital with a dressing covering her removed
implantable device site. She was scared. This was a time when she was unsure of what to do and how to do it. I had the privilege of being there with her as the community specialist wound care nurse arrived. His manner, knowledge, competence and approach reduced her anxiety, reassured her that she was not alone and his expertise in wound care physically assisted with the healing process. “…a time to weep and a time to laugh…” As nurses, we often see people at their most vulnerable, and sometimes, it’s not the biggest and messiest things that impact us the most. Sometimes, it’s a just a look an exhausted mum gives you when you hand her a cuppa; walking in to see a grandfather dressed as a gentleman, cap in his lap, nodding off as he waits beside his wife’s hospital bed; looking into the eyes of someone who is now lost in their dementia; or sitting beside a wife who’s lost her husband of 50 years as she stares in disbelief. However, in those ‘when’ moments, it’s not about us, it’s about the patient and their family. Our eyes may moisten but our heartfelt weeping is for the drive back to our office, or the drive home after our shift. Thankfully, there’s also a time to laugh. I think, as nurses, our sense of humour is one of our biggest tools for survival. It’s amazing how in any social situation where there’s nurses involved, the conversation will inevitably lead into a story about poo! “...a time to be silent and a time to speak…” Sitting with a weeping, dying father, watching the anguish on his face as he verbalises his devastation - his diagnosis means he will miss out on not just the significant future ‘when’ moments but the ordinary, everyday ‘when’ moments of his child’s life. This ‘when’ moment does not require words. It requires silence. My head bows as his does. My eyes look towards his daughter as her eyes moisten. We all sit
in silence. A silence that says sometimes life throws us a curve ball. A silence that says emotional distress can far outweigh physical symptoms. A silence that says I can’t fix this, I don’t have the answer. A silence that allows the person permission to be in that moment of despair, to acknowledge it for what it is and not pretend it’s going to be okay, that there’s a bright side or there’s people worse off. A ‘when’ moment that requires silence. Thankfully, there is also a time to speak up. As a nurse, I am in a privileged position to advocate for my patients – be that with other colleagues, other members of the interdisciplinary team, other patients or even family. Is it intimidating? Sometimes yes! The fear of being laughed at, teased, patronised or being wrong can make me think twice. But when I see a compromised elderly patient being patronised and told he’s ‘being naughty’ because he won’t keep still – when the reason for his movement is unbearable, excruciating pain, then that’s a time to speak. Thankfully, my experience of ‘when’ moments of that sort, are few and far between. So I asked myself, what is it that drives us to sometimes be the nurse in someone else’s ‘when’ moment? And I found my answer in another biblical passage from that same chapter: “So I saw that there is nothing better for a person than to enjoy their work, because that is their lot…” (Ecclesiastes 2:22, New International Version). As people, we can receive love through care – but as nurses, we have the opportunity to show love through care – at so many of the ‘when’ moments throughout life’s journey.
EDUCATION: The key to career progression With 15 postgraduate certificates and 80 units to choose from, what will you study? READ MORE
References Google 2016, When, viewed 11 August 2016 < https://www.google. com.au/#q=when+definition>.
Advancing nurse leadership www.acn.edu.au
NEW MEMBERSHIP OPTIONS FOR RN AND EN undergraduates OPTION ONE
ACN is dedicated to supporting the next generation of nurse leaders and is excited to announce the launch of two new membership options for pre-registration students.
ACN START-UP MEMBERSHIP
ACN UNDERGRADUATE MEMBERSHIP Provides access to all benefits included in the Start-Up Membership PLUS:
ACN Start-Up allows students to test the waters at no cost. ACN Undergraduate provides an extensive suite of benefits, including one-on-one career coaching, for only $52 per year. We are pleased to upgrade our valued current ACN student members to the new Undergraduate membership, allowing them to gain a competitive edge through career coaching.
