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V O LU M E 2 4 , N O. 9 A P R I L 2 0 1 7

ON THE FRONT LINE THE REWARDS OF LIFE AS A MILITARY NURSE

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CONTENTS REGULARS

20

02 DIRECTORY 03 EDITORIAL 04 NEWS 14 WORLD 15 PROFESSIONAL

EARLY CAREER NURSES AND MIDWIVES NEED JOBS

16 REFLECTIONS

THE CHANGING FACE OF NURSING UNIFORMS

18 RESEARCH 19 LEGAL

WHAT IS THE CRIMINAL REGISTRATION STANDARD?

20 FEATURE ON THE FRONT LINE

ON THE FRONT LINE

28 CLINICAL UPDATE

DO AGED CARE NURSES PERCEIVE MORE PROFIT EQUALS LESS AUTONOMY?

34 EDUCATION

WORKPLACE BULLYING

THE REWARDS OF LIFE AS A MILITARY NURSE

36 ISSUES

IMMERSIVE MENTAL HEALTH SIMULATION HELPS STUDENTS WITH CHALLENGING CONVERSATIONS

06

37 FOCUS

INDIGENOUS HEALTH

45 WORKING LIFE

HOW AN EVERYDAY NURSE CRACKED COMEDY

46 CALENDAR 47 BOOKS 48 ANNIE

16

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April 2017 Volume 24, No. 9    1


Canberra

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Melbourne & ANMJ

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

Cover Image: Lieutenant Nursing Officer Alison Pickersgill at the Lavarack Barracks in Townsville. Photo: Al Green, Australian Defence Force.

Editorial Editor: Kathryn Anderson Journalist: Natalie Dragon Journalist: Robert Fedele 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

Federal Secretary Lee Thomas

Advertising

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Northern Territory

South Australia

Victoria

Branch Secretary Yvonne Falckh

Branch Secretary Elizabeth Dabars

Branch Secretary Lisa Fitzpatrick

Office address 16 Caryota Court, Coconut Grove NT 0810 Postal address PO Box 42533, Casuarina NT 0811 Ph: (08) 8920 0700 Fax: (08) 8985 5930 E: info@anmfnt.org.au

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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

Branch Secretary Beth Mohle

Branch Secretary Neroli Ellis

Branch Secretary Mark Olson

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

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

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

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 2017 Volume 24, No. 9

ANMJ IS PRINTED ON A2 GLOSS FINESSE, PEFC ACCREDITED PAPER. THE JOURNAL IS ALSO WRAPPED IN BIOWRAP, A DEGRADABLE WRAP.

134,148

TOTAL READERSHIP

Based on ANMJ 2014 member survey pass on rate Circulation: 91,882 BCA audit, Sept 2016

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EDITORIAL

Editorial Lee Thomas, ANMF Federal Secretary On the day the nation stops to remember past and present servicemen who have fought and died in war this ANZAC day, spare a thought for Australian nurses who bravely looked after the sick and injured during the World Wars as well as those involved in all conflicts and peacekeeping missions since. Just as their predecessors before them, nurses serving for the Australian Defence Force today can often work in dangerous, trying conditions which could involve anything from working as part of a relief effort to caring for sick or injured troops during times of conflict or at peace. This month’s feature delves into some of the experiences of military nurses and describes some of the highs and the lows of their job. Equally brave are civilian nurses such as our South East Asian Treaty Organisation (SEATO) nurses who volunteered to serve in Vietnam during the war. Like Vietnam veterans many of them experienced the traumas of conflict and have consequently been affected by the same mental and physical conditions as their counterparts. However, unlike those who served in the military, SEATO nurses do not have access to veterans’ entitlements because they are viewed by the government as civilians. The SEATO nurses along with the support of the ANMF have been campaigning tirelessly for some time to have them recognised under the Veterans’ Entitlement Act. The Australian Nursing and Midwifery Federation will pay tribute to all military and civilian nurses this ANZAC day by placing a wreath at the Nurses War Memorial in Canberra. Last month the ninth Closing the Gap report card, handed down by the government, indicated just one of the seven Closing the Gap targets was on track to be met. It has been almost a decade since the federal government committed to addressing Indigenous disadvantage, making it crucial that these targets are addressed immediately.

I WOULD LIKE TO CONGRATULATE SALLYANNE JONES ON HER RE-ELECTION AS ANMF’S FEDERAL PRESIDENT. WE ALSO WELCOME LORI-ANNE SHARP WHO WAS ELECTED ANMF’S FEDERAL VICE PRESIDENT, REPLACING MAREE BURGESS.

in this month’s ANMJ focus section on Indigenous health. However it is up to all of us to make change. To find out more about Closing the Gap and to take action, go to Oxfam’s campaign website www.oxfam.org.au/ what-we-do/indigenous-australia/closethe-gap/ As I sign off I would like to congratulate Sally-Anne Jones on her re-election as ANMF’s Federal President. We also welcome Lori-anne Sharp who was elected ANMF’s Federal Vice President, replacing Maree Burgess. I look forward to closely working with both Sally-Anne and Lori-anne on tackling the crucial issues impacting nurses and midwives. I would also like to thank our previous Vice President Maree Burgess for her commitment over the past two years. Her support, assistance and counsel have been greatly appreciated.

