ANMJ April 2015

A U S T R A L I A N N U R S I N G & M I D W I F E RY J O U R N A L VOLUME 22, NO. 9

APRIL 2015

MEDICARE

UNDER THREAT The Americanisation of Australia’s health system

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Editorial Lee Thomas, ANMF Federal Secretary I am pleased to announce the ANMF Federal leadership team for the next four years. After elections were held over the past month, Assistant Federal Secretary Annie Butler and I have been returned to our substantive positions. SallyAnne Jones has been elected as President and Maree Burgess as Vice President. I am very excited by the prospect of this formidable team and what we can achieve together for the professions and Australia’s healthcare over the coming years. I would also like to take this opportunity to acknowledge outgoing President Coral Levett who chose not to run for the position this term. I hold great admiration for Coral’s strength, commitment and determination for the ANMF, and I would like to thank her for her wise counsel and very significant contribution she has made over the years.

One of our team’s immediate objectives is to protect our universal healthcare system.

To date we have fought hard against healthcare cutbacks that our current government seems so determined to implement. As an outcome of our fight, the government has back flipped on its GP tax.

This was a welcome win for all Australians who place great value in medicare.

But while we may have won this battle it appears we have not won the war - our healthcare is still under threat.

Despite backing down on the GP tax, the government still seems hell-bent on reforming the system, claiming that Medicare is unsustainable in its current form.

Yet if you look at the facts this is simply not true. Maintaining Medicare is feasible - other alternatives to fund healthcare are possible and must be considered. Removing the private health insurance rebate and introducing a ‘Robin Hood tax’, also known as a Financial Transactions Tax (FTT) on the rich, are such examples.

Without looking at the alternatives our universal healthcare remains under threat and in real danger of becoming an Americanised two-tiered health system, where people only get treatment if they can afford to pay for it.

I urge you to read this month’s feature which explains in detail the importance of our world class Medicare system and the potentially detrimental outcomes should it decline.

On 25 April I also ask you spare a thought for our Southeast Asia Treaty Organisation (SEATO) nurses who volunteered to serve in Vietnam at the time of war and who, like many Vietnam veterans, experienced the traumas of conflict resulting in physical and mental conditions. However, unlike those who served in the military, our SEATO nurses do not have access to veterans’ entitlements because they are viewed by the government as civilians. The ANMF has supported and lobbied for these nurses for some time and will continue to do so until they are acknowledged and remunerated fairly.

The 100th anniversary of the ANZAC landing in Gallipoli will be marked on 25 April. I am sure many of you will attend dawn services across the country remembering the service men and women, including the many nurses who bravely looked after the sick and injured during both world wars, all conflicts and peace keeping missions since. As a tribute to these brave men and women the ANMJ is recounting some of the very moving stories told by the nurses who served during World War I.

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April 2015 Volume 22, No.9 1

Australian Nursing & Midwifery Federation National Office www.anmf.org.au

Canberra

Editorial

3/28 Eyre Street, Kingston ACT 2604 Phone (02) 6232 6533 Fax (02) 6232 6610 Email anmfcanberra@anmf.org.au

Editor: Kathryn Anderson Journalist: Natalie Dragon Production Manager: Cathy Fasciale Level 1, 365 Queen Street, Melbourne Vic 3000 Phone (03) 9602 8500 Fax (03) 9602 8567 Email anmj@anmf.org.au

Melbourne & ANMJ

Level 1, 365 Queen Street, Melbourne Vic 3000 Phone (03) 9602 8500 Fax (03) 9602 8567 Email anmfmelbourne@anmf.org.au

Advertising Federal Secretary Lee Thomas

Assistant Federal Secretary Annie Butler

Freelance Media E: jana@freelancemedia.net.au M: 0477 882 492

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Australian Capital Territory Branch Secretary Jenny Miragaya Office address Unit 3, 36 Botany Street, Phillip ACT 2606 Postal address PO Box 1995, Woden ACT 2606 Ph: (02) 6282 9455 Fax: (02) 6282 8447 E: anmfact@anmfact.org.au

Northern Territory

South Australia

Victoria

Branch Secretary Yvonne Falckh Office address 16 Caryota Court, Coconut Grove NT 0810 Postal address PO Box 42533, Casuarina NT 0810 Ph: (08) 8920 0700 Fax: (08) 8985 5930 E: info@anmfnt.org.au

Branch Secretary Elizabeth Dabars Office address 191 Torrens Road, Ridleyton SA 5008 Postal address PO Box 861 Regency Park BC SA 5942 Ph: (08) 8334 1900 Fax: (08) 8334 1901 E: enquiry@anmfsa.org.au

Branch Secretary Lisa Fitzpatrick Office address ANMF House, 540 Elizabeth Street, Melbourne Vic 3000 Postal address PO Box 12600 A’Beckett Street Melbourne Vic 8006 Ph: (03) 9275 9333 Fax (03) 9275 9344 Information hotline 1800 133 353 (toll free) E: records@anmfvic.asn.au

The Australian Nursing & Midwifery Journal is delivered free monthly to members of ANMF Branches other than New South Wales, Queensland and Western Australia. Subscription rates are available on (03) 9602 8500. Nurses who wish to join the ANMF should contact their state branch. The statements or opinions expressed in the journal reflect the view of the authors and do not represent the official policy of the Australian Nursing & Midwifery Federation unless this is so stated. Although all accepted advertising material is expected to conform to the ANMF’s ethical standards, such acceptance does not imply endorsement. All rights reserved.

Material in the Australian Nursing & Midwifery Journal is copyright and may be reprinted only by arrang­ement with the Australian Nursing & Midwifery Federation Federal Office Note: ANMJ is indexed in the CUMULATIVE INDEX to NURSING AND ALLIED HEALTH LITERATURE and the INTERNATIONAL NURSING INDEX ISSN 2202-7114

Moving state? Transfer your ANMF membership

If you are a financial member of the ANMF, QNU or NSWNMA, you can transfer your membership by phoning your union branch. Don’t take risks with your ANMF membership – transfer to the appropriate branch for total union cover. It is important for members to consider that nurses who do not transfer their membership are probably not covered by professional indemnity insurance.

New South Wales

Queensland

Tasmania

Western Australia

Branch Secretary Brett Holmes Office address 50 O’Dea Avenue, Waterloo NSW 2017 Ph: 1300 367 962 Fax: (02) 9662 1414 E: gensec@nswnma.asn.au

Branch Secretary Beth Mohle Office address 106 Victoria Street West End Qld 4101 Postal address GPO Box 1289 Brisbane Qld 4001 Phone (07) 3840 1444 Fax (07) 3844 9387 E: qnu@qnu.org.au

Branch Secretary Neroli Ellis Office address 182 Macquarie Street Hobart Tas 7000 Ph: (03) 6223 6777 Fax: (03) 6224 0229 Direct information 1800 001 241 (toll free) E: enquiries@anmftas.org.au

Branch Secretary Mark Olson Office address 260 Pier Street, Perth WA 6000 Postal address PO Box 8240 Perth BC WA 6849 Ph: (08) 6218 9444 Fax: (08) 9218 9455 1800 199 145 (toll free) E: anf@anfwa.asn.au

2 April 2015 Volume 22, No.9

143,792

TOTAL READERSHIP

Based on ANMJ 2014 member survey pass on rate Circulation: 98,488 BCA audit, September 2014

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Contents

Volume 22, No 9.

News

4

ANZAC Special

14

Research 17 Professional 19 Legal 21 World

23

Feature – Medicare 24

Medicare under threat

The Americanisation of Australia’s health system

04

14

News

ANZAC Special

30

37

Clinical Update

Focus

A return to nursing rounds

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24

Clinical Update

30

Clinical Review

34

Issues – Respiratory 36 Focus – Women’s Health 37 Calendar 54 Mail 55 Sally 56

ANZAC Nurses

Women’s Health

April 2015 Volume 22, No.9 3

News ANMF leadership team Nurses and midwives have re-elected Lee Thomas as the ANMF Federal Secretary and Annie Butler as Assistant Federal Secretary.

Sally-Anne Jones has been elected as President following outgoing President Coral Levett who opted not to run again for another term after 12 years in the position. Maree Burgess, ANMF Victorian President has now been elected as Federal Vice President.

Ms Thomas said the result was a strong endorsement of the ANMF’s leadership and its achievements over the past four years. “As Federal Secretary over the past four years, I am proud to say that we have achieved significant growth, with our membership now standing at over 240,000 – making us one of the fastest growing unions in Australia.”

Whilst the ANMF had been successful in defeating the federal government’s GP tax, there were many more campaigns that needed to be run, Ms Thomas said.

“We need to develop sustainable solutions to the important issues in health and aged care that impact on the lives of our members and their families.”

Fighting any government attack on penalty rates, saving Medicare, improving

workloads and tackling aged care staffing problems were the key issues for the leadership team, Ms Thomas said.

“Protecting our professions will be a priority over the next four years at the ANMF. This is my guarantee to you.”

RFDS roaring new jet to improve patient care The Royal Flying Doctor Service will have a new aeromedical jet expected to halve the flying time for long-haul patient evacuations.

It is also expected to have the capacity to transfer three stretchered patients and clinical staff from the Northern Territory to any capital city in Australia without refuelling.

Royal Flying Doctor Service (RFDS) Central Operations Chief Executive Officer John Lynch said the $10 million RFDS Pilatus 4 April 2015 Volume 22, No.9

PC-24 jet, from Switzerland, would enable flight staff to reach patients in need in all corners of the territory from Alice Springs in less than 90 minutes. “At least every other day the RFDS will conduct the emergency evacuation of a critically-ill patient from Alice Springs Hospital to Adelaide or Darwin for specialist care.”

The new jet is expected to reduce the flight time to less than two hours.

The first jet will service South Australia and the Northern Territory (NT). In the NT alone, the RFDS conducts an average of seven aeromedical flights every day, which swells to over 100 throughout Australia. anmf.org.au

News GP tax scrapped but Medicare still under threat The Australian Nursing and Midwifery Federation welcomed the federal government’s backflip on its proposed GP tax last month having warned it would destroy Medicare.

ANMF Federal Secretary Lee Thomas said nurses and midwives had fought hard against the federal government’s plans to introduce co-payments for basic health services. “From the start, we all knew it was flawed policy that would hurt all Australians, particularly families, the elderly and those who are some of the most vulnerable in our communities, ultimately resulting in the dismantling of Australia’s

States to tackle ice Victoria and New South Wales announced comprehensive plans to tackle ‘ice’ addiction to protect those addicted and frontline workers, including nurses, last month.

The Victorian government released a $45.5 million ‘Ice Action Plan’ developed with the advice of Victoria Police and health and legal experts to reduce the supply, demand and harm of a drug it said is “ruining lives across Victoria.”

The plan includes training and support for those on the frontline, including nurses, who treat people affected by ice. The Victorian government committed to invest $4.7 million to help families identify and manage ice users. As part of the plan, $400,000 has been allocated to develop a new training program to help give frontline workers, including nurses, the skills to respond and to treat ice-affected patients safely.

The government has established a Specialist Workforce Advisory Group to provide specific advice on the issues affecting workers. Violence and aggression towards nurses, doctors, paramedics, police, child protection workers and social workers would not be tolerated, Victorian Minister for Health Jill Hennessy said. “The Ice Action Plan will make our hospitals safer, and give our nurses, doctors and paramedics the skills they need to safely respond to patients affected by ice.”

The Victorian government also committed

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system of universal healthcare.”

The ANMF warned Prime Minister Tony Abbott that a GP tax would merely shift health costs on to individual patients at a time when Australians suffered some of the highest out of pocket health costs in the OECD, Ms Thomas said.

“We have always maintained that Australians should have access to quality healthcare when they need it, where they need it. It shouldn’t be available to those who have the money to pay for it; otherwise we will end up with an Americanised two-tiered health system,

where you only get treatment if you can afford to pay for it.”

Ms Thomas said nurses and midwives remained reserved about further challenges to the health system. So far, Federal Health Minister Sussan Ley had refused requests to meet with the ANMF, she said. “The government must commit to ceasing its attacks on universal healthcare and outline how it will work with the ANMF and other health groups, through genuine consultation, to strengthen our public health system.

“The Health Minister must commence real consultation as a matter of urgency.”

to invest $18 million to expand drug treatment and rehabilitation so users could get the help they need. A $20 million Health Service Violence Prevention Fund would also be established to make health services more secure, which could include upgrades to hospitals, including extra CCTV cameras.

ANMF Victorian Branch Assistant Secretary Pip Carew has been appointed to the Specialist Workforce Advisory Group to provide advice on the nursing and midwifery professions to the state government’s new Ice Action Taskforce.

Ms Carew said the ANMF welcomed the Victorian government’s announcement of a plan to deal with Victoria’s methamphetamine problem. “The role of the Specialist Workforce Advisory Group is to advise on how methamphetamine use is affecting workers, specifically how to ensure a safe working environment and prevent ice-related occupational violence being experienced by the nursing and midwifery workforce and other health professionals, as well as to advise on the training needs of health professionals. It is gratifying that the Andrews Government is viewing the Ice Action Taskforce as a work-in-progress and will continue to accept advice from the ANMF and other groups who have expert knowledge about how methamphetamine abuse is affecting users, the community and the workforce.”

The advisory group will work with the 16-member taskforce to be chaired by Premier Daniel Andrews. “Across our state, good, smart kids are dropping out of school, running away from their families

and falling out of society. Ice is ruining lives, and the time to act is now,” he said.

The NSW government also announced a package to deal with ice in the community last month. The new measures would include increased roadside drug testing by police, mandatory state-wide online recording of pseudoephedrine sales in pharmacies and more funding for treatment and rehabilitation services.

“This is a tough package to go after the drug dealers peddling this evil drug, the backyard manufacturers and anyone reckless enough to get behind the wheel while high on drugs.” NSW Premier Mike Baird said.

The NSW government said it had consulted with health professionals and police to develop a multi-dimensional plan to target manufacturers and suppliers, while also addressing the needs of users and addicts.

April 2015 Volume 22, No.9 5

News ALZHEIMER’S AUSTRALIA

Call for action on dementia People with dementia, their families and carers attended a consumer summit held at Parliament House in Canberra last month to raise concerns and call for action on dementiarelated issues.

There are currently more than 342,000 Australians living with dementia, with that number set to rise to almost 900,000 by 2050, according to Alzheimer’s Australia.

“Given dementia’s significant economic and social impact, it is important that our government starts preparing and planning for adequate dementia services and supports for the future,” National Alzheimer’s Australia President Graeme Samuel said.

was about $4.9 billion. It is estimated to become the third greatest source of health and residential aged care spending within two decades.

The 2015 Intergenerational Report released last month showed a projected 5.7% increase in health expenditure by 2055 under current legislation with spending per person expected to more than double. In 2009-2010, the cost of dementia to Australia’s healthcare system

There were four priority areas the federal government must invest in, Mr Samuel said. These were: dementia prevention programs; dementia-specific services; a national program to tackle the stigma and social isolation associated with dementia; and dementia research.

More than 50 people attended the forum in Canberra last month.

One of the consumers who attended the summit, Vicki Noonan, who has younger onset dementia and is a wife, mother of two and former primary school teacher said there was an urgent need for expanded dementia-specific services, particularly for those with younger onset dementia. “People need to understand that people with dementia have unique care needs, and this is even more important for people like me who live with dementia and are under the age of 65.”

The National Dementia Helpline number is: 1800 100 500

Nurses and midwives ridding the world of nuclear weapons

Dr Amanda Ruler RN, National Vice President of the Medical Association for Prevention of War The Medical Association for Prevention of War (MAPW) is a concerned group of professionals and students from all fields of health that has played an important role in advocating for a nuclear weapons ban and a reduction of armed conflict.

There are currently about 16,400 nuclear weapons in the world, with several thousand on hair trigger alert. Nuclear weapons are unlike any other weapons in their ability to cause indiscriminate harm to millions of people in a single detonation as well as persistent, spreading and genetically damaging radioactive fallout.

The use of even 100 nuclear bombs is also likely to disrupt the global climate, causing reduced food production and widespread famine.

If future wars are fought with nuclear weapons, we are likely to destroy much life 6 April 2015 Volume 22, No.9

on earth. There are no winners in a nuclear war.

Survival today depends on reducing, controlling, channelling and redirecting the drive for power and the impulse to violence. Instead we must foster cooperation between nations on the major problems that threaten us all.

Australia is one of the biggest military spenders in the Asia Pacific region. Our Defence budget for 2013-2014 was $25.3 billion. The world spends approximately US $105 Billion on nuclear weapons every year and in 2012 the world military expenditure for that year was $1.7 trillion.

Less than a third of the world’s military spending would eradicate extreme hunger and poverty, and send all children to school. The World Bank has estimated $135 billion dollars in foreign aid is needed to eliminate world poverty.

Despite ongoing rhetoric in favour of achieving a world without nuclear weapons, governments have not yet begun negotiations on a global nuclear weapons ban treaty. However, there are very helpful signs that such a process could begin. The processes that led to treaties banning landmines in 1997 and cluster munitions in 2008 demonstrated the importance of adopting a humanitarian – based discourse, resulting in these two classes of weapons being outlawed.

Major government and civil society conferences held in Norway, Mexico and Austria in 2013 and 2014 have taken a similar approach to nuclear weapons. A momentum is building, but much work remains to be done.

To help the cause, join MAPW at www.mapw.org.au or contact Amanda Ruler RN at amanda.ruler @ mapw.org.au. anmf.org.au

When pain is gone, the smile is back.

Nothing is more effective than Children’s Panadol® 1 –4† Suitable from 1 month of age, Children’s Panadol®‡ effectively relieves pain and fever caused by teething, headache, earache, immunisation, and symptoms of cold and flu.1–3

†

Refers to non-prescription medicines at the recommended Australian doses for paediatric paracetamol (15 mg/kg) and ibuprofen (10 mg/kg).‡Guidelines recommend paracetamol for the first-line treatment of pain and fever in children.5

References: 1. Autret-Leca E et al. Curr Med Res Opin 2007;23:2205–11. 2. Walson PD et al. Am J Dis Child 1992;146:626–32. 3. Schachtel BP et al. Clin Pharmacol Ther 1993;53:593–601.

4. Celebi S et al. Indian J Pediatr 2009;76:287–91. 5. NSW Department of Health. Policy Directive: Paracetamol Use. Available at: http://www.health.nsw.gov.au/policies/pd/2009/PD2009_009.html.

Accessed January 2015.

Children’s Panadol® contains paracetamol. For the temporary relief of pain and fever. PANADOL® and package design elements are registered trade marks of the GlaxoSmithKline group of companies.

GlaxoSmithKline Consumer Healthcare, 82 Hughes Avenue, Ermington, NSW 2115 Australia. GSK1481/UC 02/15. CHANZ/CHPAN/0021/15b.

News Calls for more Aboriginal and Torres Strait Islander nurses The Congress of Aboriginal and Torres Strait Islander Nurses and Midwives is calling for more efforts to recruit, graduate and retain more of its peoples to nursing and midwifery.

The call came at a lobbying day at Parliament House held in Canberra last month.

A staggering 12,727 Aboriginal and Torres Strait Islander (ATSI) nurses were needed around Australia, according to the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM).

While there were 186 Aboriginal and Torres Strait Islander midwives, a further 852 were needed, CATSINaM’s Chief Executive Officer Janine Mohamed said.

“There are simply not enough of us to meet the health needs of our people.”

Even with the important gains that had been made, Aboriginal and Torres

Strait Islander people still died 10 years younger on average than the rest of the community, she said. “We know that if we are to turn this picture around, building and supporting the nation’s outstanding Aboriginal and Torres Strait Islander health workforce is critical to success.”

Ms Mohamed said Aboriginal and Torres Strait Islander nurses and midwives delivered first rate healthcare in a way that understood and respected culture, specific needs, obligations and challenges of their patients. “We do this within an understanding of cultural obligations and commitments to our communities and with enormous pride in our cultural identity as the first peoples of this land.”

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News As a Narrunga woman from South Australia and former registered nurse, CEO Ms Mohamed gave respect to Sister Alison Bush, an Aboriginal midwife for 40 years, from 1902, who delivered over 1,000 babies in her time. “She described pregnancy and childbirth as being ‘sacred’ to our people.”

Ms Mohamed said Sister Bush was possibly the first nurse to leave an indelible mark for Aboriginal and Torres Strait Islander nurses and midwives.

Despite the nation having had a “fresh look” at the immense challenge that still laid ahead to ‘Close the Gap’, there was still an “enormous mountain to climb”, Ms Mohamed said. CATSINaM would continue its ongoing commitment to the ‘Close the Gap’ campaign, she said.

Ms Mohamed acknowledged nonIndigenous nurses and midwives who chose to work in Aboriginal health due to their shared commitment in improving

GSK1482_Panadol_Effective_ANMJ_Half Page Ad_Landscape_v4c_FA_outlined.indd 1

Aboriginal and Torres Strait Islander peoples’ health. “Closing the Gap in life expectancy can only be achieved through such partnerships and commitment.”

CATSINaM recently commissioned a health economics analysis which showed evidence that investing in Aboriginal and Torres Strait Islander nursing education and training and employment was a costeffective approach to ‘Closing the Gap’.

“The nation now has an enhanced ability to make relatively large health and life expectancy gains in a relatively short period of time,” Ms Mohamed said.

The report is available on CATSINaM’s website: http://catsinam.org.au/ For more information on the ‘Close the Gap’ campaign, visit: www.oxfam.org.au/explore/ indigenous-australia/close-the-gap/ www.naccho.org.au/aboriginalhealth/close-the-gap-campaign/

18/02/2015 5:28 pm

News

Nurses and midwives rally against cuts to penalty rates Nurses and midwives joined rallies across Australia last month to fight for workers’ rights, in particular against any plans to cut penalty rates.