and engage with ACN’s national community of nurse leaders and nursing practitioners
your growth and development through one-on-one career coaching
to health care discussion, shape and influence government policy and represent ACN at professional and government forums
with members who are located in your area or work within settings and specialty areas you are interested in
an exclusive student welcome pack and ACN’s quarterly publication, The Hive
your skills and expertise through complimentary online CPD courses
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with, and contribute to, news and articles affecting the profession through ACN’s electronic publications
ACCESS ACN’s refereed academic journal, Collegian, the Katie Zepps Nursing Library, EBSCO and other nursing databases
For more information on the undergraduate membership options please contact ACN Membership:
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from partner offers, such as exclusive discounts from the Co-op Bookshop and Elsevier Australia
exclusive invitations to VIP networking events
for exclusive grants and awards
Leadership is a mindset – it needs to be developed and nur tured as early in a nurse’s career as possible By Dr Elise Sullivan FACN
We start with a desire to lead our destiny. Nurses enter the profession with a need to make a difference to the lives of others. We are driven by purpose and the need to contribute as Dr Elise Sullivan FACN autonomous individuals – a need to be challenged and to grow.
“ACN’s greatest wish is to support our newest nurses to start their careers from a position of great personal power and not have this diminished in any way as they transition from the safety of their educational institutions into their new workplaces.” group that our newest nurses gain the courage to take the lead and to realise their full potential as a member of the most powerful force in the Australian health care system.
The innate passion and drive of our undergraduate nurses must be protected and fostered as they enter our workplaces. They are our leaders at the point of care and will be the leaders of our profession across many areas in the future. They will shape our profession and the health care system. ACN’s greatest wish is to support our newest nurses to start their careers from a position of great personal power and not have this diminished in any way as they transition from the safety of their educational institutions into their new workplaces.
We will shortly launch our enhanced Emerging Nurse Leader Program. The first stage of this prestigious award program supports nurses completing their undergraduate, honours or masters level pre-registration program in their final years to:
ACN provides support, professional development and mentoring to new professionals so they can step into their clinical leadership. It is from the safety of belonging to a powerful professional
• Crystalise their career plan and prepare to take their first steps on their clinical leadership path
• Stand in their power as nurses • Build resilience and strength to make a difference as they enter the workforce • Develop the skills and strategies to transition into the workplace successfully
Keep an eye out for more details on this.
If you are nearing the completion of your pre-registration program, we would love to hear from you and talk about your stories of leadership, and what you need to feel confident to make a difference when you transition into the workplace. Email us at email@example.com.
EDITOR'S NOTE ACN runs a Leadership @ACN skills development program for nurses and midwifes comprised of a series of workshops, seminars, events and courses. Leadership @ACN is designed to help develop the skills, confidence and ability needed to take a leadership role in midwifery, health care or aged care. Click here for more information about Leadership @ACN.
26–28 October 2016
THE NATIONAL NURSING FORUM THE POWER OF NOW
Melbourne Park Function Centre
In focus @ACN
Have you considered being a nur se entrepreneur ? By Gary Bain RN MClinEd BN DipApSc MACN
raise our community’s standard of health, then why not encourage nurses to be different and to innovate? Kylie sees the College as a focal point for networking and a provider of resources to support such an entrepreneurial nursing culture.
There are times when life takes us in directions previously unforeseen. Our talents, experiences and aspirations are surrounded by a plethora of possibilities Gary Bain MACN to which we are largely blind when we are firmly entrenched in our regular employment and our standard daily routine. It is the occasional thrust into the unknown which gives us pause to consider our options and directions. So often this is the birth place of the entrepreneur. It is otherwise recognised as necessity being the mother of invention. This has been my experience in 2016. After nearly 30 years of continuous employment within the acute hospital sector and for most of that time, running my own outpatient wound care clinic, it was a giant step out of my comfort zone when circumstances brought this phase of my life to a conclusion. I’ve certainly had some time wandering in the dark, exploring different directions and making affiliations that didn’t work out. However, I have also been most fortunate to have made connections with role models (within nursing and outside of health care) who have trod the path that I am now on. They are, for me, a source of wisdom, guidance and encouragement.
I encourage my fellow nurses to build on your passion and expertise. Find out how you can use your skills to improve the community’s well-being whilst also broadening your own professional experience. As a fledgling nurse entrepreneur, I have found that many more people want me to succeed than people who want me to fail. So my meager advice to anyone else wishing to commence their own venture is: • • • • •
Gary Bain MACN with ACN CEO Adjunct Professor Kylie Ward FACN at the ACN VIP Cocktail Function in Sydney on Wednesday 29 June 2016.