While there is much to be done, nurses and midwives are working hard towards improving health and social outcomes for Aboriginal and Torres Strait Islander communities as indicated

@AUSTRALIANNURSINGANDMIDWIFERYFEDERATION

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April 2017 Volume 24, No. 9  3


NEWS

WOMEN’S UNPAID SUPER IN THE BILLIONS

FOND FAREWELLS AND NEW ANMF FEDERAL TEAM FORGES AHEAD

Australian women are missing out on billions of unpaid superannuation entitlements, according to research released on International Women’s Day (IWD).

Outgoing ANMF Vice President Maree Burgess does not count on having extra spare time leaving the federal executive team.

“I am not retiring, just retiring from the federal sphere,” the maternal and child health nurse, ANMF Victorian Branch President and new grandmother to a four-month old said. Ms Burgess said she felt incredibly proud to have contributed at the federal executive level to the issues that affected nurses and midwives and carers right across the country. “It is such a broad view and it has been great to be part of those discussions - on the many industrial, professional, social justice and policy issues and to hear the perspective from all the secretaries across the country – it is such a dynamic organisation.” Ms Burgess said key issues for nurses and midwives and carers had included aged care and staffing, regulation of the third level worker, assisted dying, paid parental leave (PPL) and penalty rates. “As a Maternal and Child Health Nurse, I have had a lot of exposure to families affected by PPL. But it’s about the bigger picture and everything that goes with being on the federal executive with a focus on nurses, midwives and carers and how we stand up and voice that.” Writing articles for the ANMJ had been a particular highlight, she said. “I have really enjoyed this over time. How often do you have the opportunity to write for thousands of nurses? It’s been a great way to communicate messages including social justice issues and health and wellbeing for nurses.” Another highlight had been residing as Federal Vice President at the ANMF National Biennial Conference in 2015. Ms Burgess thanked her federal executive colleagues. “It has been fantastic to work with Sally-Anne, Lee and Annie. I wish them the very best into the future.” ANMF Federal Secretary Lee Thomas said she had greatly appreciated Ms Burgess’ assistance, support and counsel. 4  April 2017 Volume 24, No. 9

Analysis of the latest ATO data found Australian women working for wages were underpaid $1.84 billion in super contributions by their employers in 2013-14.

“On behalf of all of our members, I would like to personally thank Maree for the dedication and commitment she has demonstrated over the past two years.” Ms Thomas congratulated Sally-Anne Jones who was re-elected unopposed as ANMF Federal President. “This is a vote of confidence in Sally-Anne and what she has helped the ANMF achieve on behalf of our growing membership. She has made a valuable contribution in helping set the ANMF’s priorities and the direction of our campaigns over the past two years and will continue to be a great support to the ANMF into the future.”

IT’S BEEN A GREAT WAY TO COMMUNICATE MESSAGES INCLUDING SOCIAL JUSTICE ISSUES AND HEALTH AND WELLBEING FOR NURSES.

Ms Thomas congratulated ANMF Victorian Branch Executive Committee Member Lori-anne Sharp on her election as new Federal Vice President. Ms Sharp has been nursing for over 20 years and has worked in district nursing for the last 13 years. She is currently working with the Homeless Persons Program and has been a job rep since 2001 and a Branch Councillor from 2004-2013. “We look forward to working closely with her in her new role, particularly at a time when the ANMF tackles a number of crucial issues impacting on our members and the wider community and comes under attack as a result of changes to the country’s IR system,” Ms Thomas said.

The average under-payment was $1,550. Women affected had 34% or around one third less superannuation than those who were paid correctly. “Women already struggle with a gender pay gap that has barely shifted for two decades and an earnings-linked superannuation system that shows no forgiveness for people with interrupted work histories,” Industry Super public affairs manager Sarah Saunders said. The analysis also found the amount of superannuation for women working for wages nearing retirement (55-64) was shockingly low. Around half had less than $94,050 and 30% had less than $53,760. In comparison, men aged 55 to 64 had $154,300 and $83,050 respectively. Current statistics show 40% of single older women live in rental accommodation and are forced to live in poverty. This year’s IWD theme Be Bold for Change was a stark reminder that women in the workforce needed significant change in their working lives to ensure protection of their rights, ANMF Federal Secretary Lee Thomas said. There were current renewed attacks on industrial conditions and entitlements of women, she said. “Women are significantly economically disadvantaged throughout the course of their working lives. But there are many economic inequities working women are currently facing – whether it be the gender pay gap, the loss of earnings through pregnancy, cuts to their PPL or the reduced superannuation earned for their retirement.” Research by the McKell Institute found women will be greater affected by the recent announced cuts to Sunday penalty rates with women more likely to work under an award and to work part time. “The ANMF is committed to continuing the fight,” Ms Thomas said. A Senate Inquiry into unpaid superannuation guarantee entitlements was due to report as the ANMJ went to print.

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NEWS

KATHLEEN BAIRD

SALLY MCMANUS

MIDWIFERY FOCUS TO COMBAT DOMESTIC FAMILY VIOLENCE A staunch women’s advocate, academic and midwife has used International Women’s Day to highlight the need for better strategies to support women experiencing domestic family violence (DFV). Griffith University’s Dr Kathleen Baird, a midwife and Director of Education for Midwifery and Nursing, Women’s and Newborn Services at the Gold Coast University Hospital said women were reaching out for support more than they ever had before. “It’s imperative that women feel empowered and safe to report and receive support when disclosing about a history of DFV. “Coming from my background as a midwife, I still believe that pregnancy is one of the optimum times that women are able to disclose any domestic violence issues in the home and that midwives are often the only professionals that a woman may feel comfortable discussing these with, especially if the midwife is working within a continuity of care model.” Dr Baird was recently appointed Deputy Chair of the Queensland Domestic Violence Death and Homicide Review Board; and on the Queensland Domestic and Family Violence Implementation Council since 2015.