Thousands of Australians rallied around the country on 4 March to fight for the rights of working Australians. The recent full scale Productivity Commission inquiry into rights at work showed: it could deliver cuts to penalty rates; the abolition of the minimum wage; and bring back unfair individual contracts.

A recent ANMF survey of more than 13,000 nurses and midwives found an overwhelming 93% warned they would be prepared to take action to protect their penalty rates. Over 60% said this would include stop work or strike action.

The national ANMF survey’s key findings of the 13,101 respondents found that 92% currently do shift work outside of normal hours; and 90% reported shift work affected their life outside work, particularly 10 April 2015 Volume 22, No.9

night and weekend shifts.

Of those respondents 38.9% said penalty rates compensated for the effects of shift work on their lives, while 49.2% reported they at least partially compensated.

A stark warning to the government, 87% of survey respondents indicated they would stop working shift work if penalty rates were removed or lowered. An overwhelming 92.7% said they would take action to protect their penalty rates and just over 60% indicated they would take stop work or strike action.

One survey respondent said: “Shift work is exhausting. It affects my social and personal life, health and fitness. I love nursing but if penalty rates are taken I’d leave the industry.”

Another nurse said this month alone, she’d

had only one weekend off. “This weekend I’m working night shifts all weekend, leaving me no time at all to spend with my family or friends. Shift work, particularly afternoon and night shifts means that even days off can leave you exhausted.”

ANMF Federal Secretary Lee Thomas said the overwhelming response from its members clearly showed the importance of penalty rates to nurses and midwives as some compensation for missed time with their children, families and friends and social and community activities to do their job. “Nurses and midwives deliver care 24-7, they must – this is how the health system survives.”

Ms Thomas said thousands of nurses and midwives had described the significant toll shift work had on their lives, in particular on their families, friendships and even their anmf.org.au

News AN OVERWHELMING 92.7% SAID THEY WOULD TAKE ACTION TO PROTECT THEIR PENALTY RATES AND JUST OVER 60% INDICATED THEY WOULD TAKE STOP WORK OR STRIKE ACTION health. “They have told us that penalty rates make a big difference and allow them to bring at least some balance into their lives.

“It’s only fair and just that nurses and midwives are fairly compensated for working these unsociable hours, on weekends, public holidays and special days like Christmas, when they leave their own families and friends to care for others.”

NSW Nurses and Midwives’ Association (NSWNMA, ANMF NSW Branch) General Secretary Brett Holmes said nurses and midwives felt compelled to act. Attacks on penalty rates for nurses and midwives could mean a cut in take home pay by up to 30% working shifts, he said. “Attacks like these on penalty rates are a direct attack on

Qualification in human behaviour: a professional and career development opportunity Sue Kokonis

On a daily basis, nurses and midwives deal with people from all walks of life and in all states of mental wellness. As the first point of contact for patients, carers, family and friends who are responding to a stressful situation, nurses and midwives often take on an important role in managing a range of behaviours.

Understanding how to analyse behaviour, relationships and motivations of people is a skill that many nurses have innately, but this is often not formally recognised.

There are many options available to those wanting to upskill in this area.

Short courses, attending conferences

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nurses and midwives’ right to fair pay and conditions, regardless of where they are employed throughout the health and aged care sectors.

ANMF ACT Branch Secretary Jenny Miragaya said nurses and midwives were also not prepared to stand by and watch the future of Medicare at risk. “The Abbott government’s narrative is that Medicare is not sustainable, that a ‘price signal’ needs to be sent, and that there is no such thing as a free healthcare system.”

Ms Miragaya said Australia spent about 9% of GDP on health and had achieved a healthcare system which ensured equitable access for those who needed it when and where most. “It is the envy of the world.

The US spends more than 15% of GDP on a healthcare system which is far from equitable, does not ensure universal access and has the capacity to bankrupt those most in need of care.”

Greens Deputy Leader and industrial relations spokesperson Adam Bandt said the Greens would move to stop the Productivity Commission examining the issues in its inquiry into the workplace relations

and reading up on the variety of texts that cover this topic are just a few. But if you want to further your knowledge in human behaviour, a degree in psychology could be the best option.

While taking on a university degree can appear daunting, particularly for those already balancing work and life commitments, the tertiary system has evolved to be more flexible for working adults, making upskilling or formalising experience attainable.

Understanding of developmental, cognitive and social psychology can be applied at both an organisational and personal level. Paired with nursing and/ or midwifery experience, a psychology degree can open a mired of professional and career opportunities.

For most people it’s not an option to quit a job and return to full time study, which is why many universities are developing degrees that are tailored to the ‘working professional’.

This includes courses offered on weekends and evenings to allow for

framework. MP Bandt said he suspected the attack on penalty rates and the minimum wage wasn’t “dead but just resting”.

The Greens have called on the government to exclude the minimum wage and penalty rates from the Productivity Commission’s inquiry into the workplace relations framework.

Australian Council of Trade Unions (ACTU) President and former ANF Federal Secretary Ged Kearney said the federal government’s Fair Work Amendment bills would take away rights at work and make it easier for employers to force workers on to unfair individual contracts that would slash penalty rates. The federal government had already cut 8,000 public sector jobs and planned to slash another 8,000 more, she said. “At the same time, it is trying to reduce job security and redundancy rights for public servants, increase working time hours, remove rights and entitlements, reduce leave entitlements, and remove guaranteed super contribution rates from agreements.”

Ms Thomas said the ANMF and its members would fight hard to protect penalty rates and would remain among the union’s key agenda issues in 2015.

work commitments, courses offered in week long blocks allowing students to take leave to complete a subject, and courses offered fully online so that students can study in their own time.

The popularity of the online learning model is the flexibility that it offers. Studying online means you can continue to work and study concurrently – no matter what your roster might look like. It also means that what you learn in the online classroom one day can be applied straight into your work environment the next.

The nursing and midwifery professions work closely with different people. If you have an interest in human behaviour and want to take the next step in your career, a psychology degree could be the career advantage that you need to get you there.

Swinburne Online offers degrees fully online: www.swinburneonline. edu.au/courses/bachelor-socialscience-psychology

April 2015 Volume 22, No.9 11

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Search more Postgraduate & CPD course opportunities at HealthTimes.com.au 12 April 2015 Volume 22, No.9

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News NMBA UPDATE Registration fee drop The national registration fee for nurses and midwives is being reduced to $150 this year. This is to be consistent with NMBA’s commitment to maintaining fees at a reasonable level. Additionally, registrants who hold both nursing and midwifery registrations will now only pay one registration fee.

To ensure nurses and midwives register, the NMBA is launching its 2015 registration renewal campaign this month. If you are a registered nurse, an enrolled nurse, a midwife or a nurse practitioner, look out for renewal reminders from the Australian Health Practitioner Regulation Agency (AHPRA) starting around mid-March.

A series of email reminders will be sent throughout the renewal campaign.

Make sure your email contact details as held by AHPRA are up to date so you don’t miss them.

To update your contact details use AHPRA’s secure online services for health practitioners.

If you do not renew your registration by 31 May, or within the following onemonth late period, your registration will lapse. Your name will be removed from the national register of nurses and midwives and you will not be able to practise without making a new application for registration.

We remind you to carefully read the NMBA’s requirements for registration renewal. Make sure you understand the

Gender pay gap at record high The national gender pay gap has increased to a record high, according to the latest data released last month.

The Australian Bureau of Statistics (ABS) data showed the gender pay gap at 18.8%. On average, a man working full time earns $1,587.40 per week while a woman working full time earns $1,289.30 per week. That equates to a difference of $298.10 per week. The new figures are anmf.org.au

declarations you must make regarding mandatory registration standards.

Giving false or misleading information is grounds for the NMBA to refuse registration.

National Board registration standards are published on our website.

Specialist recognition and the nursing profession On transition to the National Scheme, the Nurses and Midwifery Board of Australia (NMBA) considered the endorsement of a range of nursing specialties and at the time it was decided to limit registration to those under the Health Practitioner Regulation Law as in force in each State and Territory.

The NMBA however, made a commitment to review this matter in 2013–2014. A project was initiated to undertake an exploratory study to inform the National Board in relation to the possible need for and value of regulating all health professional specialties for the purpose of registration.

IF YOU DO NOT RENEW YOUR REGISTRATION BY 31 MAY, OR WITHIN THE FOLLOWING ONEMONTH LATE PERIOD, YOUR REGISTRATION WILL LAPSE. identified a number of documents that required revision or re-write and a number of recommendations to improve stakeholder engagement with our web page.

Based on this review, a new suite of updated and streamlined NMBA documents including guidelines, policies, position statements, fact sheets and frameworks are being finalised. We now have the following documents available: Revised documents • Fact sheet - The context of practice

for registered nurses and midwives • Fact sheet - The use of health

The project has now been completed and we have published a position statement- Specialist recognition and the nursing profession, which can be viewed on on our website under codes, guidelines and statements.

Context of practice for registered nurses and midwives, plus other new and revised documents published The NMBA has conducted a review and analysis of its suite of documents to ensure consistency across the national policies, guidelines, standards, codes and position statements. The review

based on data collected in November 2014.

The national gender pay gap has increased 1.4% since November 2013 when the gap was 17.4%.

Workplace Gender Equality Agency’s Research Executive Manager Dr Carla Harris said it was “very concerning” to see the national gender pay gap at a record high of 18.8%. “It’s clear that women aren’t getting the same earning opportunities as men, and this has implications for women’s financial security, particularly in old age.”

practitioner protected titles New document • Position Statement - The role of

nurses and midwives in a national emergency More documents will be added in the coming weeks and can be viewed under codes, guidelines and statements on the NMBA website.

For more information on the above go to: www. nursingmidwiferyboard.gov.au

Australian Council of Trade Unions (ACTU) President Ged Kearney said the government could no longer pay lip service to increasing women’s participation in the workforce and tackling inequality. “The time for talk is over – Australian working women need action.”

Ms Kearney said Australian unions called on the government for several recommendations, including: to expand paid parental leave to 26 weeks (at the minimum wage) and include superannuation; and increase childcare funding.

April 2015 Volume 22, No.9 13

ANZAC Special ANZAC nurses This year marks 100 years since the ANZAC offensive at Gallipoli. As the soldiers fought at the front lines, behind the scenes nurses undertook their own battle – keeping alive the many wounded soldiers who came into their care.

Jessica Gadd shares some of their stories.

Wards and patients. [3rd Australian General Hospital, Turks Head Peninsula, Lemnos 1915]. Photograph by AW Savage. Mitchell Library, State Library of NSW.

Dawn 25 April 1915: the ANZAC troops landed at Anzac Cove, charged with the task of capturing one of two Turkish forts located on the Gallipoli Peninsula. The troops soon realised that the campaign would be much more difficult than first thought: the fierce resistance they encountered resulted in a stalemate that would last for eight months, with heavy losses incurred on both sides.

Treating the ANZAC casualties ferried from the peninsula to the hospital ships were allied nurses, among them Sister Ella Tucker Australian Army Nursing Service (AANS), who records on that fateful April morning on board the hospital ship Gascon just seven nurses treated 557 patients with “shells bursting all around”.

“The wounded from the landing commenced to come on board at 9am and poured into the ship’s wards from barges and boats,” Sister Tucker wrote. “The majority still had on their field dressing and a number of these were soaked through. Two orderlies cut off the patient’s clothes and I started immediately with dressings. There 14 April 2015 Volume 22, No.9

were 76 patients in my ward and I did not finish until 2am.” (quoted in Baker 1989).

In May, a month later, Sister Tucker was still becoming accustomed to the ghastly nature of her duties on board. The wards were crowded and poorly ventilated, particularly on the lower decks, and both nurses and patients often suffered from seasickness. In her diary she records: “Every night there are two or three deaths, sometimes five or six; it’s just awful flying from one ward into another … each night is a nightmare, the patients’ faces all look so pale with the flickering ship’s lights.” (quoted in Baker 1989).

Another nurse to work with the Gallipoli casualties, Sister Alice Kitchen, was horrified by the conditions endured by the soldiers before they received treatment. On 12 August 1915, she wrote in her diary: “To leave injured soldiers in the blazing sun for days without dressing their wounds or giving them water is mass murder. Our poor boys. If only the world knew how badly they are treated.” (quoted in The Sydney Morning Herald 2004).

Serving on hospital ships brought the Australian nurses into close contact with the fighting at Gallipoli. Although the Turkish and German forces generally refrained from attacking the hospital ships, they occasionally did come under fire and in one case a bullet narrowly missed a nurse, Daisy Richmond, who stepped aside just in time to avoid being fatally shot – the bullet instead hitting one of the patients in the leg.

Wounded soldiers were generally only on the hospital ships for a short time before being transferred to stationary hospitals – initially in Alexandria, 1,050km away in Egypt – and then on the Greek Island of Lemnos, much closer at just 60km by ship, where a number of hospitals were established by countries such as Britain, Canada and Australia.

Records show that at least 130 Australian nurses were stationed on Lemnos. About 25 of these served in the second Australian General Hospital; the rest served at the third Australian General Hospital, known as 3rd AGH. Both hospitals were located on the Western Shore of Lemnos’ Mudros Bay, one of the largest natural harbours in the eastern Mediterranean. anmf.org.au

ANZAC Special IN JUST TWO MONTHS, FROM AUGUST TO OCTOBER, 57,000 SICK AND 37,000 WOUNDED WERE EVACUATED FROM THE BEACHES OF GALLIPOLI TO THE ALLIED HOSPITALS ON LEMNOS Illness would prove as much a danger to the soldiers as fighting on the front line: diggers were as likely to die from dysentery and dehydration as they were from bullet or shrapnel wounds. There was little or no triaging on the piers at Anzac Cove in the first months of the campaign – it was often a first come, first serve basis when it came to getting on to the hospital or transport ships off the peninsula.

“Unlike the few official hospital ships, the transports were often filthy, having carried horses and mules, and they were known as ‘black ships’ – legitimate targets because they could be carrying soldiers or ammunition,” explains historian Jim Claven.

Desperate days Nurses experienced many of the same privations the soldiers experienced, including the terror of being under attack, harsh climatic conditions, inadequate water and food supplies, overwork due to understaffing, dysentery, and the psychological repercussions of enduring the horrors of war. One of their biggest challenges was to maintain good cheer for the benefit of their patients, despite often being unable to do much to help them or ease their suffering.

This frustration was felt keenly by Brisbaneborn Matron Grace Wilson, who was en route to serve in France with the entire 3rd AGH unit when a request for further assistance treating the wounded from Gallipoli saw them transferred to Lemnos.

They arrived on 8 August only to learn that although their medical supplies had not yet arrived, wounded soldiers were already awaiting their care, lined up on the bare hillside above the bay. Matron Wilson records the hospital’s desperate first days: 9 August — Found 150 patients lying on the ground — no equipment whatever … had no water to drink or wash.

10 August — Still no water … convoy arrived at night and used up all our private things, soap etc, tore up clothes [for bandages].

11 August — Convoy arrived — about 400 — no equipment whatever … Just laid the men on the ground and gave them a anmf.org.au

drink. Very many badly shattered, nearly all stretcher cases … Tents were erected over them as quickly as possible … All we can do is feed them and dress their wounds …

A good many died … It is just too awful — one could never describe the scenes — could only wish all I knew to be killed outright. (quoted in Bassett 1992) It would be nearly three weeks before the promised supplies arrived, during which time the nurses cared for the wounded with no sanitation and almost no water, using their own torn-up petticoats for bandages. Once the hospital tents did arrive, the nurses had to learn new skills in keeping them upright, for they were often blown over during wild weather.

These skills mastered, and supplies finally in hand, the nurses at 3rd AGH were tending to more than 900 wounded by the end of August, and they managed to achieve an overall mortality rate of just 2.5% during the hospital’s time on Lemnos.

“To give an idea of scale, in just two months, from August to October, 57,000 sick and 37,000 wounded were evacuated from the beaches of Gallipoli to the allied hospitals on Lemnos, and from August more than 100,000 casualties were shipped from Mudros to other medical facilities in Egypt, Malta and England,” says Mr Claven. “Despite these numbers and a scarcity of medical supplies, some 98% of the patients recovered. The main way they achieved this was through sanitation. The nurses helped patients stabilise and recover largely by maintaining cleanliness and good hydration.

“The nurses were commended at the time

by Australia’s senior medical commander; Lieutenant General Featherstone, who wrote: ‘I believe that the hospital would have collapsed without the nurses. They all worked like demons and were led and guided by Miss Wilson’.”

After the evacuation of Gallipoli, 3rd AGH and its staff were transferred to Abbassia, Egypt. In 1916 Matron Wilson was recommended for the Royal Red Cross, First Class for ‘distinguished service in the field’, among other honours (Bassett 1992).

Grave of Nurse Clarice Daley and Sergeant Ernest Lawrence, St Kilda Cemetery.

Photograph Jim Claven, 2014.

Love finds a way What’s an ANZAC nurse to do when her former beau shows up in an army hospital off Gallipoli?

She marries him, of course!

Third Australian General Hospital nurse Clarice Daley, from Box Hill, Melbourne, married Sergeant Ernest Lawrence on Lemnos on 21 October 1915. The marriage was witnessed by Matron Grace Wilson, who must have turned a blind eye to the rules because Sister Daley remained on Lemnos working as a nurse (at the time, married women were not permitted to nurse) until Gallipoli was evacuated.

Sergeant Lawrence continued to serve until he returned to Australia in late 1918. The two are buried together at Melbourne’s St Kilda cemetery.

April 2015 Volume 22, No.9 15

ANZAC Special COMMEMORATING THE WWI NURSES’ SERVICE IS ONE OF THE MAIN INTENTIONS BEHIND A MEMORIAL STATUE THAT WILL BE ERECTED LATER THIS YEAR IN MELBOURNE’S ALBERT PARK, NOT FAR FROM PRINCES PIER, WHERE MANY OF AUSTRALIA’S NURSES AND DIGGERS MADE THEIR DEPARTURE. The Minister and witnesses gather around the bride and groom after their wedding at the Church camp, West Mudros [Lemnos].

21 October 1915.

Women at war The Australian War Memorial reports over 3,000 civilian nurses volunteered for active service during WWI, many of them through the Australian Army Nursing Service (AANS), which was formed in 1903 as part of the Australian Army Medical Corps. Overall during WWI more than 2,000 AANS members served overseas alongside Australian nurses working with other organisations, such as the Queen Alexandra’s Imperial Military Nursing Service (QAIMNS), the Red Cross, or privately sponsored facilities, and 423 served in hospitals in Australia. During the war 25 of these nurses died and 388 were honoured for their service (Australian War Memorial).

The Gallipoli campaign began to wind down in December 1915, with all of the troops and medical staff evacuated

by January 1916. Many of the nurses who served at Gallipoli went on to serve elsewhere in the war – Matron Grace Wilson would even go on to serve in WWII. Dr Kirsty Harris, author of More than bombs and bandages: Australian Army nurses at work in World War I (Big Sky Publishing, 2011), says that while many military nurses had been given the opportunity to develop a wider set of nursing skills and roles, it is not obvious that they were able to use them in civilian nursing on their return.

“Certainly, military theatre nurses had a greater knowledge of trauma management and emergency operations, useful for dealing with increasing numbers of casualty 16 April 2015 Volume 22, No.9

patients from vehicle and industrial accidents,” Dr Harris writes in her essay Work, Work, Work: Australian Army Nurses after the First World War. “War nurses were able to carry out anaesthetics, surgical work and dispensing, normally the domain of other medical professionals.“ Dr Harris points out that while some historians believe that the AANS set the standards for Australian hospital nursing after WWI, on return many nurses actually left hospital nursing and went on to pioneer other fields such as infant welfare, repatriation nursing, industrial and school nursing. Many would also go on to open private nurses’ homes.

“It is evident that army nurses did not draw significant attention to their military nursing.

From a historical perspective, many were singularly silent or ‘self-forgetful’,” Dr Harris writes. “Others related that ‘no words could adequately describe’ the great services they rendered, so they also said nothing. Not enough is known about these First World War days of military nursing – as an article in the Victorian nursing journal Una in 1917 recorded, they might well be called ‘the Silent Service’.”

Commemorating the WWI nurses’ service is one of the main intentions behind a memorial statue that will be erected later this year in Melbourne’s Albert Park, not far from Princes Pier, where many of Australia’s nurses and diggers made their departure. The memorial’s other intention is to celebrate the island of Lemnos’ connection with the nurses and soldiers who served at Gallipoli.

“Despite the hardships, Australians obviously had good memories of their time on Lemnos,” Historian Jim Claven says. “There were many streets and houses across Australia called Lemnos or Mudros – and there’s even a soldier settlement town called Lemnos near Shepparton, in Victoria. There is evidence that the famous Simpson’s donkey was from Lemnos. It’s a story that needs to be told.”

The Lemnos Gallipoli Memorial is planned to be unveiled at Albert Park, 8 August, 2015, the centenary of the arrival of the Australian nurses on Lemnos. For more information: http://lemnosgallipolicc. blogspot.com.au/ Reference: Australian War Memorial: Great War nurses www.awm.gov.au/exhibitions/nurses/ww1/ Australian War Memorial, Royal Red Cross, First Class: Matron G M Wilson, 3 Australian General Hospital: www.awm.gov.au/collection/RELAWM31816.002/ Barker, M.,(1989) Nightingales in the Mud: The Digger Sisters of the Great War, 1914-1918 www.anzacsite. gov.au/5environment/nurses.html Bassett J.,(1992) Guns and Brooches : Australian Army nursing from the Boer War to the Gulf War, p.46 www.anzacsite.gov.au/5environment/nurses.html Harris K., ‘Work, work, work: Australian Army nurses after World War I’, in Martin Crotty (ed.) When the Soldiers Return: November 2007 Conference Proceedings, School of History, Philosophy, Religion and Classics, University of Queensland, Brisbane, 2009, pp 183-193.