A key consideration has been to develop an awareness of my strengths and to build upon my existing skillset. What am I good at? How can I use my skills to assist others? Who needs what I can deliver? How do I market myself? Can I provide something unique? The questions go on. Herein is the value of a mentor. Someone who can share in your vision and yet be sufficiently detached in order to advise analytically rather than get caught up in the emotions of a fledging enterprise. I have a few Yoda equivalents whom I highly value.
I was most fortunate recently to have spent some time with ACN’s CEO Adjunct Professor Kylie Ward FACN. I shared with her my story, describing how I have gone from employee to sole trader. She was excited about my journey into business and private practice. Nurses are by nature creative, adaptive and visionary. So if there are opportunities for nurses to improve a patient’s welfare, to enhance clinical excellence, to improve cost-efficiencies or to
Do something you are good at Find a mentor to guide you Be patient, persistent and persevere Network constantly Be prepared to diversify and be open to otherwise unconsidered possibilities EDITOR'S NOTE Gary Bain is a Nurse Educator and Clinical Nurse Consultant specialising in wound management. He is also Principal at The Wound Guy. Gary has presented at various ACN Wound Management and Advanced Wound Management CPD Short Courses. Click below to find out more about these courses: Wound Management Advanced Wound Management
Communit y Nursing – a reflection of one passionate communit y nurse By Karen Sergeev
Nursing in the community is a passion of mine and I have had the privilege to work as a community nurse in various parts of NSW since 1987. In that time there have been many changes from working alone with no mobile phone, no educator support, no allied health support, no weekend services and washing your own fleet car. Karen Sergeev
“It is very humbling to be allowed to care for someone in their own home and as a community nurse you are investing in the health and wellbeing of your local community.”
The role of a community nurse has changed over time in line with changes in technology and society. In 1987 I was responsible for the general nursing care of clients living in a geographical area, from children to aged seniors. If a client required equipment, such as a shower chair or oxygen cylinder, the nurse would load the items in the car, deliver and set it up. Bandages were washed and reused by clients; there were no clinical rooms for sterile procedures and no Dopplers, pulse oximeters or bladder scanners. Local schools provided vision, hearing, height, weight, gross motor and scoliosis checks, and immunisation. Health promotion was also a requirement of the position, and general health checks and education were provided to teachers, council workers and local businesses. The only specialist nursing services available were for diabetes and palliative care. Home care and Meals on Wheels were the only services available to support people at home. GPs did home visits even at night if called. By comparison, in the mid-2000s, as a community nurse, I had a mobile phone, a computer and a fully serviced and well-stocked fleet car. Allied health is now available in some areas and specialist nursing is the norm (from wound management and stomal therapy to cardiac and respiratory rehabilitation). Education is provided by online modules and in services supported by a nurse educator. The amount of clinical competencies and mandatories has
continued to grow. The influx of non-government service providers requires a broad knowledge of the local services to ensure clients can access the necessary support. Clients live in diverse environments, from public housing, caravans and remote farming properties to city apartments and multimillion dollar mansions. Facilities in homes range from boiling a kettle for hot water to under floor heating in the bathroom. Some clients have a fully equipped bedroom and others share a mattress on the floor. Client’s family situations also vary from living alone to sharing a house with several generations. Some families provide unconditional support to their loved ones and others visit rarely and offer minimal support. I have done wound dressings in garages, under trees, at schools or at places of work. I have walked across snowy paddocks for home visits, opened farm gates and driven on gravel roads and highways. I have fed chickens and collected eggs, had gifts of home-grown produce, washed clothes, made sandwiches and emptied bins, all to assist a client to remain at home. Through it all I have met many wonderful people: clients, carers and colleagues who have helped shaped my experience of life and death. It is very humbling to be allowed to care for someone in their own home and as a community nurse you are investing in the health and wellbeing of your local community.
Community & Primary Health Care Nursing Week
Nurses where you need them 19–25 SEPTEMBER
EDITOR'S NOTE Karen’s story features in the 2015 Community and Primary Health Care Nursing Week: Nurses where you need them eBook. This year, we’re asking nurses to share a story that describes a time ‘when’ your nursing care has impacted on the health and wellbeing of individuals and/or communities. The 2016 Community and Primary Health Care Nursing Week: Nurses where you need them eBook will be released online on Monday 19 September. Click here to find out more.