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Part of the integrated response to DFV in Queensland was to focus on training programs for the midwifery profession – with midwives and healthcare professionals working with key community agencies, Dr Baird said. “Broadly speaking we advocated for two things in relation to midwifery: routine enquiry in every antenatal clinic which can support women in or at risk of a DFV situation; and also for DFV specialist training for midwives, GPs and other professionals working within the health sector in order that they can respond effectively and safely in supporting women and their families.” Queensland Health had recently supported a comprehensive training package which provided both online and face to face training, as well as ‘train the trainer’ sessions for midwives and senior clinicians, Dr Baird said. “Only with people talking about DFV and governments acting will we continue to see change.” Dr Baird is currently leading a study on women’s personal perceptions and experiences of being asked about DFV by a midwife.

ACTU APPOINTS NEW LEADER The newly elected Secretary of the Australian Council of Trade Unions (ACTU) has pledged to fight corporate greed, stop cuts to penalty rates, and grow the union movement while at the helm of the nation’s peak union body. Sally McManus, previously an ACTU vice president, was elected unopposed to the top job last month to fill the vacancy left by the departure of former Secretary Dave Oliver. Ms McManus becomes the ACTU’s first female secretary and forms an all-female leadership team along with current president and former ANMF Federal Secretary, Ged Kearney. After more than two decades spent protecting the rights of working people, Ms McManus said she was looking forward to building and leading a movement that restores fairness back to Australia. “We are living through a time when corporations and the very rich have become far too powerful and this has happened so quickly that our laws and rights that keep things in balance have not kept up. “Australians are less secure in their work and rights for working people are just not strong enough.’ Ms McManus singled out the

Fair Work Commission’s recent decision to slash penalty rates as prime example of growing inequality and said stopping the cuts would be her first challenge. “Workers, in their unions, will fight until this unfair decision is reversed by the government, no matter how long it takes, so that no worker can ever be worse off by a Fair Work Commission decision again.” Ms McManus said she believes strong union movement is the key to forcing change. ANMF Federal Secretary Lee Thomas described Ms McManus’ appointment as an historic milestone and welcome the opportunity to work together with a strong union leader. “In her long career in the union movement, Sally has proven to be a strategic leader and highly effective campaigner and her appointment will assist in bolstering the ANMF’s own public campaigns on behalf of our members and our fight to ensure a fair and equitable healthcare system for all Australians.” ACTU President Ged Kearney said Ms McManus’ unwavering passion and commitment to working people and knowledge of industrial issues had earned her a solid reputation for leadership and vision. “We look forward to her leading the fight to protect and expand the rights of working people in this country at a time when corporate power threatens to undermine all we have fought for.”

April 2017 Volume 24, No. 9  5


NEWS

RNS UPSKILL IN REMOTE EMERGENCY CARE

A group of eager RNs (pictured) attended a Remote Emergency Care (REC) course in Melbourne recently to upskill on emergency situations in the bush and beyond. The REC is a three day course offered by CRANAplus around the country for health professionals. “Probably the biggest benefit is that it gives them the confidence to respond to emergency situations in remote and isolated settings and that’s what the aim is,” CRANAplus remote clinical educator Sue Orsmond said. “For them to go away and say ‘I reckon I can do this in an emergency situation.’ It’s very much about developing confidence.” The course consists of hands-on assessments and skill stations covering cardiac emergencies, airway stations, mental health scenarios, multiple casualty in a remote scenario, spinal injuries, pain management, paediatrics and more. The course recently held at the ANMF Victorian Branch and sponsored by the Remote Area Health Corps (RAHC) included a specific session on suturing.

NURSES LEAD IN INSULIN TREATMENT FOR DIABETICS A new inter-professional model of care for diabetes patients has seen higher rates of insulin initiation and better clinical outcomes. Under the model, nurses in general practice lead the initiation of insulin treatment among patients with diabetes as part of routine care. Results of the study showed the model was associated with significantly higher rates of insulin initiation - 105 in 151 patients (70%) in the intervention group; compared with 25 of 115 patients in the control group. “Where insulin was clinically indicated in the intervention practice 70% were started on insulin compared with 20% in the control group over the 12 months,” lead researcher, University of Melbourne Associate Professor John Furler said. Insulin initiation was often delayed, particularly in primary care due to barriers in clinical practice, Professor Furler said. 6  April 2017 Volume 24, No. 9

“There’s the problem of not getting people on to insulin; it’s the way the system is organised. There are not enough endocrinologists and specialists – there are one million people with diabetes, with 10% of them going on to insulin – there are not enough resources. “We thought there was a real opportunity to do this work in a smarter way with existing resources with nurses working to their scope of practice.” A total of 266 patients in 74 general practices across Australia participated in the study published recently in the British Medical Journal. Under the ‘Stepping Up’ model of care, nurses in general practice work within their scope of practice with diabetic patients’ medication regime, including regular titration with the support of GPs and diabetes educators. “What is critical is that diabetes educators have to move from direct patient care to a mentoring role of primary care nurses,” Professor Furler said. “Diabetes educators work with nurses for their first patient to get them going. It’s a flexible intervention and it’s different for every practice nurse – they grow in confidence differently: some nurses are good to go after one patient, others may take four or five patients with the diabetic educator to become confident.