Time to Salute our unsung heroes: The Sydney Morning Herald, 12/04/2004 www.smh.com.au/ articles/2004/04/11/1081621835179.html?from=storyrhs%26oneclick=truE

anmf.org.au

Research Research shows smoking causes more deaths than thought

Elderly suicide alarming Three Australians aged 75 and older kill themselves every week, according to data released last month.

Up to two thirds of deaths in current smokers in NSW alone can be attributed to smoking, recent research shows.

The Australian Council on Smoking and Health (ACOSH) and the Public Health Association of Australia (PHAA) have called for campaigns to reduce smoking to be intensified following the findings.

The open access study published in the journal BMC Medicine showed 13% of adults reported they smoked daily in 2013.

The study was based on data from 204,953 people aged 45 years or older in NSW during 2006-2009 and linked to mortality rates to mid-2012 with no history of other cancer (other than skin cancer), heart disease, stroke or thrombosis. Overall, 5,593 deaths occurred during the study period: 7.7% were current smokers and 34.1% past smokers since the study commenced.

ACOSH President Professor Mike Daube said the results were “staggering”. “That’s nearly two million people now alive. If anything else caused that death toll it would

be seen as a national catastrophe.

“We need a clear plan from governments to reduce that toll to an absolute minimum – further tobacco tax increases, strong mass media campaigns, protection for non-smokers and support for disadvantaged groups.”

It was also, time to ban all tobacco industry promotion, he said. PHAA Chief Executive Officer Michael Moore said the research confirmed smoking was still Australia’s single most preventable cause of death and disease and “kills even more smokers that we had thought”.

It emphasised the risks of even light smoking, he said. “The conclusion is clear. We must do everything possible to encourage smokers to quit and to quit now. We cannot stand by and see yet more generations of Australians dying, often painful deaths, because they smoked.”

Are health websites too hard to read?

Australian health websites are too difficult for the average person to read, a Deakin University study has found.

The research compared the readability of Australian online health information to the average reading level of Australians. Results showed health websites were pitched above the average Australian reading level.

This made them an ineffective way to provide health information to the community, according to researchers Dr Matthew Dunn and Ms Christina Cheng with Deakin’s School of Health and Social Development.

“With around 16 million Australians active online and almost 80% of them seeking out health information the internet is clearly an important way to help people understand and make decisions about their health,” Dr Dunn said.The researchers reviewed the content of 251 web pages of 137 websites which related to health conditions, including: bowel, breast and prostate cancer; heart disease; anxiety and depression; diabetes; asthma; arthritis; back pain; obesity; and dementia.To determine readability, pages were assessed against a year eight reading level. Results showed only 2.4% of pages anmf.org.au

were considered ‘easy to read’ and 0.4% viewed below a grade eight reading level.

None of the mean grade levels of the 12 health conditions matched the grade eight benchmark, with information on dementia and obesity found to be the most difficult to read, Dr Dunn said. “That dementia and obesity information are among the most difficult to read is cause for concern. The growing prevalence of these two conditions means it is essential that easy to read health information is available to meet the needs of those most at risk of developing obesity and dementia.” The flexible and interactive nature of the internet had provided health professionals with a tool that had great potential to increase the health literacy of the general population, Dr Dunn said.

The open access study, ‘Health Literacy and the Internet: a study on the readability of Australian online health information is available in the Australian and New Zealand Journal of Public Health at http://onlinelibrary.wiley.com

The Australian Bureau of Statistics (ABS) data shows if the base age is reduced to 70, the number is closer to four per week.

Alarmingly, both the ABS and coroner consider the figures under-reported. In the 10 years to 2004, almost 1,500 Australians aged 75 and older killed themselves, mostly by hanging. The next most common method of suicide was firearms, then gas, poison, drowning and jumping from buildings.

Less violent methods such as refusing food and fluids had also been used. A recent court decision in Western Australia confirmed a competent adult could choose suicide by refusing nourishment. Former Northern Territory Chief Minister Marshall Perron said the case “highlighted just how obnoxious the current law was.”

Examples were common of terminally ill people scheming to be alone to kill themselves without interference. Fear of loved ones being implicated in unlawful acts also led to planning to suicide secretly without consultation or goodbyes. Without information or access to appropriate drugs, elderly people sought to suicide violently and alone.

As a result of being denied assistance, many deaths were unnecessarily premature, lonely and violent, Mr Perron said. “A doctor can lawfully assist a patient endure the process of dying slowly over two weeks yet they cannot lawfully assist them die in minutes by prescribing appropriate drugs.”

Mr Perron contributed a chapter on voluntary euthanasia in new publication Who speaks for and protects the public interest in Australia by think tank Australia, launched in Canberra late February.

Dying with Dignity Victoria Vice-President Dr Rodney Syme said with the rapidly growing population, the numbers of suicides could be expected to increase. Politicians should be discussing the issue, he said. “My observation is that with rare exception, politicians avoid the issue whenever they can. They try to ignore the subject in the hope it will go away.

“The community is not asking politicians to lead on this issue, they are asking them to catch up.”

April 2015 Volume 22, No.9 17

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Professional Regulation matters

Julianne Bryce, Elizabeth Foley and Julie Reeves, Federal Professional Officers It’s that time of year again when the Nursing and Midwifery Board of Australia (NMBA) will be sending us reminders to renew our nursing and/ or midwifery registration. If you’re an enrolled nurse (EN), registered nurse (RN), midwife or nurse practitioner (NP), you need to renew your registration before 31 May 2015, to be able to retain your right to practise as a regulated health practitioner.

The easiest way to renew is to use the online facility provided by the Australian Health Practitioner Regulation Agency (AHPRA), the administrator for the NMBA. The online registration renewal process is now used by most nurses and midwives. A major benefit of this is that a wealth of information on nurses and midwives is now more readily available than was previously possible. This is particularly important for an organisation like the ANMF when we need timely, accurate data to advocate for the nursing and midwifery professions at the national level.

In December last year the NMBA published information from the national registration database* which showed there are currently 356,071 nurses and midwives registered in Australia. Within this total number there are approximately 33,500 who hold dual registrations. This is made up of: • just under 4,000 who hold dual registration as an EN and an RN (EN/RN), and • almost 29,500 who hold dual registration as a RN and Midwife (RN/M) (with a very small number holding EN and Midwife registration (EN/M)).

Dual registration as an EN/RN With the introduction of the National Registration and Accreditation Scheme on 1 July 2010, the NMBA recognised that nurses in a number of jurisdictions had been able to hold concurrent or dual registration as both a RN and an EN. Initially the NMBA determined anmf.org.au

this facility for concurrent registration should cease in 2014. However, successful lobbying from the ANMF and others, and legal advice obtained by the NMBA, led to a reversal of this decision. While the numbers of nurses in this category appear small (as shown above) their dual registration status is seen as important to be retained either temporarily or on a permanent basis.

For example, an EN who has completed a Bachelor of Nursing and gained registration as an RN, may wish to maintain their registration as an EN at least for an interim period between completion of qualification and gaining employment as an RN. This is particularly pertinent in the situation of a recently graduated RN who may have a gap of some months or longer prior to being able to find a position in a transition to practice program or gain work in a supportive environment where they are employed as an RN. Dual registration has been the saving grace for hundreds of newly graduating RNs across the country.

Those graduates who are also ENs have had the opportunity to continue to deliver safe and competent nursing care as an EN under the supervision and delegation of an RN, in this interim employment period.

Dual registration has also served to avoid the necessity for the newly graduated RN to seek casual employment in an RN role in an often unpredictable and potentially stressful and unsupervised environment.

Dual registration as an RN/M The ANMF Branch professional officers advise us that some RN/M members have received advice from state/territory APHRA offices they should not maintain their dual registration. There is no legitimate reason for this and the ANMF strongly encourages members to retain dual registration as a registered nurse and a midwife. While there is now a separate register for these two

protected titles, there is only one fee. There are many work situations in which it can be advantageous to hold registration as both a nurse and a midwife, such as, rural, remote or isolated practice.

The NMBA’s fact sheet on Scope of practice for registered nurses and midwives provides information for renewal of registration for those who wish to retain dual registration as an RN/M. This includes meeting the requirements of mandatory registration standards as both a nurse and a midwife.

The NMBA fact sheet is clear that you can make a case regarding common elements for work and education across your role as a nurse and a midwife. This specifically applies to demonstrating having met continuing professional development and recency of practice requirements.

Members are encouraged to contact their ANMF Branch staff if assistance is required in renewing dual registrations for EN/RN or EN/M or RN/M.

NMBA Board elections The NMBA National and State/Territory Boards work under the Health Practitioner Regulation National Law Act 2009 in achieving the primary function of protection for the public. Information on these Boards is outlined at: www. nursingmidwiferyboard.gov.au/ About/Board-Members/Being-a-Boardmember.aspx. Board appointees serve three year terms and any nurse or midwife is eligible. So, when elections are open, put in your application and get on board!

For more information on all of the above go to: www. nursingmidwiferyboard.gov.au Reference: * www.nursingmidwiferyboard.gov.au/About/ Statistics.aspx

April 2015 Volume 22, No.9 19

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VOUCHER

Legal Is failing to declare a criminal history unprofessional conduct?

Linda Starr

A primary function of the National Registration and Accreditation Scheme is public protection and patient safety, achieved through the regulation of 619,509 practitioners across 14 professions under the Health Practitioner Regulation National Law (2009) (the National Law). Each year practitioners are required to declare whether they have met four mandatory regulation standards: • criminal history; • continuing professional development, • recency of practice and; • professional indemnity insurance.

The Australian Health Practitioner Regulation Agency (AHPRA) is required to assess the suitability of all new applicants to hold registration in their particular discipline and criminal history checks (CHC) are an important component of this assessment.

All new applicants must declare any criminal history information (CHI) when they first apply for registration; those registered must declare any change in their criminal history since their last application for re-registration.

The National Law empowers AHPRA to check the criminal history of new applicants as well as the history of those already registered at any time.

What should you disclose?

There is no national uniform jurisdictional definition of criminal history, hence what is included in a CHC will vary across each state/ territory. Queensland for example, does not include traffic offences although Tasmania does whilst Victoria has a much narrower definition of criminal history resulting in less information being released in their reports.

However, the National Law defines criminal history as: • All convictions for an offence.

• All guilty pleas and findings of guilt by a court of an offence.

• All charges for an offence of the person applying for registration regardless of jurisdiction either before or after the commencement of the national law.

Spent convictions legislation does not apply to a practitioner’s obligation to disclose a criminal history, hence all details of your criminal history must be disclosed regardless of when they occurred or the anmf.org.au

outcomes of the offence or charge laid.

Each National Board has developed a Criminal History Registration Standard indicating the information that must be disclosed and the weight this will be given in terms of its relevance to an applicant’s registration. A serious and recent offence that has some relevance to professional practice will attract more weight when considering the persons suitability to practice. Serious offences include, rape, murder, armed robbery and terrorism whilst significant offences include common assault, dangerous/drink driving, cultivating/ dealing drugs, and theft. The following link will take you to the Nursing and Midwifery Board of Australia’s Standards on CHC: www.nursingmidwiferyboard.gov.au/ Registration-Standards.aspx During 2013/14 AHPRA conducted 61,000 criminal record checks that showed 3,597 (6%) practitioners had a criminal history resulting in three applications for registration being refused and either conditions imposed upon or undertakings accepted on 152 further applications for registration.

Practitioner audits, where declarations that regulation standards have been met are conducted randomly each year. Whilst there is no offence under the national law for not disclosing a criminal history, a failure to do so may be grounds for the practitioners National Board to take some action as illustrated in the following cases.

In HCCC v Belkadi (No 2) complaints against the practitioner included inappropriately accessing confidential information of two discharged patients and subsequently visiting these, soliciting money totalling $47,017.71 from the first patient’s husband and $2,500 from the second patient. In addition, she also failed to disclose a series of criminal offences on her annual renewal of registration form with the Board from 2004-2009. These offences occurred in 2004 – convicted of stealing and larceny and 2005 - convicted of stealing, larceny and shoplifting. The tribunal finding the particulars of each complaint established held that the practitioner demonstrated, unsatisfactory professional conduct, professional misconduct and was an unsuitable person to hold registration.

Throughout the hearing the practitioner continued to make misrepresentations of the circumstances of the offences, failed to demonstrate remorse with respect to the impact of her conduct on the victims, and demonstrated a lack of professional integrity and lack of candour on her registration renewals. On this point the tribunal noted that it was imperative that the regulatory authority must be able to rely on full and

honest declarations of practitioners who hold registration. The practitioners’ registration as a nurse and midwife was cancelled, holding she was not entitled to reapply for three years and a prohibition order issued that prohibited her from providing a range of services including that of a personal care assistant, community health care, health education or mental health care until such time as she was once again registered.

In another case of dishonesty, the practitioner obtained a credit card and pin number from an elderly patient with metastatic prostate cancer in need of palliative care, without his knowledge or consent and used it to pay her own personal debts and to purchase an internet shopping voucher. Conduct that is not only criminal but a serious breach of trust and substantially below the standard that could be expected of a nurse of the same standing. The practitioner had also made successive applications for re-registration from 2009 to 2013 each time declaring that she had no CHI to declare, despite being convicted in 2008 of two counts of fraud inappropriately receiving $11,000 in Centrelink payments. For this offence she was sentenced to six months imprisonment, suspended on entering a good behaviour bond for 19 months. The tribunal noted that although this conduct had no apparent connection with nursing, when considered together, over several years, there was a demonstrable pattern of dishonesty. The tribunal returned a unanimous verdict of professional misconduct, reprimanding the practitioner in the strongest terms and cancelling her registration with an order that she could not apply for registration until 2018. In addition a prohibition order was issued preventing her from engaging in any services or acts related to or incidental to the practice of nursing and/or midwifery until 2018 (Nursing and Midwifery Board of Australia v Morley 2014).

It is understandable that practitioners may feel embarrassed and anxious about disclosing past criminal conduct, however, the legal and ethical obligations of a health professional require them to demonstrate a level of professional integrity through honest declarations when applying for registration.

References: HCCC v Belkadi (No 2) [2012] NSWNMT 14 Nursing and Midwifery Board of Australia v Morely [2014] SAHPT 17

An expert in the field of nursing and the law Associate Professor Linda Starr is in the School of Nursing and Midwifery at Flinders University in South Australia.

April 2015 Volume 22, No.9 21

A better way to care for patients with dementia in hospital Dementia causes progressive cognitive impairment, affecting memory, judgement, language and everyday tasks. Alzheimer’s disease is the most common type of dementia.

Dementia is a national health priority

50%

20% 20% of patients in hospital aged over 70 have dementia

>50% of patients in hospital aged over 90 have dementia

311,000+

550,000+

Australians have dementia

Australians will have dementia by 2030

Patients with dementia are at greater risk of harm RIP

RIP Patients with Dementia are 2x more likely to experience falls, pressure injuries or infections in hospital...

6x more likely to develop delirium...

50%

2x more likely to die in hospital, and...

50% of dementia episodes go undetected in hospital

2x more likely to be readmitted to hospital

Not recognising dementia is a safety and quality issue

We can improve hospital care of patients with dementia

Be alert to delirium and the risk of harm to patients with dementia

Recognise and respond to patients with dementia

Provide safe and high-quality care tailored to the needs of patients with dementia

www.safetyandquality.gov.au/abetterwaytocare #BetterWayToCare

World Canada embraces euthanasia

Travellers to Europe issued measles alert

The Supreme Court of Canada has handed down a decision that now allows doctors’ assistance in dying.

The controversial decision has given Parliament one year to enact the legislation.

The Supreme Court of Canada’s decision overturned the long-held interpretation of the country’s criminal code about ‘aiding and abetting suicide’.

In 1992, the Canadian Supreme Court decided in a split vote of five votes to four that aiding and abetting suicide, without qualification, was a serious criminal offence.

The recent decision this year was overturned with a unanimous vote of nine, on the basis the original decision ran counter to Canada’s Charter of Rights and Freedoms as it violated the rights of individuals suffering from serious and incurable diseases. The new decision enables physician assistance in dying in controlled circumstances.

The court acknowledged that vulnerable people could be protected, while still allowing competent, seriously ill and suffering adults to a physician-assisted death.

This was hailed as a “truly momentous decision and one which is likely to reverberate around the world,” Dying with Dignity Victoria Dr Rodney Syme said. “Instead of a blanket prohibition, it recognises the need for a specific exception in relation to doctors treating people with specific medical circumstances – intolerable and incurable suffering.”

Dr Syme said it added “enormous” weight to the argument for similar legislation in Australia. “This fundamentally endorses everything we have been arguing for in Australia.”

He called on politicians and legislators to follow the lead of the growing number of

First rapid test for Ebola A first rapid test for Ebola-affected countries has been approved by the World Health Organization (WHO).

The ReEBOV Antigen Rapid Test Kit is able to correctly identify about 92% of Ebola infected patients and 85% of those not infected with the virus. While nucleic acid tests (NATs) were more accurate to test for Ebola, they were anmf.org.au

overseas jurisdictions in ending the violation of human rights in this area. “The change in the reasoning of the Supreme Court of Canada in the last 22 years reflects the change in ethical thinking in the world in that time, the change in legal and medical practice in certain countries, and the demonstration by empirical studies that those changes can be safely accomplished.”

Currently euthanasia is not legal in Australia.

ANMF Federal Secretary Lee Thomas said voluntary euthanasia was a complex social issue which continued to be debated by nurses, midwives and the wider community.

“We support advance care planning where individuals consider end-of-life decisions while they have the capacity to do so, and to provide instructions about their wishes for future treatment as direction for their family and health professionals.

“Our membership comes from diverse cultural, religious and ethnic backgrounds and our members hold a range of ethical views on voluntary euthanasia and their opinions need to be respected.”

The criteria for a physician-assisted dying by a patient affirmed by the Canadian Supreme Court were: • To be a competent adult; • Clearly consent to the hastening of death; • Have a grievous and irremediable medical condition (including an illness, disease or disability; • Be suffering intolerably.

more complex to use and required wellestablished laboratories, according to WHO. They also required a turn-around time from 12-24 hours, whereas the newly approved rapid test could take 15 minutes. The antigen test is easy to perform and does not require electricity, so could be used at lower health care facilities or in mobile units for patients in remote settings. WHO still recommends confirmation of diagnosis of Ebola using an approved Ebola NAT.

The World Health Organization Regional Office for Europe has called on policy-makers, health care professionals and parents to immediately step up vaccination against measles across age groups at risk.

Seven countries in the European region, including Italy, Germany and Russia reported 22,149 cases of measles in 2014 and so far in 2015.

The World Health Organization (WHO) has warned travel could increase the risk of exposure to measles virus and its spread to those not vaccinated.

It comes as the ACT Chief Health Officer Dr Paul Kelly alerted Canberra residents to be aware of measles symptoms after a case was notified in February. “The case acquired the infection on a recent overseas trip and this is the first case of measles to be notified to ACT Health in 2015.”

WHO warned the outbreaks threatened the goal of eliminating the disease by the end of 2015. Even though measles cases fell by 50% from 2013 to 2014, large outbreaks continued.

Measles outbreaks have continued to occur due to pockets of susceptible people who were unimmunised, in particular to growing numbers of parents either choosing not to vaccinate their children or who faced barriers to access vaccination.

“The priority is now to control current outbreaks in all affected countries through immunisation activities targeting people at risk,” Deputy Director of the Division of Communicable Disease, Health Security and Environment at the WHO Regional Office for Europe Dr Nedret Emiroglu said.

“At the same time, all countries, with no exception, need to keep a high coverage of regular measles vaccination, so that similar outbreaks won’t happen….and measles can be eliminated once and for all.”

April 2015 Volume 22, No.9 23

Feature

24 April 2015 Volume 22, No.9

anmf.org.au

Feature

The Americanisation of Australia’s health system While the federal government has finally taken its unpopular GP tax off the table, the freeze to the Medicare rebate has been extended and the co-payment for PBS subsidised medicines still stands. As the government vows to wield its razor to health costs, our universal healthcare system remains in the firing line, writes Karen Keast.

Registered nurse Michelle Cashman began her nursing career three years after Australia’s Commonwealth-funded health insurance scheme was first introduced as Medibank in 1975.

More than three decades later, the Central Coast nurse who works in the public sector, fears Medicare is slowly being eroded and will eventually be destroyed under the Abbott government’s proposed changes to our ‘fair go for all’ health system. “I find it really scary. I’ve always known this system where everybody gets the same equal, good healthcare. I’ve always been really proud of that,” she says.

Many of Michelle’s patients are frail, elderly people with complex care needs and some are also palliative care patients. They are vulnerable people on fixed incomes, at the latter end of their lives, who often can’t afford private health insurance. Any anmf.org.au

changes to Medicare will compromise their care, Michelle says.

“You don’t become a nurse to become rich - you do nursing because you care about people, you want to help people,” she says. “If you have a patient come in and you can’t give them the care that they require, then that’s just soul destroying.

That goes against everything that we believe in.

“Whether our patients are rich or poor, all our care should be provided on a needs basis - if someone needs the care, then we give them that care. I think that’s a pretty powerful advantage for Australia and I don’t want our healthcare system to be damaged.”

Our Medicare marvel Medicare holds an esteemed place in our national psyche. Australia’s equitable April 2015 Volume 22, No.9 25

Feature

“AUSTRALIANS SHOULD HAVE ACCESS TO QUALITY HEALTHCARE WHEN THEY NEED IT, WHERE THEY NEED IT. IT SHOULDN’T BE AVAILABLE TO THOSE WHO HAVE THE MONEY TO PAY FOR IT, OTHERWISE WE WILL END UP WITH AN AMERICANISED TWOTIERED HEALTH SYSTEM, WHERE YOU ONLY GET TREATMENT IF YOU CAN AFFORD TO PAY FOR IT.” Australian Nursing and Midwifery Federation Federal Secretary Lee Thomas

healthcare system is also the envy of countries across the globe.

Medicare has helped Australia deliver some of the best health outcomes in the world.