Community & Primary Health Care Nursing Week In 2015, ACN launched an annual national campaign â€“ Community and Primary Health Care Nursing Week: nurses where you need them. The aim of this campaign is to raise awareness of the current and potential contribution of community and primary health care nursing to the health care system and highlight its impact on the wellbeing of individuals and those in local communities. When most people think of nurses, they picture a traditional hospital setting. Community and primary health care nurses work in a wide variety of non-traditional settings. These settings can include prisons, schools, medical centres, sexual health clinics, aged care facilities, rehabilitations clinics, and outreach services.
Community and primary health care nursing covers a very broad number of roles and also includes nurses that work in rural and remote areas. These nurses are sometimes the only health professional a community has access to. They are responsible for health promotion and education, illness prevention, treatment and care of the sick. Community nurses often work in roles that go unnoticed in the wider community. However, the care that they provide alleviates the pressure on the hospital system. Community nurses visit patients recovering from surgery in their own homes to change dressings and administer medication, freeing up beds in hospitals. Baby health nurses visit new mothers in their own homes to check on
Nurses where you need them 19â€“25 SEPTEMBER 2016
the health of newborns, and provide assistance and advice. Nurses in school settings provide valuable education on health and hygiene to students. In home nurses assist in keeping the elderly in their own homes. The benefits of these nurses are immeasurable and yet, they go unnoticed by many. By launching Community and Primary Health Care Nursing Week, ACN is aiming to educate the health care community, government officials and the wider community about the important contribution community and primary health care nurses provide to our health care system. This year Community and Primary Heath Care Nursing Week runs from the 19â€“25 September.
For more information and to register your support, visit our website.
With thanks to the support of our official sponsors
HOW TO GET INVOLVED:
Read stories from our eBook
There are a range of activities that ACN is encouraging nurses and the broader community to become involved in during Community and Primary Health Care Nursing Week.
Hold an event to put your town on the map
Wear an orange scarf or t-shirt
Join ACN as a supporter
Spread the word!
In focus @ACN
Home visiting enhances maternal, child health and developmental outcomes By Trish Lowe MACN
The Maternal Early Childhood Sustained Home-Visiting (MECSH) model of care is an exciting new health care innovation being introduced into child and family health nursing services across the Southern NSW Trish Lowe MACN Local Health District (SNSWLHD) over the next three years. MECSH is an evidence-based model of care, currently utilised in NSW, Victoria, UK, USA and South Korea. However, SNSWLHD is the first rural health service in Australia to adopt the MECSH program. The program was developed by the Ingham Institute for Applied Medical Research, Western Sydney University Professor Lynn Kemp, and the Translational Research and Social Innovation (TReSI) team. The program enables structured and sustained home nurse visits (with up to 25 visits by the same nurse) for families at risk of poor maternal, child health and developmental outcomes.
By implementing the MECSH program, the SNSWLHD aims to provide responsive and timely care to people who need it the most. This familycentred model of care helps develop parenting skills to combat barriers to effective parenting in vulnerable families, for example, addiction, poverty, violence and mental health issues. To date, 35 permanent child and family health nurses in SNSWLHD have completed face-to-face MECSH training. This training will be followed by further online learning modules and expert support from the TReSI team over the coming months. Outcomes of this model of care will be evaluated, including breastfeeding rates, engagement and family participation rates. EDITOR'S NOTE
“This family-centred model of care helps develop parenting skills to combat barriers to effective parenting in vulnerable families.”
For further information on this program, please contact Child and Family Health Clinical Nurse Consultant, Trudy Wynne MACN on Trudy.Wynne@gsahs.health.nsw. gov.au or SNSWLHD Manager of Women’s Health, Child, Youth, and Family, Annie Flint on Annie.Flint@gsahs.health.nsw.gov.au.
In focus @ACN
What nursing the dying has taught me about life By Musette Healey MACN
If someone had asked me as an 18 year old nursing student or a new graduate nurse what speciality area I wanted to work in, cancer and palliative care would not have been on my list. My Musette Healey MACN initial experiences of death as a young nurse were not positive ones and therefore, I had decided aged care and palliative care were not my areas of nursing.
be so sad’. At the time I don’t think I realised the impact the environment, the children and their families were having on me. These children were facing something that we considered life threatening, treatment was brutal (we often used to say that we make them sicker to get them better), their daily lives were turned upside down as they spent days on end in hospital with anxious parents rather than at school with their friends, they were often socially isolated due to compromised immune systems yet they all did it with a smile and that simplicity and innocence we associate with children.