The diabetic educator is available for phone support, it’s pragmatic and flexible.” Professor Furler said there was great respect of the role the diabetic educator played. “This allows them to manage the more complex patients including Type 1 diabetes patients. It’s a simple intervention of how we reorient clinical practice and the interprofessional roles for patients to get the appropriate sort of care. There are barriers but if we can provide the right sort of support and change the way people work we can achieve much better outcomes.” The outcome of the study was evidence based and linked to better outcomes, Professor Furler said. “After 12 months we found that patients had significantly better HbA1c levels which is associated with better long term outcomes. Results of additional follow up of outcomes at 24 months and analysis of cost effectiveness are due to be published. “It is very, very important we work through this hurdle in addressing the needs of people with diabetes in primary care because of the scale of the problem. This is a chronic problem and it’s not going away.”

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NEWS “The training is to assist the remote and isolated health workforce to develop knowledge and skills around emergency situations specific for those that work in resource poor environments both in terms of personnel and equipment,” Ms Orsmond said. “The training is contextualised to that setting and the facilitators have either worked in remote settings or have the empathy and understanding of working in those settings.” The topics are designed with a focus on the issues health professionals working in remote and isolated places may be faced with. Some of them are based on people’s personal experiences and the facilitator provides the opportunity for ‘war stories’ of participating students. The 24 RNs who participated in the recent Melbourne REC were a mixture of very experienced RANs and some new to remote. “For a lot of clients the course is the first dipping of the toe into remote. They come and do the course and network with others and find opportunities and get a sense of whether they like it,” Ms Orsmond said. “For this particular RAHC course it was a requirement for them to be able to work in remote areas and they have to do it every two to three years so we had some people who were very experienced doing the course to maintain their currency.”

Ms Orsmond said it was a case of ‘use it or lose it’. “Working in a remote setting every day you are faced with unexpected births, palliative care, chronic disease management, primary healthcare – there is a whole repertoire of skills required. “Those people in an ED in a tertiary hospital in Melbourne day in and day out practice emergency care. Those working in remote and isolated places practice emergency care as well as do the job of the GP, the medical specialist, the chronic disease manager, the credentialed diabetes educator – they need so many strings to their bow and emergency care is just one of them.” The REC was considered to be the entry level course for working in remote and isolated places, Ms Orsmond said. Recent course participant and new to remote RN Catherine Dally said she valued the opportunity to network with some of the experienced RAHC nurses. “Overall the course helped us understand and review our background knowledge, and gave us the confidence that we need to draw on from this and previous experiences.” For more information, visit https://crana.org. au/education/

RNS AT THE REMOTE EMERGENCY CARE COURSE, MELBOURNE

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NEWS

HOW NURSES RALLIED IN THE AFTERMATH OF THE BOURKE STREET TRAGEDY It was an ordinary Friday afternoon as news spread of a major incident unfolding along Melbourne’s Bourke Street mall in January this year. Being one of Victoria’s two dedicated trauma services, the Royal Melbourne Hospital’s Emergency Department stood on high alert. On this day, the ED had been given a heads up by the ambulance service that the incident nearby could escalate rapidly. Tragically, in one of the most devastating events Melbourne has witnessed, a crazed driver mowed down dozens of pedestrians walking along the footpath of the bustling CBD mall. Six of them would eventually pass away. Susan Harding, Nurse Unit Manager at The Royal Melbourne Hospital’s Emergency Department, said the forewarning allowed the trauma service to clear the department and ensure theatres were on standby. “For us, we were probably the hospital of choice on the day because of our close proximity. “That was a blessing and a challenge as well because obviously the lead-in time and pre-notification wasn’t much because the proximity was so close.” Ms Harding said the ED had prepared for the worst. “If we can start with an empty department it gives us more opportunity to provide timely care. “From an organisational perspective, everybody that 8  April 2017 Volume 24, No. 9

was available was basically redeployed to the Emergency Department to perform some sort of role.” Eleven of the Bourke Street casualties were treated at the RMH, with two of the injured passing away. “The injuries were quite horrific as for some people there’d been the impact of actually being hit by the car and falling post that. There were a lot of fractures. A lot of abrasions. “Any death that we have is sad and obviously it was just that sliding doors moment. It could have been anybody on that particular day and it’s very sad that these people were just going about their daily business and something horrible has happened.” Ms Harding said the ED’s response to the incident was finished in under two hours, with patients transferred to other areas such as Intensive Care. She said the ED is used to dealing with the unpredictable but suggested that the highprofile nature of the incident had a greater impact than normal. Some nurses sourced information from social media as part of their own closure while others avoided it altogether, she added. “This is what we do on a daily basis but I think the thing that made this more challenging was the fact that everybody knew the location. Everybody knows where the Bourke Street mall is. Everybody’s been to the Bourke Street mall. So it became very personal. “One of the challenges post the incident was there was such media saturation regarding the stories of these people. So the people that we saw and gave really great care to, then we knew their stories, their life, their families, so it became very personal.” Ms Harding said the hospital conducted several debriefs following the emergency response to evaluate the department’s process and ensure staff wellbeing. Executives also made sure staff were given updates on the patients.