Australia’s life expectancy rates are above the OECD average and the nation also has one of the lowest rates of amenable deaths.

In a 2014 Commonwealth Fund study of 11 nations on healthcare quality, access, efficiency, equity and healthy lives, Australia ranked fourth out of 11 countries, behind the United Kingdom, Switzerland and Sweden.

The United States, where the majority of healthcare facilities are in private hands, is home to the most expensive healthcare system in the world but the US ranked last - underperforming compared to other countries.

While ObamaCare is being rolled out and is expected to provide health cover for an extra 26 million people by 2024, the US remains without universal coverage.

Forecasts show 31 million Americans will still lack insurance cover after the policy is fully implemented.

Australian Nursing and Midwifery Federation (ANMF) Assistant Federal Secretary Annie Butler fears Australia is heading down 26 April 2015 Volume 22, No.9

America’s privatisation path, where only the rich can afford healthcare. The Abbott government’s moves to tinker with Medicare spells disaster, she says. “They look like little things on the outside to Medicare but they are actually not. They are designed to dismantle the system of Medicare as a means of providing universal healthcare.

payment for PBS subsidised medicines remains on the table, while the Medicare rebate freeze is being extended for four years. What’s more, the government is now considering other healthcare reforms in a bid to solve its much trumpeted budget crisis and its claims that Medicare is unsustainable.

“The majority of our members work in the public sector and it has never been a consideration for them about what money a patient might have. The threat of that Americanisation of the health system, where they may have to ask somebody the question - do you have insurance? - is a complete nightmare for them.”

The Commonwealth Fund study shows Australia spent 9.1% of GDP on health in 2012, compared to 16.9% in the US, while an Australian Institute of Health and Welfare report, Health Expenditure Australia 2012-13, revealed spending on health for the period slowed to record low levels, not seen since the mid-1980s.

Ms Butler says the government’s claims that Medicare is unsustainable is “complete and utter nonsense”. The government is determined to dismantle Medicare due to its ideological belief in a user-pays system, she says.

Last year, the government proposed the $7 GP co-payment which was then changed to the $5 GP tax before being dumped. Both payments raised concerns that bulk-billing rates would be eroded, pushing the costs of public healthcare on to individual patients.

Under the plan, bulk-billing would act as a safety-net, not a universal right, for concession-card holders, children aged under 16 and those in aged care facilities, leading to the creation of a two-tiered, Americanised healthcare system.

The government’s proposed patient co-

“The goal is privatisation because they believe that the private system is more efficient in running things,” she says. “A market driven system might be good for the car market or something like that, but not for people’s health and for your nation’s citizens - where they all pay tax, and they’ve agreed to pool their funds so that the resources can then be fairly distributed. anmf.org.au

Health should never be underpinned by a market philosophy.”

Australia has one of the highest out-ofpocket health costs. The Consumers Health Forum estimates Australians pay an average of $1,075 per year - $94 higher than the average paid in other developed countries.

The cost of healthcare is already a major deterrent for some Australians. Australian Bureau of Statistics figures in 2013-14 found almost 5% of Australians delayed or failed to see their GP because of the cost. Last year, the COAG Reform Council revealed 8.5% of people in 2012-13 held off or did not have their prescriptions filled due to cost - and the figures were up to 12.14% in disadvantaged areas and 36.4% for Indigenous Australians.

Designed in the 1960s and 1970s to meet health needs at the time, there has been no major review of Medicare since its establishment. Ms Butler says structural reform of the health system and broadening Medicare to enable nurse practitioners, midwives and other health professionals to have better access to Medicare bulk-billing is a smarter way to prepare for health into the future while also saving funds in the health budget.

Removing the private health insurance rebate and introducing better tax concessions directed towards the rich, such as the ‘Robin Hood tax’, also known as a Financial Transactions Tax (FTT), will “reap huge amounts” in revenue, she says.

Medicare misinformation Dr Con Costa, Doctors Reform Society (DRS) President, says Australians have been fed a “huge disinformation campaign” about the costs of Medicare. He says Medicare spending has remained stable for many years and is low compared to the total funds spent on health.

“Everything the government has said on Medicare is either not true, blatantly false or misinformation,” he says. “When they say health costs are going up, they are really referring to hospital costs, not Medicare bulk-billing, which is GP. They are deliberately misinforming us on this.”

A practising GP in Canterbury, Sydney, Dr Costa says the government has not given up on its GP tax. The proposed four year freeze on the Medicare rebate sends a strong signal to GPs to start charging for their services - a back door way of introducing the co-payment.

It won’t be just a $5 co-payment, he anmf.org.au

says. The difference between a bulk-billed consultation of $36 and the private doctors fee of $75 will mean a $40 co-payment to see the GP, if the planned freeze on the Medicare rebate goes ahead.

Dr Costa says this means sick people will delay seeing a GP due to the spiralling costs, in turn leading to an increasing dependence on emergency departments and hospital care. The real problem of high hospital costs will only be exacerbated, not improve.

“Eventually you will only get GP health if you are covered by private health insurance - and that’s Americanisation of our health system - healthcare for those who can pay and not as a right.”

Expanding primary care, particularly in the community, is the solution to containing Australia’s health spending. With the majority of the health budget being poured into hospitals, Dr Costa says refocusing Medicare to enable high-end users of hospitals, such as the frail elderly, those with chronic lung or heart disease, the mentally ill and dying, to access quality care in the community is paramount.

Dr Costa proposes a greater role for GPs in nursing homes, supported by registered nurses and specialists, that would enable local GPs to oversee the care of up to 20 or 30 local aged care residents, and also offering salaried GP positions in the larger aged care facilities.

“That way we’re not calling the ambulance every two or three minutes to send these frail elderly and often high dependancy care Australians to the local emergency department, where it costs 10 times as much to see them as it does for a GP to treat them in their home - and if the elderly are admitted to hospital, it’s $1,000 a day.

“The money saved from reducing unnecessary ambulance rides back and forward to emergency departments, could go back into primary healthcare/GP care to fund practice nurses, for example, or ancillary staff like physiotherapy and social workers, to improve the care in the community.”

Dr Costa says if the federal government really wanted to reduce “waste” in the system, it would eradicate the 30% private health insurance rebate and redirect the $6 billion in savings into the nation’s strained public hospitals or into expanding Medicare to include a national dental scheme.

AVERAGE COST

$1,075 The Consumers Health Forum estimates Australians pay an average of $1075 per year $94 higher than the average paid in other developed countries.

HEALTH SPEND

9.1% of GDP

16.9% of GDP

The Commonwealth Fund study shows Australia spent 9.1% of GDP on health in 2012, compared to 16.9% in the US

8.5% Last year, the COAG Reform Council revealed 8.5% of people in 2012-13 held off or did not have their prescriptions filled due to cost

Reducing the high price Australia pays to drug companies for off-label medicines is April 2015 Volume 22, No.9 27

Feature Registered Nurse Michelle Cashman

another area which could potentially shave billions of dollars from the health budget, he says. “For a cholesterol-lowering offlabel tablet, a statin, we’re paying $42 on the PBS per script whereas the same cost for a generic in New Zealand is $3 and in Great Britain is $2. The government is happy to give these extra billions of taxpayer dollars to the big drug companies and the private health insurance funds, yet they turn around and attack Medicare and people’s access to their GP - which is the cheap, cost efficient end in the system. So it’s not really about saving money, it’s about privatisation of our health system.”

General practice nurses The rebate freeze will impact on general practices and there’s also concerns it could affect the nation’s 11,000 practice nurses.

“The costs of staff, their lease, their indemnity are all increasing over time, so if you freeze the rebate it means that there is less money to employ practice nurses,” Australian Medical Association President, Associate Professor Brian Owler, recently told media. “It makes it more difficult for GPs to do the sort of quality general practice that we expect and need in this country, and…the only way (to do) that is to either have shorter consultation times, which is something that doctors don’t want to do, or you increase the rate of private billing.”

Karen Booth, president of the Australian Primary Health Care Nurses Association (APNA), says while it’s important to manage the costs of the healthcare system, the impact must be considered. “A freeze on rebates to general practice could make 28 April 2015 Volume 22, No.9

some practices unviable, and will certainly make others look for ways to reduce costs – which may ultimately impact on access and care for the most vulnerable patients.

It’s of concern to APNA that one response from some general practices may be to reduce nurse positions.”

A primary healthcare registered nurse and nurse manager in general practice for 17 years, Ms Booth says general practice is crucial to population health activities, including screening and timely intervention to catch and treat health problems early before they end up in crisis, needing expensive hospital care. “Nurses are key to these important prevention and care activities, and to help general practices and the health system meet and manage the challenges ahead and meet the demand for patient healthcare.”

While nursing in general practice is a fast growing profession, Australia’s uptake and utilisation of practice nurses across their scope of practice remains well behind that of countries such as the United Kingdom and New Zealand.

Ms Booth says government policy and general practice financing needs to support multidisciplinary team care, including practice nurses, to achieve better consumer access and more cost-effective care. “The whole community will benefit,” she says.

Nurse practitioners The national President of the Australian College of Nurse Practitioners (ACNP), Chris Raftery says the freeze to the Medicare rebate means patients will pay more to see

GPs and nurse practitioners (NPs). “The fee structure is changing across the board including NP services,” he says.

Medicare Benefits Schedule (MBS) payments for nurse practitioners have been frozen for the past five years, and there’s been no increase to CPI since the MBS items were first introduced in 2011. Mr Raftery fears the freeze will make it more difficult for nurse practitioners to make a living. “NPs are already on a low payment for the work that we do,” he adds.

The freeze will put more pressure on patients’ hip-pockets, which could also have an impact on nurse practitioners.

“There is a huge difference in the access to Medicare rebates for NPs compared to GPs, that is ultimately costing the government more,” Mr Raftery says. “For undertaking the same activity such as writing a script or medical certificate after a medical review, an NP service would only obtain about a third of the rebate for the patient, compared to a GP, although the outcome is the same. This means a huge cost difference for patients.”

The College, which is opposed to copayments, is continuing to lobby the federal government and health department to increase access for Australia’s 1,100 nurse practitioners. Nurse practitioners remain an untapped resource in our health system despite having the potential to deliver more efficiencies and reduce costs, Mr Raftery says.

“The current referral processes are costing the government big money by requiring anmf.org.au

Feature Dr Con Costa

GP involvement in addition to the NP, hence a second Medicare rebate (is) claimed and paid.”

Mr Raftery says health reform, not medical reform, is vital. The fee for service payment model is costly and restrictive to NPs. Mr Raftery suggests paying GPs and nurse practitioners a wage, and giving nurse practitioners the same access as general practice in a bid to increase the number of patients seen.

“Also reduce some of the restrictions on NPs,” he adds. “We are a very regulated workforce that is trying to give care often to patients in the grey areas that are missed. We work in rural remote areas where health resources are few. We also cover the area between the hospital and primary health for patients.”

Saving Medicare The ANMF, the New South Wales Nurses and Midwives’ Association (NSWNMA), other unions and health groups have joined forces with Save Medicare Sydney, an open community campaign group, in a fight to safeguard Medicare against government attacks.

Save Medicare Sydney fears the government’s move to freeze the indexation of the Medicare rebate until 2018 delivers yet another blow to Medicare. The group holds concerns that bulk-billing GPs in working-class areas and Aboriginal health centres will be left to absorb the cuts.

Jean Parker, of Save Medicare Sydney, warns Medicare is far from safe. anmf.org.au

Jean Parker

“Prime Minister Abbott and [Health Minister Sussan] Ley want Medicare bulkbilling to become a safety net for the vulnerable,” she says. “The government wants to break the universal nature of Medicare that keeps the system fair.

Medicare bulk-billing is for all patients, not just the very poor.”

campaign and getting more active is really brilliant in that way,” she says.

Save Medicare Sydney is calling for the government to reverse the freeze on the Medicare rebate and provide a guarantee that Medicare will remain fully-funded and universal.

The University of New South Wales’ Centre for Health Equity Training Research and Evaluation review of the deal between Australia and 11 other nations across the Asia-Pacific region shows the TPP risks increasing the cost of the PBS and boosting the cost of co-payments for medicines.

Nurses and midwives have been at the heart of the movement to save Medicare.

When nurse Kerry Rodgers questioned Treasurer Joe Hockey on the ABC’s Q&A program last year about the co-payment, her comments struck a chord with Australians, Ms Parker says.

Medicine price rise Changes to Medicare coupled with the proposed Trans-Pacific Partnership (TPP) will have dire ramifications for the state of the nation’s health.

“Potential risks to health outcomes include declining health status in the community, increased hospitalisations and increased mortality,” the report states.

Ms Rodgers told Mr Hockey co-payments not only unfairly affect those with chronic and complex care needs but also those with a limited capacity to pay.

Michelle says she’s concerned medicine prices will blow out under the TPP. It’s a “terrifying” prospect considering some of her patients are on 20-plus medications a day.

“As a consequence they will delay treatment and end up in the emergency department and may require inpatient care at a much higher cost to the system, not to mention the indefinable cost to the patient physically and emotionally,” she said.

“This is madness.”

“You add up the costs of those medications with any changes to Medicare and it just wouldn’t be Medicare,” she says.

“Let’s be honest - it would no longer be Medicare because the important words in Medicare are ‘medical care’ - that’s what it’s all about.

Ms Parker says the community takes note when nurses and midwives stand up and talk about threats to our health system.

“People take a lot of notice - nurses and midwives being a part of the Medicare

“We don’t want it to go that way but this is not far off on the horizon. These changes will just annihilate our public health system and that means Australians generally are going to suffer.”

April 2015 Volume 22, No.9 29

Clinical update

A return to nursing rounds – person centred or a task too far?

Sarah Lyons, Scott Brunero and Scott Lamont

Nursing rounds have been reintroduced in many clinical areas in order to improve nursing care and patient outcomes focusing on patient safety and satisfaction. The term ‘nursing round’ is used to describe several different practices and models in nursing of which the main concepts can be summarised as ‘scheduled intentional nursing rounds’, ‘nursing teaching rounds’, ‘nursing ward rounds’, and ‘nursing grand rounds’. This article explores the concept of ‘scheduled intentional nursing rounds’ (Meade et al. 2006).

30 April 2015 Volume 22, No.9

anmf.org.au

Clinical update Nursing rounds Nursing rounds involve a checklist approach to patient care where nurses proactively attend to patients needs at scheduled intervals (usually hourly or second hourly).

Nursing rounds are said to offer a more efficient way of organising nursing work by standardising the frequency and manner in which nurses review their patients, improving patient satisfaction, safety, care delivery and nursing work processes (D’Alessio et al. 2010).

Nursing rounds have emerged as a practice solution to reduce preventable adverse outcomes related to patient’s in-hospital stay and also to improve patient satisfaction by standardising the frequency that a nurse interfaces with the patient. Purposeful nursing rounds encompass a practice where nurses attend to and document scheduled patient reviews at pre-determined and regular intervals (hourly or second hourly).

Nursing rounds are aimed at preventing adverse outcomes specifically falls and pressure injuries. Nursing rounds involve regular ‘checks’ on patients to promote visibility of nursing staff which is said to increase patient satisfaction.

A REVIEW OF DOCUMENTED ROUNDS RECORDED ON CHECKLISTS ALSO ACT AS ‘EVIDENCE’ TO SUPPORT OR CHALLENGE THE SUCCESS OF IMPLEMENTING NURSING ROUNDS Increased visibility of nurses is said to reduce patient anxiety and allow regular opportunities for patients to ask questions about their care, as well as have their immediate care needs met at that time.

Patient satisfaction in the context of this intervention is usually evaluated by comparing the number of call bells pre and post implementation. A reduction in call bell use is said to indicate an improvement in patient satisfaction related to timely care provision (Meade et al. 2006). A review of documented rounds recorded on checklists also act as ‘evidence’ to support or challenge the success of implementing nursing rounds (Halm, 2009). There is also a suggestion that this intervention has a further benefit of reducing nursing staff stress levels and workloads as they are not anmf.org.au

called away from their current tasks to respond to as many call bells (Berg et al.

2011; Duffin, 2010).

The term nursing rounds may be used to describe several different practices in contemporary health however it is the reemergence of the once retired practice that has gained attention in recent years (Halm, 2009).

The re-emergence of nursing rounds: The American ‘corporate care model’ versus the British ‘back to basics’ approach A review of both the American ‘corporate care model’ and the British ‘back to basics’ approach raises some questions around the value of nursing rounds as a patient safety initiative as well as its relevance to healthcare and modern nursing.

The American ‘corporate care model’ The ‘Studer Model’ has demonstrated some success in improving patient satisfaction scores, the evidence to support any improvements in patient safety is less convincing (Studer Group 2007). Based on a hospitality model of customer service, several strategies have been introduced into healthcare organisations in the US to standardise nurse-patient interactions and build customer (patient) loyalty.

Strategies aimed at improving the patient’s perceptions of care provision have since become common place in many healthcare facilities including rounding, scripting and the use of acronyms to remember the ‘five fundamentals of service’: Acknowledge, Introduce, Duration, Explanation, Thank You. Many studies credit the instigation for these changes to one research study (Californian Nurses Association, 2010).

In 2006 Meade, Bursell & Ketelsen supported by the Studer Group sought to examine the effect that regular rounding by nurses had on patient call bell use.

The quasi-experimental study examined the frequency and reasons for call bell use, the impact of hourly and second hourly rounding on call bell use, and the effects of such rounding had on patient satisfaction as well as patient safety as measured by the rate of patient falls.

This study reported statistically significant reduced call bell use overall, as well as a reduction in the rate of patient falls and increased patient satisfaction. Based on these results Meade (2006) recommended hospitals not only adopt nurse rounding as

standard practice but also suggested nurse rounding represented the new direction for healthcare delivery, urging organisational restructuring that supported this approach to improve patient care management, safety and satisfaction. In 2007 The Studer Group produced an ‘hourly rounding supplement’ to assist other organisations who wished to replicate this study.

An extensive search of the literature was completed and fifteen studies were found that had used the Studer Group model: United States of America (11), United Kingdom (2), Saudi Arabia (1) and Australia (1).

Of the 15 studies, three demonstrated statistically significant reductions in rates of falls (Sherrod, 2012). One study reported a reduction in hospital acquired pressure injuries from two to one over the eight week study period (Saleh et al. 2011). The majority of the studies focused on the impact that nursing rounds had on patient satisfaction as an outcome measure. Five studies reported improvements in patient satisfaction.

Bourgault (2008) saw an improvement in satisfaction scores after they introduced hourly rounding and scripted nurse language to assess the three ‘P’s of pain management, personal needs and positioning-the environment. Kessler (2012) reported sustained improvements in patient satisfaction scores and reduced falls rates over the six year period since the implementation of scripted nursing rounds.

Kessler (2012) credited this success in part to the staffs’ strict adherence to the nursepatient interaction script warning that any deviation from the standardised protocol would result in poor outcomes.

Sherrod (2012) reported improvements in patient satisfaction but no statistically significant reductions in rates of falls or hospital acquired pressure injuries. They suggested further research exploring the effects of hourly rounds versus second hourly rounds. These researchers also recommended future studies into the impact that different types of staff may have on performing intentional rounding.

D’Alessio (2010) reported improvements in all aspects of patient satisfaction except for pain and comfort. Woodard (2009) reported improvements in both patient satisfaction and rates of falls. The study conducted by Woodard (2009) was unique in that the charge nurse was responsible for conducting April 2015 Volume 22, No.9 31

Clinical update the nursing rounds, whereas the remaining studies involved direct care nurses.

While the impact of nurse rounding on nurses was not formally assessed in their study, Berg (2011) suggested that nursing rounds helped to organise nurses’ work by reducing unnecessary steps and improving workflow. Ford (2010) suggested a reduction in recorded call bell use equated to a quieter work place freeing up nurses to attend to patient care and charting. In a study that did seek to gain nurses’ perceptions of patient rounding the results revealed that while nurses recognised the benefits for patients and families they perceived significantly less benefits for nurses’ challenges reported by nurses included staffing, skills mix, patient acuity and time consuming documentation (Neville et al. 2012). Other studies reported nurses prioritised looking after high acuity patients over maintaining rounding schedules (Deitrick et al. 2012) with the remaining studies not reporting any statistically significant improvements.

British ‘back to basics’ approach While there has been some uptake of Meade’s (2006) work, internationally (Saleh et al. 2011; Duffin, 2010) the impetus for the re-emergence of nursing rounds in the United Kingdom (UK) for example, seemed to signal a return to the basics of nursing care with a focus on promoting patient comfort (Castledine et al. 2005). Described as a modern take on the traditional ‘back rounds’ patient comfort rounds aimed to meet patient’s fundamental needs, promote nurse-patient communication and provide an opportunity for a ‘general overview of safety’.

In an era where treatments were less advanced, comfort was once the focus of nursing as it facilitated recovery (Duffin, 2010). Modern day patient comfort rounds suggested increased nursing presence enhanced the therapeutic relationship between the nurse, the patient and their families. Nursing rounds in this form described activities such as fluffing pillows and checking linen for crinkles and cleanliness and attending to personal care needs as the essence of care. This campaign had the support of the UK Prime Minister who blamed failings in care on bureaucracy and the pursuit of targets. He went on to call for all nurses to establish regular scheduled rounds so that patients could talk to a nurse at least every hour (Kendall-Raynor; 2012).

32 April 2015 Volume 22, No.9

An Australian study went on to explore the relationship between nursing rounds, patient satisfaction, safety and the practice environment focusing on patient comfort (Gardner et al. 2009). In this quasiexperimental study, Gardner et al. (2009) were one of the first groups to develop their own patient satisfaction survey instrument which they used in conjunction with the Practice Environment Scale of the Nursing Workforce Index. Hourly nursing comfort rounds were conducted between 1600hrs and 2200hrs Monday to Friday by an Assistant in Nursing (AIN). The study aimed to optimise the role of the AIN in skills mix.