Several years later though, I found myself back working in an area where I would see death and dying, and where my sense of self and my mortality would be challenged - I found myself working in paediatric oncology.
Don’t get me wrong, there were some awful days were there were kids and parents crying, kids who were getting sicker by the second and days were you struggled to get to the toilet let alone have lunch, however these are not my overwhelming memories.
As a nurse working with cancer and palliative care patients and their families for over 10 years, my perceptions of life and death have been challenged. I have had many a conversation with colleagues, family, patients and strangers about death and dying. What has always struck me is the fear we have as a society about death. Death is one of the few certainties we have in life - the part we don’t know is when, where and how.
My memories are of kids being yelled at to slow down as they ran down the corridor with their IV pole five steps behind them so they didn’t miss something on the starlight channel, or playing UNO and being beaten by a nine year old while she had her chemotherapy, or the smile from the 15 year old boy as you enter the room to start the next round of treatment.
Now most people’s first reaction to hearing I worked in paediatric oncology was ‘oh that must
These kids (and their families) showed me resilience, they showed me that the simple things in life matter, that life is for experiencing and enjoying
everything it throws at us and they also taught me how to look after myself. As I write this I feel a mixture of emotions at the variety of memories - I am smiling but the tears are gathering and threatening to spill. For a variety of reasons I moved on from my paediatric experience and moved back to adult nursing, still within the area of oncology and palliative care. It then became very apparent to me the differences between how adults view the world and children view the world. Many of the adults I
initially engaged with were all doom and gloom, even if their diagnosis had a cure rate of 80%. They felt sorry for themselves as they struggled to manage the side effects of treatment. Many had one foot in the grave so to speak but they didn’t talk about it because many of the cancer messages are about staying strong and positive or they didn’t want to add to their families stress. The contrast between how my paediatric patients and how my adult patients managed was startling and an eye-opener for me.
“Death has taught me to value life and the rollercoaster ride that it is, to not underestimate what I and those around me are capable of, to embrace the inner child and have fun…” I started using some of the communication techniques I had learnt to explore why adults were managing things with such a different outlook. Some of the things that I discovered is that adults have learnt ‘how to be sick’, that we put on a mask to protect those we love and care about, that death and dying is not an option that we are prepared to consider as medicine is so advanced. While I understood and appreciated the perspectives of my patients, I found myself wishing they could capture the simplicity and innocence I had seen in my paediatric patients. I wish that they had the courage to let the mask fall and let their loved ones in. I wish that as a society, talking about death and dying was not taboo. I have spent a lot of time talking to people and reading about the psychological side of dealing with cancer and death in an effort to ensure that I am able to support patients and families. I have learnt to take opportunities to open the lid on these topics and to encourage patients to explore their thoughts and feelings. From this I have found that sometimes, once the door is open, all people need is a willing ear to listen. Like many nurses working with people who have a life-limiting illness or are dying, I have struggled with ‘what do I say?’ or ‘how do I respond?’. In fact, some days I still struggle, but the one thing I will always do is be honest. When families or patients raise those tough topics like death or funerals, I encourage them to talk about it and I
take the time to listen (or find someone who can) because often they are just trying to get their own head around what is happening. I have learnt that you cannot predict what is going on in someone’s head and it is far easier to work this out if you just ask ‘what are you thinking?’ or ‘how are you feeling?’. I have also learnt that everyone has a different reason for living and if I am going to help them live the best life they can, then I need to know what that is. Is it watching the Friday night football? Or being able to shower independently? Is it meeting the first great grandchild due in a week? Whatever it is, it is important, and as nurses, families, friends and partners it is good to know. For families, this information can be empowering and freeing, it can relieve some of the pressure at a time when logical thought is difficult. I still struggle with why we find it difficult to discuss dying and death. Is it because of the emotions that we attach to death? Is it because we think we are being fatalistic or morbid? Is it self-preservation? Whatever the reason, we need to break down the walls and make talking about death a normal part of life. How many of you know what sort of funeral your parents or your partner want? How many of you know if your next of kin wants to be resuscitated if they have a heart attack? Have you thought about how you would tell your kids that someone they
love is dying, or explain what happens when they ask what happens when someone is cremated? All my knowledge and skills has been put to the test over the last few years as I have walked the cancer journey with several close family and friends. At times I have second guessed myself but these experiences has added to my experience and challenged me to walk the walk and not just talk the talk. I have had these difficult conversations with many members of my immediate family and yes, they are tough but they have empowered me and given me a sense of certainty that when the time comes I know what I need to do. Death has taught me to value life and the rollercoaster ride that it is, to not underestimate what I and those around me are capable of, to embrace the inner child and have fun, to make time for those important to me, that every day is precious and I want to experience as much of it as possible, that those tough conversations can teach us things we never knew about each other and deepen relationships.