NEW NATIONAL HELPLINE SERVICE FOR NURSES AND MIDWIVES Nurses and midwives now have access to a dedicated 24 hour confidential telephone and online support service for any health and wellbeing concerns. The Nurse & Midwife Support (NM Support) launched in Melbourne last month provides advice and referral on health issues for Australia’s nurses, midwives, students, employers, educators, concerned friends or members of the public. The new service is a Nursing and Midwifery Board of Australia (NMBA) initiative and run independently by Turning Point, a leading addiction treatment, research and education organisation in Australia. Turning Point Program Director Anthony Denham said the service was about providing anonymous ‘no strings attached’ support for nurses and midwives to deal with health issues that affected their personal lives and work. “This may include stress caused by work, family problems, relationship issues,

as well as alcohol and drug related issues or mental health concerns.” NMBA Chair and RN Lynette Cusack said nurses and midwives could access the service from anywhere in Australia. “Whether they are based in a city or in a rural or remote location… confidential support is now just a free phone call away.” NM Support RN Mark Aitken said the type of support provided was based on individual assessment. Nurses and midwives trained in counselling and support services man the phone lines from 7am to 11pm with qualified counsellors after hours. “This national 24/7 1800 free call service is available anywhere in Australia for nurses and midwives or members of the public concerned about a nurse or midwife about a particular issue, need or concern. It is nurse and midwife led.” “If needed, we can hook in to referral to other services - if they do not know how to access a psychologist or mental health plan to contact their GP, or it might be drug and alcohol services or mental health services. “It is absolutely important that nurses and midwives know this is an anonymous and confidential service. This service is provided by an independent organisation Turning Point which is an arm’s length from the Board [NMBA].” The Nurse & Midwife Support, telephone line is 1800 667 877 or nmsupport.org.au

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NEWS NSWNMA SECRETARY BRETT HOLMES ATTENDING A RALLY IN SYDNEY LAST MONTH OPPOSING CUTS TO PENALTY RATES.

EROSION OF PENALTY RATES COULD HIT NURSING AND MIDWIFERY Fresh legal advice regarding the recent decision by the Fair Work Commission (FWC) to slash penalty rates across the retail, fast food, and hospitality industries has heightened fears that nursing and midwifery could be next on the chopping block. Legal analysis undertaken by Maurice Blackburn, on behalf of the Australian Council of Trade Unions (ACTU), found the landmark decision to cut penalty rates may now pave the way for a reduction in other sectors such as nursing and midwifery in the near future. While the FWC insisted that retail and hospitality were different to other industries when handing down its verdict, the legal findings claim many of the justifications used for reducing penalty rates likely apply to other industries as well and hence open the door to broader attacks. Some comparable characteristics which led to the view include the prevalence of entry level jobs for relatively unskilled workers, consumer expectations demanding services on weekends and public holidays, the potential for the reduction of penalty rates to boost employment, and insufficient adverse effects to employees working weekends to warrant not reducing penalty rates. According to the legal advice, nurses, teachers, cleaners, and construction workers are now among those who face a growing risk of having their penalty rates taken away. Australian Nursing and Midwifery Federation (ANMF) Federal Secretary Lee Thomas said the analysis pinpointed the low-paid aged 10  April 2017 Volume 24, No. 9

care sector, where workers provide so-called ‘non-essential’ services, as being highly vulnerable. “It’s our members working in aged care and non-traditional health settings who are most at risk of cuts to penalty rates.

MOST CHILDREN VACCINATED DESPITE PARENTAL CONCERNS

“Any cuts to their income would compound the disadvantage they already experience – the majority are women, they are lower paid, with less capacity to accumulate decent superannuation savings, and in many cases they are about to suffer the loss of paid parental leave (PPL) entitlements.”

The ANMF reiterates support for the national immunisation program and the latest national poll shows the majority of parents vaccinate their children.

ANMF Senior Federal Industrial Officer Nick Blake echoed the fears, pointing to historical attempts by aged care employers to trim down labour costs and implement substandard EBA’s as a guide to their probable mentality in the wake of the decision. “There’s a real fear that they [aged care employers] will look closely at this decision and use it as an opportunity to put in a claim that their circumstances are not any different.” Mr Blake believes the aged care sector could be targeted because the workforce largely consists of women from a low-skilled migrant background, many whom are employed on a casual basis and work multiple jobs to make ends meet. Mr Blake said other contributing factors surround poor pay, low levels of union representation, and a reluctance to engage in industrial action due to wanting to ensure elderly patients are not placed at risk. “There’s no justification for reducing the wages of workers who are already poorly paid as it is.” A recent survey conducted by the ANMF showed 80% of its members would consider abandoning nursing and midwifery if they lost their penalty rates. Ongoing public backlash following the FWC decision has included several rallies across the country and campaigns to highlight the plight of ordinary Australians, with more than a million workers now standing to lose as much as $6,000 per year under the conditions. The pay cuts are set to take effect from July but will be phased in over time to reduce impact on workers. ACTU president Ged Kearney warned that all employees who currently receive penalty rates for working unsociable hours now risked losing their entitlements. “The safety net is broken and must be immediately strengthened to ensure no Australian worker sees their pay go backwards. “Australian Unions will not stop campaigning until this decision is overturned with legislation that protects penalty rates and other conditions for workers.”

ANMF Federal Secretary Lee Thomas said it was very concerning One Nation leader Pauline Hanson questioned the validity of vaccination last month. “When it comes to the importance of vaccinating children, you must not play politics with people’s lives.” Results from the latest Australian Child Health Poll last month showed many Australian parents had significant concerns around vaccination.