While there were no statistically significant changes to patient satisfaction levels, the results from the practice environment scale showed an improvement in the nurses’ perceptions of quality of care, resource adequacy and professional relationship.

SOME SUGGEST NURSING ROUNDS ADVOCATE FIRST ORDER PROBLEM SOLVING WHERE PATIENTS ARE EXPECTED TO FIT INTO RIGID PREDETERMINED SCHEDULES.

An intention of implementing nursing rounds is to improve patient outcomes, which the nursing rounds literature argues to comprise of patient satisfaction, patient safety and patient care (Berg et al. 2012).

A critique of these concepts may provide some clarity around the intentions, goals and outcome measures related to the implementation of nursing rounds.

of organisation and inefficiency on the part of nurses that results in poor patient care and outcomes. While Garling (2008) called for the deconstruction of traditional work practices and the empowerment of nurses, nursing rounds arguably advocate the return to antiquated practices that deskill nurses. Nursing today involves critical thinking, reflection and problem solving; partnering with patients to promote shared decision making (Hiscock, 2008). Some suggest nursing rounds advocate first order problem solving where patients are expected to fit into rigid predetermined schedules. The very nature of structuring and scripting the interactions between nurses and patients may act to dehumanise the process of nursing care and threaten the nurse-patient relationship (Californian Nurses Association, 2010).

Patient centred care

Patient satisfaction

Contemporary healthcare places the patient at the centre of care and decision making.

Patient centred nursing refers to an approach established through the development of therapeutic relationships between professionals, patients and others significant to them in their lives (Hiscock et al. 2008).

It is underpinned by values of mutual respect, autonomy and understanding. It is enabled by cultures of empowerment that foster continuous approaches to practice development (McCormack et al. 2010).

Nursing rounds have been described as a standardised way of organising nursing work to improve quality care benefiting both patients and nurses (Duffin, 2010). Nursing rounds typically involve routine surveillance of patients and often include a checklist of nursing interventions to be attended at that time such as offering toileting assistance, assessing and addressing patient comfort and positioning and communicating to the patient the plan for a nursing staff member to return in an hour (or the agreed interval) (Tea et al. 2010).

Patient satisfaction is described in the literature as the patient’s perception of caring. (D’Alessio et al. 2010). Presence has been described as the art of ‘being with’ without the need to be ‘doing to’ the person. Presence in the context of person centred care goes beyond being physically present (McCormack et al. 2010).

Nursing rounds and patient outcomes

The principles of nursing rounds infer a lack

While patients expect that nurses will be competent and knowledgeable their satisfaction is related to the quality of the care they receive (Bourgault et al.

2008). Patients equate quality care with good communication, kindness and prompt recognition and provision of care needs (Castledine et al. 2005). Staff responsiveness is an important factor to patients and an overall predictor of patient satisfaction (Tea et al. 2010). In the US corporate style evaluation surveys (modelled on the business approaches used

by Disney and other hospitality groups) are used to measure patient satisfaction.

The role of a nurse is likened to that of a ‘hostess’ where nurses’ are scored on their ability to attend to each patient’s anmf.org.au

Clinical update needs in a prompt, timely and courteous manner (Californian Nurses Association, 2010) emphasising efficiency, attitudes and aesthetics. Environmental factors such as staffing levels, patient acuity and skills mix were not addressed in these results.

Advocates of person centred care challenge the notion that a nurse should be available and attentive at all times recognising the challenges of the current heathcare environment (McCormack, 2010). In times of high turnover and busy environments they argue that it is the nurse’s ability to be present in ‘that’ moment that makes a difference in patient care. The use of interpersonal skills including communication skills can promote a therapeutic relationship and promote holistic care (Meade et al. 2006).

Patient Safety In Australia the development of new national safety and quality healthcare standards and a growing emphasis on professional competency and accountability reflect a health system focused on promoting patient safety. Evidence suggests that practice changes related to patient improvement rely on strategies that are multifaceted, innovative and patient centred (Squires, 2010). This is demonstrated by best practice guidelines aimed at preventing adverse outcomes such as falls (Australian Commission on Safety and Quality in Healthcare, 2012) and pressure injuries (Australian Wound Management Association Inc, 2012).

Patient safety is a complex issue that goes beyond individual vigilance and local work redesign. Solutions require value alignment, shared learning and collaboration, as well as process and cultural changes at a systems level. This is reflected in the collaborative leadership literature (Lamont, 2014). The notion of nurse rounding has been adopted in different clinical settings and applied to reduce isolated issues such as falls or pressure injury (Ulamino et al.

2011). However this narrow approach to patient care and safety is incongruent with evidence based principles which underpin a holistic person centred philosophy of care (McCormack, 2010).

A review of both the American ‘corporate care model’ and the British ‘back to basics’ approach raises some questions around the value of nursing rounds as a patient safety initiative as well as its relevance to healthcare and modern nursing. Nursing rounds in the form of scheduled routine anmf.org.au

checks reflect an out-dated philosophy of care reducing nursing to a discipline focused on tasks and first order problem solving. While some studies have shown nursing rounds to impact positively on patient satisfaction and comfort levels there is little evidence to support this intervention as a patient safety initiative.

References: Australian Commission on Safety and Quality in Healthcare. (2009)Preventing falls and harm from falls in older people: Best practice guidelines for Australian hospitals. www.activeandhealthy.nsw.gov.au/assets/pdf/Hospital_ Guidelines.pdf Australian Wound Management Association Inc. (2012).

Pan pacific guideline for the Prevention and management of pressure injury www. awma.com.au/publications/2012_AWMA_Pan_Pacific_ Abridged_Guideline.pdf Berg K., Sailors C., Reimer R., O’Brien Y., Ward-Smith P. (2011). Hourly rounding with a purpose. The Iowa Nurse Reporter. December: 12-14. www.thefreelibrary.comv / Hourly+rounding+with+a+purpose.-a0289217372 Bourgault A. M., King M. M., Hart P., Campbell M. K., Swartz S, Lou M. (2008). Circle of Excellence. Nursing Management. November: 18-24.

Californian Nurses Association. (2010). Scripting and rounding: Impact of the corporate care model on RN autonomy and patient advocacy, National Nurse.

November, 20-26.

Castledine G., Grainger M., Close, A. (2005). Clinical nursing rounds part 3: Patient comfort rounds. British Journal of Nursing.14 (17): 928-929.

D’Alessio E., Magsalin M., Neville K L., Patten C. (2010).

Enhancing nursing’s presence. Nursing Management December, 16-18.

Deitrick L. M., Baker K. , Paxton H., Flores M., Swavely D. (2012). Hourly rounding: Challenges with implementation of evidence-based process. Journal of Nursing Care Quality 27(1): 13-19.

Dix G, Phillips J, Braide M. (2012). Engaging staff with intentional rounding. Nursing Times 108(3): 14-16.

Duffin C. (2010). Hourly ward rounds improve care and reduce staff stress. Nursing Management. 17(7): 6-7 Ford B., M. (2010). Hourly rounding: A strategy to improve patient satisfaction scores. Medsurg Nursing.

19(3); 188-191.

Gardner G, Woollett K, Daly N, Richardson B. (2009).

Measuring the effect of patient comfort rounds on practice environment and patient satisfaction: A pilot study.

International Journal of Nursing Practice. 15; 287-293.

Garling, S. (2008). Final report of the special commission enquiry: Acute care services in NSW public hospitals Volume 1. Retrieved 15 August, 2012, from www.lawlink.nsw.gov.au/Lawlink/Corporate/ll_corporate. nsf/vwFiles/E_Volume1.pdf/$file/E_Volume1.pdf Halm M., A. (2009). Hourly rounding: What does the evidence indicate? American Journal Of Critical Care 18(6); 581-584.

Kendall-Raynor P. (2012). PM vows to cut bureaucracy and introduce hourly nursing rounds. Nursing Standard.

26(19); 6.

Kessler B., Claude-Gutekunst M., Donchez A. M., Dries R. F., Snyder M. M. (2012). The merry-go-round of patient rounding: Assure your patients get the brass ring. Medsurg Nursing. 21(4); 240-245.

Hiscock M., Shuldham C. 2008. Patient centred leadership in practice. Journal of Nursing Management.

16; 900-904.

Lamont S., Brunero S., Lyons S., Foster S., Perry L. (2014). Collaboration amongst clinical nursing leadership teams: A mixed-methods sequential explanatory study. Article first published online: 5 Nov 2014. DOI: 10.1111/jonm.12267 Journal of Nursing Management.

McCormack B., McCance T. (2010). Person-centred nursing: Theory and practice. West Sussex: WileyBlackwell.

Meade, C. M., Bursell A. L., Ketelsen L. (2006) Effects of nursing rounds on patients call light use, satisfaction, and safety. American Journal of Nursing 106(9): 58-70.

Neville K., Lake K., LeMunyon D. (2012). Nurses’ perception of patient rounding. The Journal of Nursing Administration 42 (2); 83-88.

Saleh BS, Nusair H, Zubadi N, Shloul SA, Saleh U.(2011) The nursing rounds system: Effect of patient’s call light use, bed sores, fall and satisfaction level. International Journal of Nursing Practice 2011: 17; 299-303.

Sherrod BC, Brown R, Vroom J, Sullivan DT. (2012).

Rounding with purpose. Nursing Management: January; 32-38.

Squires M, Tourangeau A, Spence Laschinger H K, Doran D. (2010). The link between leadership and safety outcomes in hospitals. Journal of Nursing Management 18: 914-925 Studer Group (2007). Hourly rounding supplement Best Practice: Sacred heart hospital Pensacola, Florida.

Available from URL: www.mc.vanderbilt.edu/root/pdfs/ nursing/hourly_rounding_supplement studer_group.pdf Accessed 15 July 2012.

Tea C., Ellison M., Feghali F. (2008). Proactive patient rounding to increase customer service and satisfaction on an orthopaedic unit. Orthopaedic Nursing 27(4): 233-240 Ulamino V, Ligotti N. (2011). Patient satisfaction and patient safety: Outcomes of purposeful rounding.

Topics in Patient Safety. 11(4): 1-4.

Woodard J., L. (2009). Effects of rounding on patient satisfaction and patient safety on a medical-surgical unit. Clinical Nurse Specialist. 23(4): 200-206.

Sarah Lyons RN, BN MN (Clin lead) is a Clinical Nurse Consultant, Nursing Services at Prince of Wales Hospital, Sydney NSW Scott Brunero RN, Dip AppSc BHSc, MN (nurs prac) is a Clinical Nurse Consultant, mental health liaison at Prince of Wales Hospital, Sydney NSW Scott Lamont RN, RMN, MN (Hons) is a Clinical Nurse Consultant, mental health liaison at Prince of Wales Hospital, Sydney NSW April 2015 Volume 22, No.9 33

Clinical review Effects of stigma on therapeutic relationships Ambreen Zubair

Mental illness not only alters a person’s feelings, thoughts and behaviour but also causes distress and difficulty in functioning.

Living with mental illness is associated with a great deal of stigma which negatively impacts on a person’s recovery (Harangozo et al 2013).

Horsfall et al (2010) explains that stigma is a combination of social stereotypes and personal attributes associated to societal endorsement of ‘inferior’ or ‘unacceptable’ human characteristics. Therefore, the person is unfairly treated, socially rejected and diminished, compared to those belonging to un-stigmatised groups.

Mestdagh and Hansen (2014) argue that commencement of psychiatric treatment initiates a process whereby an individual is negatively labelled as irrational with an unstable emotional state, incompetent, worthless and potentially dangerous to self and society. The sensed stigma results in reactions including low self-efficacy, hurt, guilt, anger and disgrace which increase the risk of physical illness and result in higher mortality rates in comparison to the general population (Parle 2012).

Several studies reveal that people with mental illness experience negative and discriminatory attitudes from mental health professionals; these include blaming, disparagement and condescending paternalism, which can cause fear, secrecy and avoidance, hence, bar therapeutic communication, and affect the levels of trust needed to comprehend, assess and act to fulfil the medical needs of an individual (Toombs 2012).

The negative and discriminatory attitude of society, as well as mental health professionals, invokes feelings of unworthiness and helplessness, thus reduces the help-seeking behaviour and give rise to self-stigmatisation (Rusch et al 2014). It is therefore suggested that mental health professionals should use patient centred humanist principles which include respect, acknowledging the person’s situation and concerns, providing emotional support and conveying optimism to avoid self-stigmatisation and commencement on a cycle of fear, shame, loss, defeat and treatment abhorrence (Brohan et al 2010).

34 April 2015 Volume 22, No.9

The therapeutic relationship with the consumer Therapeutic relationship is an enabling relationship in which health professionals are trusted to understand the clients and support them to recognise their own needs and therefore gain empowerment in their life (Elder et al 2010). Establishment of a quality relationship is often compromised because majority of people with mental illness report lack of empathy, kindness, warmth, compassion and good listening skills from the health staff and rather experience stereotyping and stigmatising behaviour which hinders the formulation of a therapeutic alliance among patients and care providers, consequently lead them to feel discriminated and being ridiculed (Sweeney et al 2014).

Patients also experience suspicion as if their concerns and physical complaints are unreal and therefore, they are not given adequate information in regard to their disease and treatment prospects (Nash 2013). Patients who attempt to take part in the decision making process and question a certain treatment can also be labelled as uncooperative patients by their mental health provider (Modgill et al 2014).

Paternalism and overprotection has been found to be widely practiced by mental health professionals to enforce medications and treatment options, whereas, patients wish to be treated like any other person of the un-stigmatised society (Mestdagh & Hansen 2014).

The combined effects of the hurtful stigmatised experience adversely affect the therapeutic relationship and become the driving force for individuals to embrace strategies including secrecy and withdrawal to avoid negative interaction with mental health professionals (Merritt & Procter 2010).

People with mental illness have to cope with the dilemma caused by their illness as well as the barriers that stigma imposes

on their opportunities to involve actively with others in order to improve their quality of life. Stigma linked with mental illness contributes to the fear of being discriminated and labelled, thus leads to under usage of mental health services and treatment options (Kondrat 2012).

Undertreated or untreated symptoms of mental disorders may include agitation, anxiety, social withdrawal and cognitive impairment, which limit communication between individuals and health professionals and becomes barriers to the timely response, ongoing assessments and interventions (Nash 2013).

The discriminatory attitude of care givers may contribute to defensive, hostile, withholding or demanding behaviour which further damages the care giver-client relationship and may result in detrimental patient reaction.

Szeto et al (2012) explains that as soon as the combination of labelling and reaction is initiated, the attitude of patient and clinician towards each other becomes automatic, which affects therapeutic communication, relationship and patient outcomes.

Kassam et al (2012) argues due to the presence of stigma in health professionals, mentally ill people also experience objectification, which means they are not treated as a person but as an object. They anmf.org.au

Clinical review

STIGMATISATION

BY HEALTH PROFESSIONALS CONSEQUENTLY INTERRUPTS DRUG ADHERENCE WHICH ACTS AS AN OBSTACLE TO RECOVERY AND RESULTS IN IMPEDING POSITIVE TREATMENT OUTCOMES

Thornicroft, G. (2013). Stigma and discrimination against people with schizophrenia related to medical services. International Journal of Social Psychiatry, 60(4), 359-366.

Harrison, J., & Gill, A. (2010). The experience and consequences of people with mental health problems, the impact of stigma upon people with schizophrenia: a way forward. Journal of Psychiatric and Mental Health Nursing, 17, 242–250.

Horsfall, J., Cleary, m., & Hunt, J. (2010). Stigma in mental health: Clients and professionals. Issues in Mental Health Nursing, 31, 450-455.

Kassam, A., Papish, A., Modgill, G., & Patten, S. (2012).

The development and Psychometric properties of a new scale to measure mental illness related stigma by healthcareproviders: the Opening Minds Scale for healthcare Providers (OMS-HC). BMC Psychiatry, 12 (62).

Kondrat, D. (2012). Do treatment processes matter more than stigma? The relative impacts of working alliance, provider effects, and self-stigma on consumers’ perceived quality of life. Best Practice in Mental Health, 8(1), 86-103.

Merritt, M., & Procter, N. (2010). Conceptualising the functional role of mental health consultation–liaison nurse in multi-morbidity, using Peplau’s nursing theory.

Contemporary Nurse, 34(2), 158–166.

are not involved in decision making and their queries in regard to their disease are not adequately responded to. Many health professionals disapprove of mental health consumers and consider them as a failure, hence, the consumer feels rejected and negatively judged which leads to selfstigma and loss of confidence (Harrison & Gill 2010).

Stigmatisation by health professionals consequently interrupts drug adherence which acts as an obstacle to recovery and results in impeding positive treatment outcomes. Recovery is the fundamental goal of mental health services, which, when hindered by stigmatisation may lead to reduced client satisfaction and less turnover of individuals to these services, therefore adversely affects physical health of individuals (Verhaeghe et al 2010). It is evident people with mental illness are at greater risk of co-morbidities including cardiovascular disease, respiratory disease, obesity and diabetes (Parle 2012).

Stigmatised treatment may lead to disparity between client’s self-esteem and their perceptions about the service which in turn reduces the client satisfaction with the care received. Less satisfied consumers experience higher self-rejection and each visit to mental health centre is negatively viewed, thus the negativity about self, contributes to the reduced help seeking behaviour (Harangozo et al 2013). anmf.org.au

Stigma is a sad reality associated with mental health and adversely affects the therapeutic relationship. Stigmatised behaviour of health professionals leads to poor patient outcome, reduced client satisfaction and withdrawal from the health services, therefore increasing the risk of physical illness and a higher mortality rate.

A strong therapeutic alliance empowers the consumer and enhances their quality of life.

Mental health professionals may contribute in reducing stigma by establishing, implementing and monitoring anti-stigma strategies. They should always remember that they can either de-stigmatise their patient or increase their stigma. Recoverybased practises should be established where treatment and rehabilitation should be provided to the patient with assertive communication to boost the patient’s selfesteem. Health professionals should not only be focused on evidence based interventions but also consider values and context as a significant part of effective treatment.

References Brohan, E., Elgie, R., Sartorius, N., & Thornicroft, G. (2010). Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: The GAMIAN-Europe study.

Elsevier, 122, 1-6.

Elder, R., Evans., & Nizette, D. (2013). Psychiatric and Mental Health Nursing, (3rd ed.). Chatswood, NSW: Elsevier Australia.

Harangozo, J., Reneses, B., Brohan, E., Sebes, J., Csukly, G., López-Ibor, J.,Sartorius, N., Rose, D., &

Mestdagh, A., & Hansen, B. (2014). Stigma in patients with schizophrenia receiving community mental healthcare: a review of qualitative studies. Social Psychiatry and Psychiatric Epidemiology, 49, 79-87.

Modgill, G., Knaak, S., Kassam, A., & Szeto, A. (2014).

Opening minds stigma scale for healthcare providers (OMS-HC): examination of psychometric properties and responsiveness. BioMed Central Journal, 14(120).

Nash, M. (2013). Diagnostic overshadowing: a potential barrier to physical healthcare for mental health service users. Journal of Mental Health Practice, 17(4), 22-26.

Parle, S. (2012). How does stigma affect people with mental illness? Nursing Times, 108(28), 12-14.

Rüsch, N., Müller, M., Lay, B., Schönenberger, T., Bleiker, M., Lengler, S., Blank, C., & W. Rössler.

(2014). Emotional reactions to involuntary psychiatric Hospitalization and stigma-related stress among people with mental illness. European Archives of Psychiatry & Clinical Neuroscience, 264 (1), 35-43.

Sweeney, A., Fahmy, S, Nolan, F., Morant, N., Fox, Z., Evans, B., Osborn, D., Burgess, E ., Gilburt, H., McCabe, R., Slade, M., & Johnson, S. (2014). The relationship between therapeutic alliance and service user satisfaction in mental health inpatient wards and crisis house alternatives: A cross-sectional study. Plos One Journal, 9(7), 100153.

Szeto, A., Luong, D., & Dobson, K. (2012). Does labeling matter? An examination of attitudes and perceptions of labels for mental disorders. Soc Psychiatry Epidemiol, 48, 659-671.

Toombs, C. (2012). The stigma of a psychiatric diagnosis: Prevalence, implications and nursing interventions in clinical care settings. Journal of Clinical Care Nursing, 24, 149-156.

Verhaeghe, M., Bracke, P., & Christiaens, W. (2010).

Stigma and client satisfaction in mental health services.

Journal of Applied Social Psychology, 40(9), 2295–2318.

Ambreen Zubair is a Bachelor of Nursing student at the Victoria University, St Albans Campus, Victoria April 2015 Volume 22, No.9 35

Issues Review of a ward based respiratory care unit Three years post implementation of a respiratory education module and annual assessments

Vara Perikala, Louis Irving, David Smallwood and Brigitte Cleveland The Respiratory Care Unit (RCU) at the Royal Melbourne Hospital is a four bed specialised unit within 5 South West, Resp, general medical ward. The RCU manage inpatients with acute respiratory diagnoses.

This involves close respiratory observation and monitoring, arterial blood gas sample taking, non-invasive ventilation (NIV– CPAP or BiPAP), high flow oxygen humidification, ICC management and tracheostomy care.

Prior to the establishment of the RCU, patients with moderate to severe acute respiratory problems could only be cared for in the emergency department (ED), or the Intensive Care Unit (ICU).

The RCU was established in 2004. Since this time many patients have been treated in the RCU. In 2011 a Respiratory Education Module (REM), practical assessments and annual competencies were introduced for registered nurses (RNs). Since the introduction of REM, the number of trained RNs able to look after this patient population increased from 16 to 41 (Perikala, Irving, et al 2012).

To evaluate the effectiveness of the unit such as effective utilisation of beds, impact of care on patient outcomes, a yearly data collection set was developed in 2012 which has continued.