Are you an RMIT Nursing alumnus?
I have learnt that it is alright to not be ok and that talking about it is empowering, that sometimes you need to throw the plan out the window and walk through the open door. Life is a balancing act and the scales should always be in favour of what makes you happy.
RMIT Nursing turns 40 next year. If you graduated from RMIT connect with us.
EDITOR'S NOTE ACN offers a Cancer Nursing Graduate Certificate. This course is designed to provide graduates with the principles of cancer nursing to improve knowledge and skills for the provision and coordination of evidenced based cancer care. Click here for more information about this course.
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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 aare qualifications. To find out more visit defencejobs.gov.au/army or call 13 19 01.
THE ARMY IS NOW RECRUITING NURSING OFFICERS A career as an Army Nursing Officer offers variety and challenges in employment and travel not always available in the normal hospital environment. You will gain experience and skills that will equip you for advancement in the Army, and will also be in high demand in your profession. You’ll also enjoy great benefits like free medical and dental, world class training, subsidised accommodation, excellent salary packages, work/life balance and unique experiences. To find out more about becoming a Nursing Officer search ‘Army Nurse’.
TO APPLY CALL 13 19 01 OR VISIT DEFENCEJOBS.GOV.AU /ARMY
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Regis tr ation s t andar d: continuing professional development The Nursing and Midwifery Board of Australia (NMBA) has been speaking to nurses and midwives across the country at our information forums, and one of the questions we often get asked is about the continuing professional development (CPD) registration standard. CPD is the means by which nurses and midwives maintain, improve and broaden their knowledge, expertise and competence, and develop the qualities needed throughout their professional lives. The
You can find the CPD standard on the Registration Standards section of www.nursingmidwiferyboard.gov.au. You can also find helpful guidelines on planning and recording CPD on our Professional Codes and Guidelines section.
NMBAâ€™s CPD registration standard requires nurses and midwives to complete a minimum of 20 CPD hours relevant to their context of practice. Remember that attending seminars, participating in journal clubs, inservice education, post graduate study and completing annual competency assessments (like CPR), can all be counted towards your CPD hours. Planning and reflection are key parts of the CPD learning that is expected of nurses and midwives.
Type of registration
Enrolled nurse, registered nurse or midwife
Registered/enrolled nurse and midwife
20 + 20 hours
20 + 10 hours
Registered nurse with scheduled medicines endorsement (rural and remote)
20 + 10 hours
Midwife with scheduled medicines endorsement
20 + 10 hours
Registered/enrolled nurse and midwife with scheduled medicines endorsement
20 + 20 + 10 hours
Figure 1: Required CPD hours (per registration period) by type of registration
Research shows that engaging your peers or supervisors to help you plan your CPD results in positive learning outcomes and evidence-based changes to practice. Reflecting on the CPD you do also supports your professional development. Keeping a CPD journal with notes and reflections on what you learned is a good way to record CPD, as well as keeping certificates of attendance from events. The NMBA recommends that you keep records of your CPD activities for a period of five years from the date you completed the CPD. The CPD registration standard applies equally to fulltime or part-time work in paid or unpaid practice. The standard applies to nurses and midwives who are on leave from work, for example on extended holiday or maternity leave. It does not apply nurses or midwives on the non-practising register. If you are both a nurse and a midwife, you will need to complete a minimum of 20 hours of CPD related to your nursing practice and 20 hours of CPD related to your midwifery practice. There may be some CPD hours which can count towards both contexts of practice, but the NMBA would also expect to see separate CPD activities specific to nursing and specific to midwifery. Midwives with an endorsement for scheduled medicines and nurse practitioners will have to complete 10 hours of additional CPD, related to prescribing, ordering of diagnostics, consultation and referral.
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