“WHEN IT COMES TO THE IMPORTANCE OF VACCINATING CHILDREN, YOU MUST NOT PLAY POLITICS WITH PEOPLE’S LIVES.”

“While the vast majority of parents vaccinate their children, we found that almost a third of Australian parents have some concerns about vaccination,” Royal Children’s Hospital Melbourne Dr Andrea Rhodes said. One in 10 Australian parents believed that vaccines could cause autism, and a further 30% were unsure – despite medical research that showed no causal link. “One in 10 parents said they were unsure whether vaccines were safe for their children, and one in six believe they contain ingredients that can cause serious harm such as mercury,” Dr Rhodes said. The sixth national poll of almost 2,000 parents found 95% of children were fully vaccinated.

anmf.org.au


NEWS Nearly three quarters of parents surveyed supported the federal government’s ‘No Jab, No Play’ policy. And 74% of parents believed they should be informed about the number of children not up-to-date with vaccines in their children’s school, kindergarten or childcare centre. Alarmingly, the poll found one in six children not up-to-date with their vaccines had been refused care by a healthcare provider. Children under six were most likely to be refused care by a healthcare provider (25%) followed by 21% of primary school-aged children and 5% of teenagers. The poll taken in January-February 2017 suggested a “worrying pattern of practice not previously identified in Australia”, Dr Rhodes said. “All children, regardless of their vaccination status, have an equal right to healthcare.”

Services Minister Cameron Dick said the cutting-edge hospital was leading the country in organ preservation and providing more patients with access to life-saving treatments.

ORGAN TRANSPLANTS SURGE IN QUEENSLAND

In Queensland, the organ donor consent rate rose from 56% in 2015 to 67% last year.

Two transport devices, affectionately dubbed ‘Mork and Mindy’, are being credited with a spike in the number of organ transplants undertaken across Queensland over the past year. The Princess Alexandra Hospital (PAH) is the only transplantation centre in Australia and New Zealand that has the Life Port kidney transport devices, which safely extends the ‘usable life’ of donor kidneys from anywhere between 12 to 23 hours.

THE DEVICES HELPED QUEENSLAND CARRY OUT 199 KIDNEY TRANSPLANTS IN 2006 – A SUBSTANTIAL 60 MORE THAN THE PREVIOUS YEAR.

The devices helped Queensland carry out 199 kidney transplants in 2006 – a substantial 60 more than the previous year.

Australian Medical Association President Dr Michael Gannon questioned the reports as it was “not ethical to deny treatment to unvaccinated children”.

While the boxes are commonly used throughout the United States and Europe, the Princess Alexandra Hospital (PAH) is the only facility in Australasia that possesses the equipment.

Dr Rhodes said ongoing education and communication to tackle patients’ concerns was needed as many were confused about whether to delay vaccines when a child had a minor illness. Nearly half (47%) of parents said vaccination should be delayed in a well child on antibiotics; and one in five (22%) in a child who had a local reaction to a previous vaccine, such as swelling or redness.

The boxes provide a sealed, sterile environment where a specially formulated solution is gently pumped through the kidney at cold temperatures to minimise tissue damage while the organ is being preserved outside the body. During this stage, the device captures and records data on temperature, flow rate, vascular resistance and pressure, affording clinicians crucial additional data. Queensland’s Health and Ambulance

“As soon as a donor’s family makes that decision to donate a life-saving organ, time becomes crucial for our transplant specialists,” Mr Dick explained. “The Mork and Mindy boxes extend that window of time, giving medical teams increased flexibility and the opportunity to preserve the kidneys for longer before they are transplanted.” PAH Manager Transplant Services, Dr Aimee Cunningham, said the ‘Mork and Mindy’ boxes ensured distance wasn’t a barrier for patients. “Not giving those patients that opportunity because they live too far away is simply not an option. The Life Port boxes mean we can continue to provide excellent care regardless of where people are in Queensland.”

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NEWS

NURSE NAVIGATOR ROLL OUT IN QUEENSLAND Queensland will introduce a further 119 new nurse navigators this year to guide complex patients through the healthcare system and help stem the chronic disease tide to the ED. Queensland introduced 121 nurse navigator positions state-wide last year. “We are seeing very early on that this new model of care is improving patient outcomes and enabling an integrated approach to health service delivery,” Queensland Health and Ambulance Services Minister Cameron Dick said. “Patients with an appointed nurse navigator are experiencing less emergency department presentations, less unnecessary hospital admissions and less avoidable readmissions than ever before.” Minister Dick made the announcement last month at Wide Bay where there will be an additional five nurse navigators on top of the three already employed. Fraser Coast Manager of the Nurse Navigators and RN of 16 years’ experience Kirsten James said the navigators would provide patients with an essential point of contact working across multiple services and specialties. “By putting individuals at the centre of their healthcare, we will educate and empower them to become confident in managing their conditions, strengthen their relationships

RECORDS TUMBLE AS NSW EMERGENCY DEPARTMENTS FLOODED WITH PATIENTS A record number of patients are presenting to NSW emergency departments and placing the health system under increasing pressure, the latest data from the Bureau of Health Information (BHI) has revealed.