Aim of the study To evaluate the utilisation of RCU since implementation of the REM, as evidenced by: • Number of post met call patients admitted to RCU and had NIV; • Number of patients admitted to RCU from ED, ICU and other areas of the hospital; • Number of NIV hours; • Mean stay and length of stay; • Adverse events ie.: – Pressure injuries – Falls – Critical medication errors – Mortality

Methods Prospective data on all patients admitted to the RCU in 2012 and 2013 was analysed.

Results Total number of patients admitted to RCU was 277 in 2010, 324 in 2011 (an increase of 47); and 362 in 2012 (an increase of 38), majority of RCU patient admissions were from ED and ICU. (130 patients were admitted from ED in 2013 compared to148 36 April 2015 Volume 22, No.9

in 2012), while (80 patients were admitted from ICU in 2013 compared with 83 in 2012). In 2013, five patients stayed more than 12 days compared to eight patients in 2012. Length of longest stay patient stay is reduced by 10 days in 2013 compared to previous years.

Mean duration of stay was 2.8 days. Hours of NIV used increased by 232 hours in 2013. There were no significant adverse events, and one episode of nasal bridge pressure injury. Major causes of mortality were end-stage COPD, severe pulmonary hypertension, and pulmonary fibrosis.

Conclusion Post implementation of respiratory education module (REM) and practical assessments and annual competencies enables more RNs to care for this patient population and other speciality patients throught the hospital, who require respiratory support.

They are as follows; Resp, Medical, Urology, Vids, Ortho, EGS, NS, ENT, Plastics, GS, Trauma, Renal, MONC, FACIOMaXILLARY, Palliative, Neuro, Gastro, Endo, Oncology, Haematology, Vascular, BOE, NEPS, Optho, OMFS, Hepato Biliary, Cardiology CTS. Mean length of RCU patient stay was 2.8 days and mean NIV used hours were 11.7 hours/day. These results indicate that, RCU provides adequate respiratory support and ongoing monitoring. Protecting four RCU beds has greatly improved patient outcomes and reduced admission pressure on the ICU and ED.

Discussion Ward nurses now look after different patient population in the given context of experienced advanced practice nurse supervision. This is achieved through clear development of patient management plans, completion of annual assessment and competencies.

The RCU has had a positive impact on ward morale, nursing staff recruitment, and retention and job satisfaction. After implementation of REM there have been

significant improvements in staff skills, proficiency and competency.

The respiratory consultant and registrar conduct twice daily ward rounds in the RCU. This has resulted in the ability to provide safe and evidenced based clinical care for unwell respiratory compromised patients outside of the ICU setting.

RCU provides excellent clinical opportunity for advanced respiratory trainees and the opportunity to work in a collaborative multidisciplinary team, establishing a credible benchmark for other RCU’s and respiratory education models. The RCU beds are cost effective compared to ICU and ED beds.

Acknowledgements 5SW Nursing Staff, 5SW Nursing Educators, Kathy Quade, Nurse Unit Manager at the Royal Melbourne Hospital Reference Perikala V; Irving L; et al, 2012; Implementing a Respiratory Education Module (REM), bedside assessments and competencies in a ward based respiratory care unit. Australian Nursing Journal; July 2012; volume 20; Number 1

Vara Perikala is a Clinical Nurse Consultant Respiratory /Acute Medicine at the Department of Respiratory Medicine and Medicine and Community Care and Endorsed Nurse Practitioner, Royal Melbourne Hospital Associate Professor Louis Irving is a Director Respiratory and Sleep Medicine; Director Clinical Training at the department of Respiratory Medicine, Royal Melbourne Hospital Associate Professor David Smallwood is Deputy Director of Respiratory medicine and Head of the Medical Unit 3 at the Department of Respiratory Medicine and Medicine and Community Care, Royal Melbourne Hospital Brigitte Cleveland is a Nurse Unit Manager at the Department of Respiratory Medicine and Medicine and Community Care, Royal Melbourne Hospital anmf.org.au

Focus – Women’s health Koori Maternity Service

Kate Brown, Women’s Health Unit Manager (left) with Karan Kent, Koori Maternity Service Project Officer

By Claire Polatidis A dedicated Koori maternity service is being offered to Aboriginal and Torres Strait Islander women at Peninsula Health, in Victoria’s South East.

Karan Kent, Koori Maternity Service Project Officer, works with the Women’s Health Unit and community health staff to provide a culturally safe and supportive environment of care during and after pregnancy.

“This collaborative approach involves women supporting women through consistency of care, relationship building, trust, and understanding. It empowers women and their families to engage with the program, gain information and begin to understand the endless parenting questions, fears and issues that may arise

Overcoming barriers to perinatal data entry

By Alison Craswell

With healthcare moving at increasing speed to paperless environments and automated collection of data via electronic monitoring, the entry of mandated data continues to be required by midwives (Balestrieri-Martines 2014).

An example of this is perinatal data.

Explicitly captured for the health of women and their babies, the perinatal data collection is used nationally for research, funding allocation and education (Data Collections Unit 2010). Given its importance, there is a critical requirement for accuracy.

Doctoral research examining the factors affecting midwives while entering perinatal data found that midwives face many barriers to entering complete and accurate perinatal data. Shifting focus of the midwife from the woman to the computer was identified as a anmf.org.au

with their growing baby,” Ms Kent explains.

Kate Brown, Women’s Health Unit Manager, added: “With an Aboriginal community worker like Karan and a midwife working together, patients are in the best possible care as all their social and emotional wellbeing and clinical needs are being met.”

Early indicators for the Koori Maternity Service show an increase in the number of women attending antenatal appointments.

Nurses, midwives and allied health staff

concern in dealing with computers for data entry at point of care (Craswell, Moxham & Broadbent 2014). Additionally, midwife participants identified that entering data was not perceived by themselves or outsiders as part of their midwifery role. Other challenges identified included competing with other healthcare professionals for computer time, finding time within an already busy workload to enter data, password lockouts and the use of password sharing by midwives to be able to fulfill the requirement to enter perinatal data. Inconsistent professional development and understanding of field definitions also contributed to frustration and perceived inaccuracies.

Despite these and other challenges, participants expressed an ability and desire to achieve complete and accurate perinatal data entry for the women and babies in their care. Midwives articulated awareness of data entered for perinatal data collection as being used for research and how this directly impacted on the mothers and babies in their care. Findings from the research led to the development of the Theory of Beneficial Engagement.

This substantive theory suggests that if midwives realise the importance of the data, they will more easily overcome the

report the initiative has enhanced their understanding of cultural differences.

This 12 month pilot is funded by the Department of Health in Partnership with VACCHO (the Victorian Aboriginal Community Controlled Health Organisation).

Claire Polatidis is Media and Content Adviser, Corporate and Community Relations at Peninsula Health in Victoria

challenges enabling entry of more accurate and complete perinatal data.

Recommendations to enhance the process of perinatal data entry for midwives include improved design and functionality of software and ongoing professional development for users emphasising the value and benefit of collecting perinatal data to the care of mothers and their babies. Complete and accurate perinatal data entry into the computer contributes to high standards of midwifery care.

References Balestrieri-Martinez, B. (2014), Implementing an Automated Data Collection Process for Reporting the Perinatal Care Core Measure Set. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 43:S51. doi:10.1111/1552-6909.12437 Craswell, A., Moxham, L., & Broadbent, M. (2014).

Shared responsibility for electronic records: Governance in perinatal data entry. In H. Grain, F. Martin-Sanchez & L. Schaper, K. (Eds.), Studies in Health Technology and Informatics (Vol. 204, pp. 19-24). Amsterdam: IOS Press.

Data Collections Unit. (2010). Perinatal Data Collection Manual. Retrieved from www.health.qld.gov.au/hic/ manuals/pdc/PDCManual_2010.pdf

Dr Alison Craswell is Associate Clinical Lecturer, CQUniversity, Noosa/ Post doctoral researcher, University of the Sunshine Coast, Qld April 2015 Volume 22, No.9 37

Focus – Women’s health Increasing women’s health literacy

By Sara Hristov

What is health literacy?

It has been defined as: ‘the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions’ (Nielsen-Bohlman et al 2004). Evidence has shown that low levels of health literacy are associated with poorer levels of overall health status and health outcomes (Berkman et al 2011).

Interpreters Required for sessions

Presentation Evaluations – responses to questions 70

67 60

65

One

62

Two

Three

50

40

38

66%

44%

30

33 35

20 10

0

0

Interpreters used

No interpreter

In 2006 the Australian Bureau of Statistics (ABS), reported that 59% of the Australian general population had low levels of health literacy (Osborne 2014).The populations that are at higher risk included people from culturally and linguistically diverse populations (CALD), people with lower levels of education, the elderly, Indigenous Australians and people from lower socioeconomic groups.

Nutbeam (2000) states, “Education has been an essential component of action to promote health and prevent disease...” Part of my role as Women’s Health Clinical Nurse Consultant is to provide health education/ workshops to women in the community.

The topics that are covered include, but not limited to, preventative health – pap tests, breast awareness and mammograms, general health and wellbeing – diet and exercise, cardiovascular disease , contraception/family planning, emotional health – stress, anxiety and depression, sexual health including HIV and blood bourne viruses.

Most of the groups are from CALD backgrounds including newly arrived migrants and refugees. Interpreters are used when providing education sessions, if needed/requested. The groups that I provide education to fall into the high risk 38 April 2015 Volume 22, No.9

Percentage strongly agree

Percentage agree

0

0

Percentage disagree

0

0

0

Percentage strongly disagree

groups, as mentioned previously.

As part of quality assurance, evaluation forms are collected for all education sessions. A review of education sessions provided during January to October 2014 gave the following information: • Number of Sessions – 12.

• Total number of participants – 109.

• Interpreters used – eight of 12 sessions.

CALD backgrounds included Vietnamese, Spanish speakers (participants mainly from South America), Arabic speakers (participants mainly from Iran, Iraq, Syria and Lebanon), Polish, Sudanese and Somali.

“good topic.”

Three questions were on the evaluation forms where participants were asked to circle their response from strongly agree through to disagree. The questions asked were: Q1 – The topic/s were interesting and met your needs.

Q2 – The session was delivered in an understanding and clear manner.

Q3 – The presenter provided relevant resources to take away from the group.

References Nielsen-Bohlman L, Panzer AM, Kindig DA. (2004).

Health literacy: A prescription to end confusion.

Washington DC: Institute of Medicine

They were also provided with space to write comments; some of the comments were as follows: “great opportunity to ask our question’s, in a comfortable and safe environment,” “new information and relevant.”

Nurses are in an excellent position to provide health education to communities. This is important in increasing the community’s health literacy, which will improve health outcomes. Nurses are able to provide education to individuals and communities on health information and the capacity to use it effectively. We need to recognise this as an important part of our role, and to be recognised for the contribution that we make to the health literacy of our communities, and to showcase our work.

Berkman N, Sheridan S, Donahue K, Halpern D, Crotty K. (2011).Low health literacy and health outcomes: An updated systematic review. Ann Int Med, 155 (2) Osborne Richard H. Improving health literacy, Medical Observer www.medicalobserver.com.au/news/ improving-health-literacy (accessed 20/11/2014) Nutbeam Don. Health literacy as a public health goal: a challenge for contempory health education and communication strategies into the 21st century. Health Promotion International, Vol 15, No.3, Oxford University Press 2000

Sara Hristov is a Clinical Nurse Consultant Women’s Health (SWSLHD) anmf.org.au

Focus – Women’s health

Make it happen

By Helen Wilmore

International Women’s Day (IWD) is celebrated around the world on 8 March each year.

It provides an opportunity to celebrate women’s achievements while calling for greater equality. In some countries like Russia, China, Bulgaria and Vietnam International Women’s Day is a national holiday.

Historically International Women’s Day began with women taking action. The event originated in 1908 when women garment makers in New York demonstrated to demand better working conditions and the right to vote. In England, women, known as the Suffragettes, were meeting and marching to demand the right to vote. The Suffragettes adopted the three colours of Green, White and Violet (Purple) to stand for their slogan ‘Give Women the Vote’. Since then these colours have been internationally used to symbolise solidarity, IWD and women’s struggle to obtain anmf.org.au

equal rights. Green, white and purple colours are used for banners, flags, rosettes, badges, documents, and clothes worldwide to market women’s issues and equality struggles.

Women’s rights activist Gloria Steinem said, “The story of women’s struggle for equality belongs to no single feminist nor to any one organisation but to the collective efforts of all who care about human rights”.

The first International Women’s Day was held in 1911 and from its inception International Women’s Day has stood for equality between women and men.

IWD theme for 2015 was: ‘Make It Happen’. While many economic, political and social improvements have been made for women, equality remains a worldwide focus and a basic human right for women.

‘Make It Happen’ was themed for equal recognition of women in the arts, for more women in science, engineering and technology, for increased financial independence of women, for growth of women owned businesses, for fairer recognition of women in sport, for more women in senior leadership roles and for greater awareness for women’s equality.

This is the time of year when women’s

health nurses embrace IWD at a local level.

Partnerships involve non-government organisations, local health services, women’s groups, corporations and organisations to recognise and celebrate the achievements and contribution women have made in their area. Activities include breakfasts, BBQ’s, photo & poetry competitions, seminars, webinars, entertainment, storytelling and awards to name a few. Purple was the key colour for IWD this year which was incorporated on websites, blogs, emails, buildings, playgrounds, canteens and clothing.

In NSW the state government sponsored the 2015 Sydney International Women’s Day breakfast held at Australian Technology Park.

Funds raised at the breakfast supported UN Women’s projects to tackle issues of poverty and women’s economic leadership.

References www.internationalwomensday.com/about.asp (Accessed 14/01/2015) http://.facs.nsw.gov.au/about_us/media_releases/nswgovernment-partnerships-with (Accessed 22/01/2015) www.un.org/en/events/womensday/history.shtml (Accessed 14/01/2015)

Helen Wilmore is the CNC of Women’s Health, South Eastern Sydney Local Health District, NSW April 2015 Volume 22, No.9 39

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Focus – Women’s health Changes for the maternal and child health nursing profession

By Rayleen Breach and Linda K Jones

There have been an enormous amount of changes in nursing due to the introduction of national registration and the flow on effect that this has had on maternal and child health nurses.

The great disparity that exists regarding education requirements across Australia has the potential to impact the maternal and child health (MCH) nurses in Victoria. This is partly because the Victorian MCH nurses are the only jurisdiction that requires a midwifery qualification and a minimum postgraduate Graduate Diploma in Child and Family Health (DCFH) to practice in this area. In addition, the absence of a national minimum practice standard left the benchmark for the

services open to interpretation.

A study, attended for the Degree of Doctor of Philosophy at RMIT University, Melbourne, explored the knowledge, attitudes and beliefs of the Victorian MCH nurses to the national changes to registration and service provision. A qualitative explorative descriptive (QED) method was employed for this study with purposive sampling of 48 nurses. The findings indicated that the loss of notation for the MCH nurse qualification appeared to have caused a considerable amount of concern to all participants interviewed. In regards to the national framework, however, there was surprisingly limited knowledge regarding what would constitute a national service framework.

In addition there was agreement that the framework from Victoria could be a significant benchmark for consideration for the national service framework to be based on. In doing so, this would enable increased flexibility for the national services to work with vulnerable and disadvantaged families through the provision of proportionate support and an increased level of service frequency, intensity and interventions.

Additionally it was found that the attempts from the Council of Australian

Connecting parents with the right information at the right time By Julie Green Everyone who works in nursing or midwifery is acutely aware of just how much information mothers and fathers seek during the lifechanging experience of becoming a parent and caring for a family.

Aside from health professionals and family, the internet plays a significant role in connecting new parents to information (Johnson 2014). In this age of evidence-based practice and the portability and ubiquity of devices that keep us connected, nurses and midwives can be very influential in connecting parents to quality information that is grounded in what works and opinion-free.

The website, Raising Children Network, has been providing evidence-based information for parents - and professionals who work with parents - since 2007.

An important point of difference to the many parenting websites out there is that raisingchildren.net.au is evidence-based, commercial-free, and freely available.

The website is accessed daily by 25,000 Australian parents. They are looking for credible information relevant to a wide variety anmf.org.au

of practice areas such as breastfeeding, nutrition, infant sleep, child development, coping with emotional changes, adolescence, family relationships, and just as importantly, how to look after themselves.

The majority of Raising Children Network visitors return again and again, indicating a strong connection and trust with the information it provides as parents progress through different stages of the parenting journey.

Its 2,000 articles, videos and multimedia resources are all developed and reviewed by a panel of Australian health professionals, including expert nurses and midwives.

Annual visitation to the website is growing exponentially. In 2014, its 8 million visitors read in excess of 15 million pages.

Resources relating to pregnancy, birth and the first years of life always feature in the

Governments (COAG) to offer consistency between jurisdictions in fact appeared to be creating further disparity. It was clear from the findings that there was a perceived lack of consultation and communication with decisions regarding what changes were being proposed prior to implementation of the national changes to registration.

Recommendations from this research included, that further research be attended to thoroughly examine how the national service compilation would be accomplished.

The need to thoroughly investigate and have a national collaborative discussion on the future direction then decide the direction the service should precede.

Likewise, while retaining and preserving the current Victorian MCH service is commendable the service needs to be current, reflective and responsive to community needs.

Dr Rayleen Breach is a maternal and child health nurse and casual lecturer at RMIT University, Victoria Dr Linda Jones FACM is chairperson SEH CHEAN, midwifery coordinator, Disciplines of Nursing and Midwifery, RMIT University, Victoria

list of most popular pages.

Parents learn as they go. Their need to access reliable information never stops.

An early mention of Raising Children Network by a helpful women’s health nurse or midwife can help build parental selfefficacy, connect parents with local services and help with the day-to-day (and nightly!) decisions of raising children.

Visit www.raisingchildren.net.au, like Raising Children Network on Facebook or follow @RCN_AUS on Twitter. The Raising Children Network is an initiative of the Parenting Research Centre and the Murdoch Childrens Research Institute with The Royal Children’s Hospital Centre for Community Child Health. It is funded by the Australian Government.

Reference Johnson S. A. (2014), Maternal devices, social media and the self-management of pregnancy, mothering and child health’, Societies, Vol 4 pp. 330-350.

Dr Julie Green is the Executive Director Raising Children Network Parenting Research Centre; Honorary Fellow, Murdoch Childrens Research Institute; Honorary Research Fellow, The University of Melbourne April 2015 Volume 22, No.9 41

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Focus – Women’s health Evaluation of a novel opt-out consent process involving pregnant women

By Louisa Lam and Christine East

The Declaration of Helsinki adopted by the General Assembly of the World Medical Association at the Finland Convention in 1964 set standards for conducting trials involving humans. Since then, in developed countries, obtaining informed consent from potential participants has been well-recognised as a vital part of clinical trials in order to protect human rights.

There are many recognised and ethically acceptable forms of consent: opt-in, opt-out, implied and even, under some circumstances, waiver of consent.

Traditionally, clinical trials use opt-in consent and this consent is obtained by the research coordinator, most commonly a nurse or midwife. The process requires the potential participant to be fully alert, undisturbed and of sound mind. For many research studies eg. studies recruiting patients in the emergency department requiring immediate medical treatment, or studies recruiting pregnant women in the process of labour, it is also time-critical.

In many clinical situations it would be impractical, or sometimes even impossible, to obtain consent within a limited timeframe. Even though waiver of consent or delayed consent are sometimes used, many important clinical studies using opt-in consent processes have failed to recruit a sufficient number of participants because of the challenging timeframe within which anmf.org.au

to obtain patient consent. The consequence of this is that such trials may fail to be completed on time, within budget, or even at all, thereby compromising the provision of high quality, evidence based data to inform clinical practice guidelines.

The Australian National Health and Medical Research Council’s (NHMRC) National Statement on ethical conduct in human research was amended to include optout consent for patient recruitment in March 2014. If used properly, this new initiative should improve efficiency in patient recruitment. Currently there is no data available on how opt-out consent is received by potential research participants, nurses/midwives and doctors when used in randomised control trials (RCT).

Professor Christine East is currently leading an NHMRC-funded, ‘Flamingo’ randomised controlled trial which is recruiting participants at the Royal Women’s Hospital (ACTRN12614000818639). This trial

started using the traditional opt-in consent approach for participant recruitment, but later received approval for using optout consent; the use of two consenting methods in the Flamingo trial has provided a unique opportunity for us to evaluate the effectiveness of the opt-out method of consent. We are planning to conduct the evaluation using face-to-face, in-depth interviews and surveys.

We are calling for a potential PhD candidate to be involved in the study. If you are interested in maternity care, ethics and clinical research, please contact Dr Louisa Lam or Professor Christine East (on behalf of the Flamingo Steering Group) for further details. Email: Louisa.lam@monash.edu or christine.east@monash.edu Dr Louisa Lam and Professor Christine East are both in the School of Nursing and Midwifery, Monash University, Faculty of Medicine, Nursing and Health Sciences, Victoria April 2015 Volume 22, No.9 43

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Focus – Women’s health Poor access to sexual and reproductive healthcare in rural and remote SA

By Wendy Abigail

Research into health professional’s views of sexual and reproductive health (SRH) issues in rural and remote areas of South Australia was recently conducted by Dr Wendy Abigail from Flinders University School of Nursing and Midwifery.

The ethically approved online survey sought the views of healthcare professionals to identify the SRH issues women in rural and remote areas of South Australia experience for the purpose of informing policies and practice.

Healthcare professionals from rural and remote areas of South Australia reported poor access to sexual and reproductive healthcare was the main barrier women faced. This included poor access to pregnancy counselling services. Over half of the health professionals reported that there

Strong healthy behavioural change program for women

By Azita Keytash, Linda Jones and Andrew Frances Environmental factors prior to and after conception has an enormous impact on the developing embryo and can cause long term problems that can lead into adulthood.

There is growing body of evidence that environmental factors during embryonic development can cause irreversible alteration in epigenetic markers and induce various adult diseases, such as cardiovascular, neurological and metabolic disorders later in life (Adamo et al 2012; Boekelheide et al 2012; Gluckman & Hanson 2008).

Most women modify their risky behaviour, such as stop smoking, reducing alcohol consumption and altering their life style to healthier one, such as consuming folic acid and multivitamins when they know they are pregnant, however many women only learn about their pregnancy around eight to 14 weeks of pregnancy.

This means women unaware of their pregnancy may miss their opportunity for providing an appropriate uterine anmf.org.au

were no local services available to women for pregnancy options counselling. Respondents also reported limited access to services and limited service options for women who were seeking pregnancy option counselling and referrals. Counselling was mainly provided by GPs, although to a lesser extent telephone and specialist nursing staff counselling options were reported. Barriers to pregnancy counselling for women in rural and remote areas were reported to include long travel distances, transport issues, lack of social support, costs and lack of confidentiality.

Poor access to contraception was another major issue reported by the health professionals. Reasons for poor access included lack of confidentiality, lack of knowledge, distance and travel to access services. Health professionals viewed that services most needed in rural and remote areas of South Australia include family planning clinics, increased access to contraception and free contraception.

Further research is required to explore rural and remote women’s experiences of their access to SRH services. This research could include how they navigate the identified

environment for their growing embryo.

Preconception care is a relatively new concept and provides a unique opportunity to improve women’s health and also pregnancy outcomes. Despite the general acknowledgement of the potential valuable impact of preconceptual care, very little preconceptual care is provided for women.

There is preconceptual care for women who are identified as being of high risk, such as women who have diabetes or other medical conditions. But this is often done informally as part of medical care and certainly is not all encompassing.

A healthy lifestyle program for women that was successfully developed and tested in America by Weisman and colleagues (2011) is to be trialed. This program involves a series of face to face educational and motivational sessions aimed to bring about behavioural lifestyle changes in women.

The sessions are around the areas of healthy lifestyle which includes physical activity and nutrition, stress and anxiety, smoking and alcohol consumptions, and discussion on pregnancy risk factors. These are not about undertaking boot camps but instead about how women can embrace all of this into their normal daily activities and become strong healthy women.

Dr Wendy Abigail

poor access to SRH services and also possible solutions that could be implemented in rural and remote areas to address the deficits in SRH service provision.

For further information regarding the research contact Wendy Abigail at wendy. abigail@flinders.edu.au Dr Wendy Abigail works at the School of Nursing and Midwifery, Flinders University, South Australia References Adamo, Kristi B., Ferraro, Zachary M., & Brett, Kendra E. (2012). Can We Modify the Intrauterine Environment to Halt the Intergenerational Cycle of Obesity?

International Journal of Environmental Research and Public Health, 9(4), 1263-1307.

Boekelheide, Kim, Blumberg, Bruce, Chapin, Robert E., Cote, Ila, Graziano, Joseph H., Janesick, Amanda, Rogers, John M. (2012). Predicting Later-Life Outcomes of Early-Life Exposures. Environmental Health Perspectives, 120(10), 1353-1361. doi: 10.1 186/147 1 - 2164-12-529 [Online 28 October 2011].

Gluckman, P. D., & Hanson, M. A. (2008).

Developmental and epigenetic pathways to obesity: an evolutionary-developmental perspective. Int J Obes (Lond), 32 Suppl 7, S62-71. doi: 10.1038/ijo.2008.240 Weisman, C. S., Hillemeier, M. M., Downs, D. S., Feinberg, M. E., Chuang, C. H., Botti, J. J.,& Dyer, A. M. (2011). Improving women’s preconceptional health: long-term effects of the Strong Healthy Women behavior change intervention in the central Pennsylvania. Women’s Health Study. Womens Health Issues, 21(4), 265-271. doi: 10.1016/j.whi.2011.03.007

Azita Keytash is a PHD candidate though RMIT and a midwife working at Merci, Victoria Dr Linda Jones FACM, Chairperson SEH CHEAN, Midwifery Coordinator, Disciplines of Nursing and Midwifery, RMIT University, Victoria Andrew Frances is Associate Proffessor in psychology, school of Health Sciences, RMIT, Victoria April 2015 Volume 22, No.9 45

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Focus – Women’s health Women’s health nurse role

By Rose Cole

This nursing specialty adopts a primary healthcare and health promotion focus (World Health Organization 1978; 1986) on prevention and early intervention whilst also ensuring clinical service provision individually to women.

There are five areas of practice; advocacy and community development, health education, clinical services, health promotion and research and evaluation.

Community development involves community participation in awareness raising regarding women’s health issues, particularly violence against women (16 Days of Action to Stop Violence Against Women, White Ribbon Day, Reclaim the Night, court support). Other community development activities include enhancing social connections particularly for isolated and those with poor health.

Health education occurs to community members and health professionals on

Women’s health: a nurse practitioner case study

By Shandell Elmer and Christine Stirling

Nurse practitioners are important providers of primary healthcare services. In Tasmania, the nurse practitioner movement is in its early stages of development and there is limited original research describing the scope of practice.

The variability in the implementation of the nurse practitioner role suggests the need for case study research to gain a nuanced view of the complex social processes at play.

This case study contributes to research that demonstrates the value of autonomous nursing practice to contemporary healthcare.

Studying cases in real-world contexts (Yin 2014) examines what makes the role more or anmf.org.au

specific health topics on an individual and collective basis in a variety of settings (schools, TAFE, community centres) on a plethora of women’s health issues such as cervical screening, youth health, sexuality, sexual health, contraception, violence against women, menopause and mental health issues.

Clinical service provision involves early detection and treatment of women’s health issues particularly on an outreach basis to target geographically isolated women.

We work in collaboration with general practitioners (GPs), government (child & family health, sexual health, Integrated Violence Prevention and Response Service (IVPRS), mental health, midwives, and refugee health) and non-government organisations (women’s health centres, youth services, Women’s Domestic Violence Court Advocacy Scheme (WDVCAS).

Health promotion aims to prevent and minimise ill-health by working with government and non-government agencies in relevant programs, for example LOVE BITES and Kinks and Bends which are demonstrated successful school based sexual assault and family violence prevention programs.

Research and evaluation ensures continuous quality improvement and the provision of evidence-based practice.

Community needs assessments are an integral part of the women’s health nurse

role to determine sites of outreach clinics (eg. cervical screening rates including unscreened and under screened for a local government area), along with research projects to determine appropriate models of care.

less effective in particular settings.

care, as well as the emphasis placed on early intervention and promoting self-care. Data indicates the majority of services provided by the nurse practitioner focus on preventative health and health promotion. Consequently the nurse practitioner enhances the health literacy of the women attending thereby increasing their ability to participate and make effective decisions about their own health. The mutually respectful nature of the interactions between the nurse practitioner and the women fosters reciprocal learning and knowledge acquisition. For the women attending the service, this is empowering and enhances their health literacy. For the nurse practitioner, this further increases her knowledge and understanding about the efficacy of her interventions.

Characteristics of complex social interventions make it difficult to determine exactly what makes them work. Through a realist evaluation approach, this study aimed to determine the effectiveness of the nurse practitioner role and to understand ‘what works, for whom, in what circumstances, in what respects and why’ (Pawson and Tilley 1997). The context, mechanism and outcome configurations generated systematically evaluated the nurse practitioner role from the perspective of the health service, the nurse practitioner and the clients. Mixed methods captured the multidimensional characteristics of the nurse practitioner role.

The context for the nurse practitioner role was a key determining factor for client access and satisfaction. In this case, the context is described as an accessible health clinic based in a women’s health centre, operating within a nursing framework and employing principles of women’s health that afford women choice and participation. Feedback from women who attend the service highlighted the nursing skills of therapeutic listening, education, goal setting and clinical

These services provided by women’s health nurses are unique as they identify disadvantaged women known to experience the lowest levels of health and wellbeing, particularly; Aboriginal and Torres Strait Islander background, Culturally and Linguistically Diverse background (especially refugees) and other socioeconomically disadvantaged and marginalised women such as women with mental illness, women who are alcohol and other drug affected and women who have experienced violence. As primary healthcare providers we provide a pathway to access and negotiate the health system.

References WHO (1986). Ottawa Charter for Health Promotion.

An International Conference on Health Promotion.

Ottawa, Ontario, Canada, November 17-21.

World Health Organization (WHO)/UNICEF (1978).

Primary healthcare. Report of the International Conference on Primary healthcare. Alma Ata, Geneva, USSR, September 6-12.

Rose Cole is a Women’s Health Nurse at Mudang Mudjin (Building Strong Foundations), Cranebrook Community Health Centre, NSW

Reference Pawson, R., and N. Tilley., (1997). Realistic Evaluation.

London: Sage Publications.

Yin, Robert. 2014. Case study research: design and methods. London: Sage Publications Inc.

Dr Shandell Elmer and Associate Professor Christine Stirling are both from the School of Health Sciences, Faculty of Health, University of Tasmania April 2015 Volume 22, No.9 47

Focus – Women’s health

Awareness of domestic and family violence in rural regions

By Anne Smart

One woman dies each week in Australia as a result of violent acts.

Key findings from the Women in NSW 2014 Report show women continue to experience particular types of crime, namely sexual and domestic-related violence. From the 2013 National Community Attitudes towards Violence against Women Survey – Research Summary, a new challenge was identified which was to engage the community in responding to known risk factors for violence, such as controlling behaviours or disrespect towards women.

To meet this challenge the ‘Moving Bus Message’ project was initiated in 2013. The project is a collaboration involving Orange Domestic Violence Action Group (local

service providers), GoTransit, high schools participating in LoveBites - a respectful relationships evidence based program, community members which was funded locally through grants.

The creative artwork displayed on the buses from LoveBites, along with other image work, is used to inform and educate our community on issues related to domestic and family violence, and to encourage an attitudinal change towards violence against women and children as unacceptable. The project has the potential to reach 40,000 people in our area and visitors.

The signage and artwork within the entire fleet of buses aims to capture people’s attention as buses make their way around streets and central business district areas over a 16 week period during summer.

Collectively the community will be asked to ‘help us to put an end to domestic violence’. The 1800 RESPECT number is included on the message as a contact service and people will be referred to local Orange services by 1800 RESPECT phone counsellors.

Expected benefits for Orange community will be wider continuous exposure of information and education, over a longer period of time, covering holiday festive time, encouraging a ‘respectful community’ for families and friends. Measures to evaluate the project include; data collated from 1800 RESPECT and ‘likes’ on Orange Primary & Community Health Facebook site along with posted comments. Anecdotal feedback via general public comments will also be captured by project team members.

References www.vichealth.vic.gov.au 6 February 2015, 2013 National Community Attitudes towards Violence against Women Survey – Research Summary www.women.msw.gov.au/publications/women_in_nsw_ reports 6 February 2015 www.whiteribbon.org.au/white-ribbon-importance 6 February 2015

Anne Smart, is a Women’s Health Clinical Nurse Consultant with Western NSW Local Health District and located at Orange Health Service Community Health, NSW

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Focus – Women’s health Women and depression: making meaning and decisions about electroconvulsive therapy

By Karen-Ann Clarke

Electroconvulsive therapy (ECT) is an effective treatment for some types of depression, yet it remains a procedure that is associated with significant adverse effects such as cognitive impairment and memory loss (Kellner 2012).

Depression is a health priority for women.

Although they experience major depression across their life span in numbers higher than men (Rich et al 2013; Essau et al 2010), they are more likely to be prescribed ECT than men are, even when both genders have similar diagnoses and symptoms. Professional observations by the author have informed the current program of PhD research being conducted.

Previous work has not highlighted the impact of gender on the experience of receiving ECT as a treatment for depression.

The experience of women and the impact of social, economic, cultural, political and medical forces on their decision-making with regard to specific mental health treatments has been largely ignored and

this in turn has created a situation where little is known about the clinical practice of ECT with regard to informed decisionmaking. There is a dearth of literature that reflects the experiences of women and for many women their stories of mental healthcare are not complete.

A review of the literature shows that much of the contemporary work on depression considers men and women as a homogenous group. A lack of gendered analyses therefore precludes the emergence of gender-specific information relating to risk factors and treatment options.

The international consumer movement compels researchers to include the voice of the individual with the lived experience of mental illness at the centre of their work, however there is a significant gap in literature exploring the experience of mental healthcare from a woman’s perspective. It would appear that the identification of a dominant biomedical view of women’s emotional distress, combined with current patriarchal mechanisms of power within a psychiatric environment creates a silencing effect for the stories and contexts of women’s lives.

Further research is required to offer a deeper understanding of the experience of depression, specific treatments available and the possible emotional costs for some women who attempt to seek help in mental health systems of care.

References Essau, C. A., Lewinsohn, P. M., Seeley, J. R. and Sasagawa, S. (2010). Gender differences in the

developmental course of depression, Journal of Affective Disorders 127, 185-190.

Kellner, C. (2012) Brain Stimulation in Psychiatry. ECT, DBS, TMS and Other Modalities, New York: Cambridge University Press.

Rich, J. L., Byrne, J. M., Curryer, C., Byles, J. E. and Loxton, D. (2013) Prevalence and correlates of depression among Australian women: a systematic literature review - January 1999-January 2010, BMC Research Notes 6(424) available: www.biomedcentral. com/content/pdf/1756-0500-6-424.pdf [accessed 17 October 2013]

Karen-Ann Clarke is a Registered General and Mental Health Nurse and is a lecturer in nursing at the University of the Sunshine Coast.

Expand your leadership skills with the Leadership@ACN program Leadership MASTER seminar for senior nurses and midwives

Leadership FIRST workshop for early/midcareer nurses and midwives

For more information: www.acn.edu.au/leadership

• 21 April, Melbourne • 26 May, Perth • 16 June, Adelaide • 18 June, Darwin

• 5-6 May, Adelaide • 28-29 May, Canberra • 16-17 June, Brisbane • 23-24 June, Hobart • 1-2 July, Melbourne • 23-24 July, Perth

To register your place: www.acn.edu.au/leadershipevents Or phone 1800 061 660 Australian College of Nursing

Focus – Women’s health

Women diagnosed with chronic hepatitis B

By Tracey Cabrié

In 2011 there was an estimated 218,000 people living with chronic hepatitis B (CHB) in Australia and only 56% are estimated to have been diagnosed (MacLachlan et al 2013). People born overseas in hepatitis B (HBV) endemic areas (particularly from Asia, the Pacific and Africa, as well as parts of Europe and the Middle East), Aboriginal and Torres Strait Islander people, people who inject drugs and men who have sex with men are priority population groups most affected by CHB (MacLachlan et al 2013).

Pregnancy is the only time that universal testing for HBV occurs, which often means it is the first time a woman is made aware of her CHB diagnosis (ASHM 2014). This can be a very stressful time for a pregnant woman and her family, so relevant CHB resources and education in her own language, with the use of an interpreter if required, is essential. Information provided should also include testing of other family members, sexual partners and household contacts to check whether they are immune, require HBV vaccination or also have CHB. All women with CHB should be referred to a

specialist for review during their pregnancy, and if they are not currently receiving any monitoring for their CHB by their GP or a specialist this should be considered in the discharge planning process, and appropriate discharge summary letters and referrals should be made.

Despite the guidelines for perinatal transmission, a review done at three hospitals in Victoria demonstrated that HBIG and HBV vaccination is administered 90% of the time, but in other areas we are not doing so well – HBV viral load (HBV DNA) testing is done in less than 20% of

Preventing perinatal transmission of HBV All babies of CHB mothers should: 1

Be given hepatitis B immunoglobulin (HBIG) and the first dose of HBV vaccine within 12 hours of birth.

2

Have three subsequent doses of HBV vaccine at 2, 4 and 6 months of age.

3

Be tested for HBsAg and anti-HBs after 9-12 months of age (at least three months after final dose of HBV vaccine).

4

During pregnancy the mothers viral load (HBV DNA) should be tested; if it is high (>10,000,000 IU/ml) antiviral therapy should be considered in the third trimester.

(ASHM 2014 p104)

50 April 2015 Volume 22, No.9

women and only 18% of women were referred for specialist care during their pregnancy (Giles et al 2013).

Improvement in CHB diagnosis and management will help prevent the increasing burden of chronic liver disease and liver cancer, now the fastest increasing cause of cancer death in Australia (ASHM 2014).

For more information on CHB for both health professionals and people living with CHB go to: www.hepbhelp.org.au References ASHM., (2014).B Positive – All you wanted to know about hepatitis B: A guide for primary care providers.

2nd edn. Sydney: ASHM. Giles, M.L, Grace, R, Tai, A, Michalak, K, Walker, SP., (2013). Prevention of mother-to-child transmission of hepatitis B virus (HBV) during pregnancy and the puerperium: current standards of care. Australian and New Zealand Journal of Obstetrics and Gynaecology. 53 (3): 231-5.

MacLachlan, J.H, Allard, N, Towell V, Cowie, B.C. (2013). The burden of chronic hepatitis B infection in Australia, 2011. The Australian and New Zealand Journal of Public Health. 37(5): 416-22.

Tracey Cabrié is a Integrated Hepatitis B Clinical Nurse Consultant, for the Victorian Infectious Diseases Service, Melbourne Health, The Doherty Institute, Victoria anmf.org.au

Focus – Women’s health Understanding the dilemma of de-infibulation for women living with female genital mutilation By Olayide Ogunsiji Female genital mutilation (FGM) also known as female circumcision (FC) is a global and women’s health issue that is of a particular concern to Australia due to an increasing migration of women and girls from countries where the practice is prevalent (World Health Organization (WHO 2011).

It is a cultural practice which refers to a range of procedures intended at partial or total removal of the female genitalia for nontherapeutic reasons (Ball 2008). FGM involves the narrowing of the vaginal opening and presents a peculiar healthcare challenge to healthcare providers in western countries such as Australia who are unfamiliar with the practice. Studies have identified a knowledge gap among western healthcare providers caring for women living with female genital mutilation. Understanding the ordeal faced by circumcised women undergoing deinfibulation will bridge this gap particularly for the inexperienced healthcare nurses and midwives who may encounter these women in the course of care provision.

Prominent in the care of circumcised women presenting for obstetric and gynaecological care is de-infibulation which is the opening

Cultural explanations and procedures about female genital mutilation

By Dr Olayide Ogunsiji and Professor Lesley Wilkes.

Female genital mutilation (FGM) is used interchangeably with other terms such as female genital cutting (FGC) and female circumcision (FC).

However, FGM is used by the World Health Organization (WHO 1998) to portray the extent of the seriousness of the practice and the significant physical, emotional, mental and sexual trauma associated with the procedure.

It is a cultural procedure unfamiliar to many healthcare providers in western countries such as Australia.

Due to international migration of women living with the consequences of this practice, nurses and midwives face the challenge of caring for an increasing number of women anmf.org.au

up of the narrow vaginal wall to enable positive birthing outcome. A qualitative study of 11 midwives caring for circumcised women in Sydney, New South Wales revealed that making a decision about de-infibulation presents a number of concerns for affected women. Understanding these concerns is important in the development of adequate supportive intervention. Circumcised women have lived their lives with the belief that female circumcision is in their best interest in making their husbands enjoy sexual relationship by narrowing the vaginal opening. De-infibulation presents physical, psychological and emotional dilemma for the women. Physical, in terms of the opening of the narrowed vagina they were used to.

Psychological, due to the women living with the constant fear that their internal organs would fall out as well as fear of the unknown about engaging in sexual intercourse.

While emotional, it involves giving-up what they have cherished in their countries of birth. In caring for circumcised women, the participating midwives suggested an understanding of this dilemma and provision of psycho-social support for affected women.

living with anatomically different female genitalia. FGM is reported as a foreign concept to western health providers and engaging circumcised women in meaningful discussion that can lead to attitudinal change towards the practice is challenging (Ogunsiji 2015). This challenge is due to limited understanding of the cultural issues that underpin the practice and the inhumane experience of the women who undertake the procedure. Gaining insight into the cultural issues that inform FGM and the associated procedures will empower nurses, midwives and other health providers in Australia and other western countries in educating affected women and girls against the practice. This will contribute to the global effort at eradicating the practice.

stated that rather than inflicting harm on their girls, Africans believe that they are preparing their daughters for marriage. The procedures according to the women used to be attended with crude instruments such as razor blade and broken glass while the legs of the girl to be circumcised are held wide open. While some of these findings have been reported in some literature, empirical studies in Australia with these findings are lacking. This study is important in raising the awareness of Australian health providers about the practice.

Engaging a group of five African migrant women in face to face qualitative interviews which lasted between 60 minutes to 90 minutes, findings revealed that female circumcision is a cultural practice passed on from one generation to the other. The women in the study stated that Africans believe that girls that are not circumcised will be promiscuous and may not get husbands to marry. They further stated that it is a thing of great shame for the family of a married woman who is not found to be a virgin on the day of marriage. The participating women

References Ball, T. (2008). Female genital mutilation. Nursing Standard (Royal College of Nursing [Great Britain] 23(5), 43–47.

World Health Organization (WHO). (2011). An update on WHO’s work on female genital mutilation (FGM) : Progress report (Department Of Reproductive Health And Research, Trans.). In World Health Organization (WHO) (Ed.). Geneva Switzerland.

Dr Olayide Ogunsiji is Lecturer, Deputy Director, Learning & Teaching (Curriculum) in the School of Nursing and Midwifery at the University of Western Sydney, NSW

References World Health Organization (WHO). (1998). Female genital mutilation: An overview. Geneva: WHO. Ogunsiji, O.O. (2015). Female genital mutilation (FGM): Australian midwives’ knowledge and attitudes.