12  April 2017 Volume 24, No. 9

with health professionals and empower them to make good decisions about their health.” Nurse Navigation Manager of Cairns and Hinterland Helen Kulas said nurse navigators were like ‘puzzle masters’. “They get a jigsaw with a whole heap of pieces and have to work out what’s there. They put together the pieces and then find there are pieces missing – they have to work out what is missing.” Ms Kulas said navigating patients with complex needs through a siloed healthcare system delivered in a transactional manner was increasingly difficult. “It’s not patientcentred but system-centred, for patients with complex needs it’s difficult.” Patients must meet four key criteria for a nurse navigator: complexity; chronicity; fragility; and intensity. “It’s very much a chronic disease profile,” Ms Kulas said. “Nurse navigators have their clinical specialty – midwifery, paediatrics, stroke/older people – it defines where they each pick up their patients but the principles of nurse navigation are the same.” Cairns and the Hinterland has 15 nurse navigators with another five planned in the next cohort. There were five phases to patient navigation, while each individual case differs, the process usually takes from weeks to months from start to discharge. “It’s about getting the right patients, it’s not dependent on a caseload. Some patients are amazingly complex, one of these patients in crisis can literally take a week to sort out,” Ms Kulas said. QLD Health introduced the first nurse navigators in February last year. There were now 12 months’ pre and post data of nurse navigation on patient outcomes, including ED presentations, hospital admissions and Figures from the most recent quarter saw NSW hospitals break records across three key areas – the number of emergency department attendances, the number of elective surgery procedures, and overall admissions to hospital. Five years ago, EDs were seeing about 450,000 patients per quarter. But current presentations, relating to data from the period between October and December in 2016, have soared to 684,740. Hospitals under the greatest pressure all fall in Western Sydney and consist of Liverpool, Blacktown, Westmead, Campbelltown, and Nepean hospitals. Across NSW more than 25% of patients waited longer than four hours in an emergency department. More than half of emergency department presentations fell under triage four and five categories, non-urgent matters including ear aches,

NURSE NAVIGATOR HELEN KULAS

length of stay, Ms Kulas said. “The results show those patients with nurse navigators do not present to the ED as much and fully attend outpatients’ appointments. “I guess the biggest benefit is that patients have one central point, one person they can come back to who has sound clinical knowledge and that coordinates what’s going on and can advocate for them.” Nurse navigators are also in the ACT, VIC and WA. In QLD they are employed as RN/ midwife Grade 7. “The role is not just about coordinating patient care, you need to be a very experienced clinician with knowledge of system management to be able to see the gaps in the system and work around finding solutions to them,” Ms Kulas said, who has postgraduate qualifications in ICU, worked as a NSW clinical nurse specialist in ICU, NUM in ED emergency and CN educator. sprains, and abrasions. The continued rise in non-urgent and semi-urgent presentations is being partly attributed to the growing difficulty in accessing GP’s. Elsewhere, the state’s elective surgery lists still remain problematic, with 73,617 patients waiting for procedures such as orthopaedic surgery, cataract removal, and knee replacements. NSW Shadow Health Minister Walt Secord said the state’s hospital system was at breaking point. “Patients are flooding emergency departments because they cannot get into a GP’s practice or they are unable to pay extra for a GP – putting unnecessary pressure on the state’s emergency departments. “Emergency departments are meant for emergencies; not ear aches and minor sprains.”

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WORLD

GLOBAL

BANGLADESH

WHO releases antibiotic resistant ‘hit list’

Bangladeshi girls miss school due to menstruation

A startling report identifies for the first time which antibiotic-resistant bacteria pose the greatest risk to global health and are in urgent need of new effective treatments.

One third of teenage girls in Bangladesh miss school during menstruation due to lack of sanitary facilities, research shows.

The World Health Organization (WHO) has released a global priority list of antibioticresistant bacteria targeted at pharmaceutical companies, research institutions and policymakers to drive the development of new antibiotics. The report categorises bacteria into ‘critical’, ‘high’ and ‘medium’ priority groups. Bacteria listed in need of urgent new treatments include the multi-resistant Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacteriaceae responsible for pneumonia and sepsis, mainly in hospitalised patients. Resistant bacteria that also affect healthy people outside of hospitals are included in the ‘high’ priority group. They include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium, Salmonella, and clarithromycinresistant Helicobacter pylori. European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Chair of the report Professor Evelina Tacconelli said modern medicine relied on antibiotics to treat infections and to prevent them in high risk patients. “This includes transplant recipients or those affected by cancer, as well as in patients receiving common procedures such as hip replacements and Caesarean sections. However, the current pipeline of antibiotics is almost empty. “We hope that it [the report] will drive governments and research groups working in antibiotic development to set the right research priorities that will reduce the burden of antibiotic-resistant infections globally.” www.who.int/en/

14  April 2017 Volume 24, No. 9

The study of 438 girls aged 15-20 years from 15 schools in Bangladesh was published in the Northern International Medical College Journal. More than one third of girls in the study said they skipped school on the first two days of menstruation as the schools lacked proper sanitary facilities. Only 11% of schools had separate toilets for girls with water facilities; and only 3% had facilities to dispose of sanitary napkins. More than half of adolescent girls used cloths instead of sanitary pads. Poor menstrual hygienic practices were found despite good knowledge among girls. The education ministry of Bangladesh recently issued a circular for schools to improve and maintain the sanitation of school toilets. Lead author Dr Farhana Salim said implementation of school health programs for adolescents should emphasise menstrual hygiene management. “The toilets should be gender friendly; there must be proper systems of disposal of sanitary pads; sanitary napkins must be available (if needed, on payment) in school; a female teacher should be appointed to make students aware of menstrual health and hygiene; and schools should be visited regularly to identify problems regarding availability of water, cleanliness and other issues.”