Healthcare for Women International (In Press)

Dr Olayide Ogunsiji is Lecturer, Deputy Director, Learning & Teaching (Curriculum) in the School of Nursing and Midwifery at the University of Western Sydney, NSW Professor Lesley Wilkes is the Professor of Nursing at the Clinical Nursing Research Unit (Joint appointment with the School of Nursing and Midwifery, University of Western Sydney and the Nepean Blue Mountains Local Health District), NSW April 2015 Volume 22, No.9 51

Focus – Women’s health Clinicians and women’s learning package on Sugammadex (Bridion) and hormonal contraceptives

By Anne Smart and Jessica Gallagher

Women who are administered the drug Sugammadex run the risk of falling pregnant due to the potential interaction this drug may have on their oral contraception. It is therefore vital that women who have been administered the drug are aware of the potential risks so that they can take alternative contraceptive precautions.

Sugammadex is a drug commonly used to reverse neuromuscular blockade (NMB) from deep paralysis induced by rocuronium (roc) and vecuronium (vec) during surgery.

The drug works by drawing the roc or vec out of cells and back into the blood stream.

Sugammadex then binds to the muscle relaxant 1:1 with both excreted together via the kidneys.

Evidence based Relaxation Therapy: Physiological & Psychological Benefits Dr Judy Lovas Relaxation therapy is an efficacious, evidence based intervention to enhance psychological and physiological health.

This 3 hour seminar highlights the latest research in relaxation therapy and offers simple, effective skills to improve clinical practice and enhance patients’ health.

Judy conducts seminars for nurses to explain evidence based relaxation using the science of Psychoneuroimmunology. Judy teaches effective techniques such as deep diaphragmatic breathing and guided imagery to improve conditions such as pain, fatigue, insomnia, anxiety and depression.

Canberra ACT May 29 2015, 9.00am – 12.00pm Griffith Room, SouthSide Community Services Stuart Street, Griffith, Canberra Thirroul NSW Saturday May 30 2015, 9.00am – 12.00pm Escarpment Room, Thirroul District Centre & Library 352-358 Lawrence Hargrave Drive, Thirroul

anmf.org.au/education

ANMF Federal Office Twww.artandscienceofrelaxation.com 02 6232 6533 / E education@anmf.org.au

for more information

Evidence based Relaxation Therapy: Physiological & Psychological Benefits endorsed by ANMF

52 April 2015 Volume 22, No.9

However, when used, Sugammadex can make a woman’s hormonal contraceptive less effective by decreasing progestogen levels, resulting in a possible unintended pregnancy. Anesthetists cannot always anticipate Sugammadex use prior to surgery as this depends on the surgery itself.

Women administered Sugammadex, and taking oral contraceptives need to be advised to follow the missed dose advice in the product information of the oral contraceptive for any actions required. In the case of non-oral hormonal contraceptives, women will need to use an additional nonhormonal contraceptive method (such as condoms) for the next seven days.

Missed opportunities to give women this important information can result in women having an unintended pregnancy and an adverse risk of litigation, poor media attention, reputation damage and financial cost towards local health districts.

In a collaborative initiative to improve processes in communicating, informing and educating women, medical and nursing clinicians on this issue, the following resources have been developed, and include: • A Sugammadex Operational Procedure implemented in Orange Health Service.

• A ‘high visual’ label, designed with the Orange Health Service Pharmacy, placed externally on the Sugammadex drug box (discussions with the drug company Merck Sharp & Dohme to have sticky labels within the drug box for Anaesthetist’s use to place on the patient’s record continue).

• An information package for women

given at discharge, including a postcard size low literacy information card and a condom package.

• An information record tool for clinician’s documented use prior to discharging the patient.

• An electronic educational learning package for clinicians, including scenarios, a post learning quiz and evaluation.

• An audit tool for checking documentation and safe compliance.

Extensive consultations with key stakeholders led to implementation of this project, which is currently being rolled out within Orange Health Service.

This project will address NSW Health CORE values - Collaboration, Openness, Respect, and Empowerment, along with the Women’s Health Essentials of Care guideline elements and NSW State Health Plan, Towards 2021; making prevention everybody’s business, creating better experiences for people using health services, be ready for new risks and opportunities and improve the patient experience.

References Bridion Solution for Injection CMI. www.nps.org.au Accessed 5 February 2015 www.health.nsw.gov.au/policies/pd/2012/pdf/ PD2012_018pdf Accessed 6 February 2015 www.health.nsw.gov.au/statehealthplanpublications/ NSW-state-Health-Plan-Towards2021.pdf Accessed 5 February 2015

Anne Smart is a Women’s Health Clinical Nurse Consultant with Western NSW Local Health District and located at Orange Health Service Community Health, NSW Jessica Gallagher is an Anaesthetic Clinical Nurse Consultant with Western NSW Local Health District and located at Orange Health Service, Operating Theatres, NSW anmf.org.au

Focus – Women’s health HIV positive women and the role of the RDNS HIV Program

By Liz Crock

Liz Crock, RDNS CNC HIV (left) and Michelle Wesley, Peer Support Worker, Positive Women Victoria (right)

Since 1985, the HIV Program at RDNS (Royal District Nursing Service) in Melbourne has cared for women living with HIV. The program, staffed by HIV specialist nurses, is integrated with the Victorian AIDS Council (VAC) through a partnership agreement. An additional HIV specialist nurse works in a joint RDNS/Hospital Admission Risk Program role at the Royal Melbourne Hospital. Currently, RDNS supports over 60 women with HIV, coming from over 25 countries.

In Australia, HIV positive women face a hopeful future. Effective treatments are readily available. HIV positive women can have children, with extremely low risk of HIV transmission to their babies or partners.

RDNS works with the Victorian HIV Consultancy, public hospitals, maternal and child health services, general practitioners, infectious diseases specialists and VAC to optimise the health of HIV positive women and families through pregnancy, birth and postnatally.

The RDNS HIV Team cares for many women newly diagnosed with HIV. An HIV diagnosis can raise complex relationship issues; fear of anmf.org.au

infection is common and blame, ostracisation and even homelessness can result. Home nursing visits benefit women when starting treatments and to support them to access services. Trust, engagement, advocacy and empowerment are key to engagement in healthcare and to their wellbeing.

Many positive women are long-term survivors of HIV. Some have multiple co-morbidities (mental health problems, disabilities) or co-infections such as hepatitis C virus (HCV). RDNS’ HIV Team has supported HIV positive women with HCV treatment and they have successfully cleared HCV. The RDNS HIV Program uses an assertive outreach approach to help women remain engaged in healthcare and adhere to treatments, supporting them to achieve an ‘undetectable viral load’ and remain well. Providing education about harm minimisation, including safer sex, safer injecting practices and prevention of mother to child transmission, are essential elements of HIV specialist nursing. Peer support is also invaluable for women dealing with disclosure and stigma resulting from their positive status.

HIV positive women who are engaged in targeted healthcare can experience a life with hope and good health. RDNS provides a holistic, flexible and individualised model of care, to ensure that no woman is left behind.

Positive Women Victoria, peer support worker Michelle Wesley, who has been a client of RDNS’ HIV Program, says: “HIV continually presents challenges, physically, mentally and socially, throughout one’s life. RDNS’ support has been invaluable in helping me overcome the many challenges I have faced over 27 years living with HIV. Knowing I can rely on my district nurse is very reassuring. It’s just good to have nurses’ who understand HIV, have answers to my questions and don’t judge me.”

Links: RDNS HIV Program: www.rdns.com.au/services-weprovide/individuals/services-weprovide/hivaids-support-services Positive Women Victoria: www.positivewomen.org.au/ Victorian AIDS Council: www.vac.org.au/ Straight Arrows: http://straightarrows.org.au/ Living Positive Victoria: www.livingpositivevictoria.org.au/ Acknowledgments: Nalla Burk, Oscar Morata (RDNS HIV Program Clinical Nurse Consultants), Judy Frecker (RDNS/Melbourne Health, Hospital Admission Risk Program Clinical Nurse Consultant HIV)

Dr Liz Crock is an RDNS Clinical Nurse Consultant HIV, Northern and Eastern Regions Vice President, ANZANAC, HIV Nursing ANMF Special Interest Group April 2015 Volume 22, No.9 53

Calendar APRIL World Health Day (WHO) 7 April www.who.int/world-health-day/en/ 6th Biennial Conference of the Maternal, Child & Family Health Nurses Australia Our voice our future 9–11 April The Crown, Perth Western Australia www.aamcfhn.org.au/ Lung Health Promotion Centre at The Alfred 16-17 April - Managing COPD 20-21 April - Spirometry Principles & Practice 29 April-27-28 May - Respiratory Course (Mod A &B) 29 April-1 May - Respiratory Course (Module A) P: (03) 9076 2382 E: lunghealth@alfred.org.au 30th International Conference of Alzheimer’s Disease International Care, Cure and the Dementia Experience - A Global Challenge.

15-18 April, Perth Convention and Exhibition Centre WA. More than 1,500 delegates from over 60 countries are expected to travel to Perth for the conference being run in conjunction with Alzheimer’s Australia http://www.alzint.org/ World Day for Safety and Health at Work (ILO) 29 April www.un.org/en/events/safeworkday/

MAY APNA Continuing Education Workshops for Nurses in Primary Care 1-2 May 2015 – Perth 29-30 May 2015 – Adelaide www.apna.asn.au/ educationworkshops World Press Freedom Day 3 May www.un.org/en/events/ pressfreedomday/ International Conference on Nursing 4-7 May, Athens, Greece. www.atiner.gr/nursing.htm International Day of the Midwife 5 May www.internationalmidwives.org/ Lung Health Promotion Centre at The Alfred 7 May - Respiratory Update 27-28 May - Respiratory Course (Module B) P: (03) 9076 2382 E: lunghealth@alfred.org.au

54 April 2015 Volume 22, No.9

Nurses & Midwives Wellness Conference Create your healthy footprint 8 May, Melbourne Convention & Exhibition Centre. Learn how to manage stress and anxiety, conflict and negative relationships. Be opened up to new ways to build resilience, improve motivation and increase your energy levels. Earn up to eight hours CPD. www.anmfvic. asn.au/events-and-conferences World Red Cross Day 8 May. www.icrc.org/eng/resources/ documents/misc/57jqz6.htm Asia Pacific Cardiorenal Forum 8-9 May, Amora Hotel Jamison Sydney. http://cardiorenal.com.au/ 14th World Congress of the European Association for Palliative Care Building bridges 8–10 May, Copenhagen Denmark. www.eapc-2015.org/

Sydney Practice Nurse Clinical Education 23-24 May Sydney Showground. Australia’s leading event for Nurses working in General Practice. Earn up to 12 CPD hours. www.pnce.com.au 13th National Rural Health Conference People, Places, Possibilities...for rural and remote Australia 24-27 May, Convention Centre, Darwin NT. www.ruralhealth.org. au/13nrhc/ Biennial National Homelessness Summit Developing the intervention and integration strategies to break the cycle of homelessness 26-27 May Wesley Conference Centre Sydney, NSW. www.informa.com.au/conferences/ health-care-conference/biennialnational-homelessness-summit

Creating Futures Practice, Evidence and Creativity in Tropical and Remote Settings 11–14 May, Shangri-La Hotel, The Marina, Cairns. http://cf15.conorg. com.au/

JUNE

International Nurses Day 12 May www.icn.ch/

Lung Health Promotion Centre at The Alfred 11-12 June Spirometry Principles & Practice 18 June Paediatric Respiratory Update 24 June Asthma Management Update P: (03) 9076 2382 E: lunghealth@alfred.org.au

12th Behavioural Research in Cancer Control Conference Bridging the gap 12-15 May, Dockside, Cockle Bay Wharf, Sydney. www.cancercouncil. com.au 7th Australian Primary Health Care Nurses Association National Conference Brave to Bold 14-16 May, Gold Coast Convention & Exhibition Centre, Queensland. www.apna.asn.au/ Australian Dermatology Nurses Association 14th National Conference 16-17 May, Adelaide, SA. www.adna.org.au/events/ 2nd Australian & New Zealand Eating Disorders & Obesity Conference 18-19 May, Outrigger, Surfers Paradise, Qld. http://eatingdisordersaustralia.org.au/ The person centred approach to healthy weight management. If not dieting, then what?® 22-23 May 2015 – Hobart 5-6 June 2015 – Perth 19-20 June 2015 – Adelaide www.apna.asn.au/ifnotdieting

World Environment Day 5 June www.unep.org/wed/

JULY Lung Health Promotion Centre at The Alfred 14 July Educating & Presenting With Confidence 15-17 July Asthma Educator’s Course 23-4 July Smoking Cessation Course 30-31 July Creative Behaviour Change Coaching For Chronic Illness P: (03) 9076 2382 E: lunghealth@alfred.org.au VPNG (Victorian Perioperative Nurses’ Group) State Conference Strategies for Success: Safety and Quality in Perioperative Care 30- 31 July Pullman in Albert Park, Melbourne. www.vpng.org.au

Royal Children’s Hospital, Parkville, League of Former Trainees & Associates (including RCH Graduate Nurses) reunion Luncheon, with AGM & Guest Speaker 16 May, RACV Club, Melbourne. Contact Sue Scott E: sue.scott@rch.org.au M: 0402 092 601 www.rch.org.au/loft/ Prince Henry’s Hospital Melbourne, Group 1/85 30-year reunion 30 May, further details TBA. Contact Kristen Jones E: moretonview@bigpond.com or Wendy Larkin E: wendylarkin@bigpond. com or search Prince Henry’s Hospital 1/85 on Facebook Alfred Hospital Melbourne, Group 2/75 40-year reunion 13 June, Royal Yacht Club of Victoria, Williamstown.

Contact Fiona Williams E: fiona.williams777@gmail. com or Denise Peterson (nee Letcher), snail mail: 3 Sienna Close, Strathfieldsaye, Vic. 3551 Royal Adelaide Hospital, Group 754, 40-year reunion 19 June. Contact Liz Strachan E: lizstrachan1@hotmail.com M: 0405 535 762 Prince Henry’s Hospital, 2/85 Reunion 25 July. Venue and time not yet decided. Contact Vivienne Jose E: vivvy38@hotmail. com or search Prince Henry’s Hospital Melbourne Memorial Page for further details.

LaTrobe University, LaTrobe/Bendigo Campus nursing group (1988-1991), 25-year reunion 20 February 2016, Bendigo (venue being advised). Contact Steven Graham E: sgraham@ bendigohealth.org.au or Sarah Shipp (nee Prudham) E: sshipp@bendigohealth.org. au or search Facebook page LaTrobe 1991 reunion

Email cathy@anmf.org.au if you would like to place a reunion notice

anmf.org.au

Mail Culture of bullying must stop After reading an article in On The Record ‘Always report violent and aggressive incidents…..’, (publication of the ANMF Vic Branch) I feel compelled to write about my past experiences with bullying and being subjected to bad behaviour.

With 18 months of nursing experience behind me, I have been subjected to the dark side of nursing and was forced to terminate my employment after my first 13½ months with a particular employer.

That period gave me a number of negative experiences including bullying and lack of support from my manager and other support services.

Since leaving it has been acknowledged, by colleagues how badly I had been treated.

My questions to managers and nurses are, why is this behaviour allowed? Why is the behaviour so entrenched and accepted?

Why do anti-bullying policies exist if there

is no intention of supporting the victim and in turn getting rid of them? Why are bullies and staff allowed to continue working?

I am personally disgusted at the behaviour of some staff and disappointed with the lack of support that was meant to be available to me.

I will continue to believe in patient-centredcare regardless of other people’s views.

This is why I wanted to be a nurse, to give the best care I possibly can. Is this such an alien concept or unattainable goal? I have found this to be unpopular and a reason to be ridiculed. One staff member said to me ‘…you want to do everything right.’ Yes I want to give good care and I want the chance to learn, develop and improve as a nurse. This is something that was taken away from me for the 13½ months I was working. I feel as though my experience has not increased and my confidence has taken a battering.

So when is the bullying and bad behaviour going to stop? When is there going to be a stand against this? When will someone

Letter of the month

Self-selecting – beyond 55

The winner of the ANMJ best letter competition receives a $50 Coles Myer voucher.

ANMJ’s Issues section (Feb 2015) highlighted older nurses self-selecting positions out of the acute hospital system.

If you would like to submit a letter to the ANMJ email anmj@ anmf.org.au Letters may be edited for clarity and space.

Retention of older nurses is an issue. There are central truths about ageing bodies. I returned to the acute setting after over a decade out recently. I was asked what exercise I was doing to stay fit for full time shift work. The answer was nothing! But I am now seeing the wisdom of keeping up my fitness level. The ageing body also means the need for upgraded spectacles to bifocals for the rapid changes needed from computer screen to drug administration to patient care. (On a totally side issue, could pharmaceutical companies standardise drug information on pill packets, it is so ineffective and poorly written in most cases).

The fitness level needed to stay on your feet all day in a demanding context hits home once a worker gets to the dark side of 50. It is all quite gruelling. That 5am wake up call, the shift work over seven days, the constant management of the distressed and debilitated that is the patient and relatives.

anmf.org.au

take it seriously in each and every ward in our hospitals and other facilities? We all need to stop talking about this topic and start doing something. My hope would be to not need anti-bullying workshops, procedures and policies. The power lies with the senior nurses and managers. Unless they are determined to put an end to the behaviours nothing will change and many good nurses will continue to resign.

I am currently working in an organisation which isn’t ward based. Even though there are many benefits I miss the longer contact period and care of patients. Currently I am applying for other positions but as I do not have references from an ANUM or manager, because of my experiences, I wonder if I will be able to move elsewhere where I could be much happier and achieve greater satisfaction.

My hope that sometime soon the nursing culture will change and my experiences will not be repeated.

ANONYMOUS EN, Victoria

It is also a very demanding job emotionally.

The mechanics of nursing is that we see people at their worst. The vulnerable need intensive input on all fronts. There are so many patients desperately home sick, grieving and struggling.

The problem solving aspect of nursing occurs in all areas, the need to think on your feet and offer creative options.

Since working in the acute setting I have seen three highly experienced nurses aged over 60 reach breaking point, whereby the introduction of new computer systems and methods of documentation coupled with uncertainty over the hospitals future effectively led them to retire.

I welcome research on how to stay healthy in the acute sector nursing workforce post 50. The elements I see are physical, mental and emotional fatigue in the professional caring role, the structure of shift work, which is relatively unchanged after decades, and rostering needs of the workforce, (an ongoing nightmare). Also design of userfriendly patient spaces for both physical and mental health of all patients and workers.

Jenny Esots RN, South Australia

April 2015 Volume 22, No.9 55

Sally

Helping us prove what we already know Sally Anne Jones ANMF Federal President

Late last year I attended the Australian Nursing and Midwifery Federation Queensland Nurses’ Union Branch (QNU) Keeping Patients Safe symposium, where I had the privilege of listening to Professor Linda Aiken – a preeminent nurse researcher whose work in exploring links between patient safety, nursing workloads, and skill mix has recently been published in The Lancet.

already know – nurses and midwives and patient safety go hand-in-hand.

above a safe allocation increases patient mortality by 7%.

The patient experience can teach us so much about patient safety. Partnering with consumers is an important part of the patient safety agenda. It is something that is innate to the therapeutic relationship between nurse or midwife and the person they are caring for. This is shown by its inclusion in the National Safety and Quality Health Service Standards, which also includes some other nurse sensitive indicators like pressure injuries and falls.

The consequences also include negative effects on the health and wellbeing of nurses and midwives. Who can remember leaving a shift questioning whether you could face another day and return to work?

Nurses and midwives around Australia are increasingly aware of the mismatch between profit-driven healthcare and quality outcomes for patients. We saw at the seminar how powerful empirical evidence is being gathered to demonstrate what we know to be true. Nursing and midwifery practice counts. Nurses keep patients safe through surveillance, skilled observation, intervention, education, health promotion, in beginning and end of life care.

It is also about what is left undone.

When there aren’t enough resources available to do the work required, the potential for nurses and midwives to cut corners and take calculated risks increases, and they may end up omitting seemingly less important aspects of the patient experience.

Thanks to research such as Linda’s, the consequences are becoming clearer.

They include higher mortality, higher infection rates, more re-presentations, longer length of stay, and poorer patient satisfaction.

Linda’s research shows every extra patient

Working in such environments where nurses and midwives feel continually unsatisfied and unfulfilled by their work leads to expensive nurse turnover further compounding the issues in healthcare.

NURSING AND MIDWIFERY WORKLOADS ARE INEXORABLY LINKED TO PATIENT SAFETY EVERYWHERE. We are learning the value of data and leadership as the foundation for courageous conversations about patient safety and nursing and midwifery. It is more than just ratios.

It is not just about numbers or skill mix.

It is not just training. It is about properly recognising that nurses and midwives count. Who cares? We do!!!

I strongly encourage all nurses and midwives to discover Linda Aiken’s widely published work. It is essential reading for every one of us.

Linda’s research has covered over 30 countries in many continents across the globe – the breadth of her data is astounding, and it all points to one very clear conclusion: nursing and midwifery workloads are inexorably linked to patient safety everywhere.

Thanks goes to Dr Frances Hughes, the Chief Nursing and Midwifery Officer of Queensland and her team at the Nursing and Midwifery Office, as well as QNU Secretary Beth Mohle – without their organisational skills we may not have had the chance to spend some time with Linda, and this important event may not have taken place. We heard from an amazing array of leaders and researchers who shared their wisdom to help us prove what we 56 April 2015 Volume 22, No.9

Professor Linda Aiken speaking at the QNU Keeping Patients Safe symposium

anmf.org.au

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Caring for the people who care

2014 winners, left to right: Janine Buckley, representing Feros Care; Graham Custance, Care Connect; Paula Fievez, Ageing Wisely.

Know someone working in aged care who deserves an award?

Recognise aged care professionals for their outstanding care by nominating them in one of three categories:

NOMIN ATE

Outstanding Organisation Team Innovation Individual Distinction

30,000

$

*Generously supported by:

NOW!

in prizes to be won!* Proudly presented by:

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@HESTAACawards

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hestaawards.com.au Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No. 235249 Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321.

Terms and conditions apply. See hestaagedcareawards.com for details