USA

Saliva test to predict pre-term birth A simple blood or saliva test to predict whether an expectant mother is likely to have a preterm birth is underway by international researchers. The 12-month project has been funded by the Bill and Melinda Gates Foundation University of Queensland’s (UQ) Dr Carlos

Salomon said the placenta released specific biomarkers into a mother’s bloodstream during pregnancy. “We know the placenta is trying to prewarm the body by sending out signals, but we need to understand how and why the message is being sent,” he said. The UQ and University of Texan researchers have identified a placental signal and will test 100 patient samples; then classify women as high or low risk and monitor their pregnancy. “Once we know the pregnancy outcomes we can determine if our predictions, based on the panel of biomarkers identified, were accurate,” Dr Salomon said. The biomarkers investigated are microRNAs, tiny molecules which regulate the amount of protein a gene can produce. “These biomarkers can be detected in blood, urine or saliva which means any potential test would be non-invasive and pose no threat to the pregnancy,” Dr Salomon said. “By identifying which women are at risk, we hope to then be able to better understand what causes preterm delivery.”

GUINEA, LIBERIA & SIERRA LEONE

Maternal and child services suffer post Ebola Maternal and child health services in the countries most affected by the Ebola outbreak in 2014 have not recovered to pre-outbreak levels. A report published in international medical journal Lancet Global Health last month found the use of maternal and child health services in Guinea, Liberia and Sierra Leone were still struggling. The Ebola outbreak in West Africa cost more than 11,000 lives. Health facilities in six of seven health districts in Forested Guinea showed fewer deliveries and antenatal care visits in health facilities and lower attendance for vaccinations. The use of services had not completely reestablished after the end of the outbreak in 2016. Targeted interventions were needed to get maternal and child health services back on track, according to researchers. anmf.org.au


PROFESSIONAL

EARLY CAREER NURSES AND MIDWIVES NEED JOBS Julianne Bryce

Elizabeth Foley

Julie Reeves ANMF Federal Professional Officers

One of the many important roles the ANMF undertakes, as the national professional and industrial organisation for nurses and midwives in Australia, is monitoring and promoting employment opportunities for early career nurses and midwives (previously referred to as graduates). It is an unacceptable situation for our colleagues who have just graduated, to not get a job. This has a demoralising and devastating effect on the nurses and midwives who are unable to find work. There is also a loss of public investment in the education of qualified nurses and midwives, and a loss of their contribution to the health system and the future nursing and midwifery workforce. With the escalation of unemployment issues for early career nurses and midwives in 2014, the ANMF convened a national Graduate Nurse and Midwife Roundtable with key stakeholders to discuss and develop solutions to secure employment opportunities for these nurses and midwives.

THESE STAKEHOLDERS ARE VITAL TO THE DEVELOPMENT AND IMPLEMENTATION OF ONGOING SOLUTIONS TO ENHANCE FUTURE EMPLOYMENT FOR NURSES AND MIDWIVES AND ULTIMATELY CONTRIBUTING TO THE VIABILITY OF THE HEALTH WORKFORCE.

The 2014 Roundtable was a successful event with over 30 leaders in nursing and midwifery and some federal politicians attending. All participants at the Roundtable agreed there was a significant problem of underemployment of newly graduating nurses and midwives, the causes of which are complex and varied.

Reference Australian Nursing and Midwifery Federation (2017) ANMF Graduate Data Set- Nurses and Midwives, February 2017. Melbourne, Australia

anmf.org.au

A working group was then established with four main objectives - improving the data available, developing a document to debunk myths for early career nurses and midwives, identifying and undertaking required research, and lobbying government.

Over the last two years, with secretariat support of the ANMF, the group has met regularly to develop a number of key pieces of work. This includes a minimum data set that is required to make informed predictions and outcomes for future early career nurse and midwife employment. The main dataset questions included: • numbers of nursing and midwifery student commencements and completions per year; • numbers of nurses and midwives registered from Australian education providers each year; • the number of graduates employed in nursing and midwifery; and • the number of graduate or transition places available. Using the minimum data set as a framework, the ANMF worked closely with the Department of Education and Training, the National Centre for Vocational Education Research and the Australian Institute of Health and Welfare to drill down on the current available data and develop the ANMF Graduate Data Set- Nurses and Midwives, February 2017. This document outlines national and state and territory data from 2012 to 2015, allowing us to gain a more complete picture of early career nurse and midwife employment. The current limitations to the available data are also discussed within the document. In December 2016, the working group held a second forum - a National Early Career Nurse and Midwife Roundtable. Leaders in the nursing and midwifery professions were invited to attend, along with many federal politicians. These stakeholders are vital to the development and implementation of ongoing solutions to enhance future employment for nurses and midwives and ultimately contributing to the viability of the health workforce.

A number of early career nurses and midwives who had just finished their program or recently completed a transition program presented their perspective throughout the day. They discussed their experiences, concerns and expectations. Associate Professor Tracey Moroney from the University of Notre Dame at the time and who is now working at the University of Wollongong, presented her research on support and what it means for early career nurses. Lisa Collinson from the Australian Primary Health Care Nurses Association gave an overview of their transition to practice pilot in primary care. Michelle Gunn from the Australian College of Nurses spoke about the Queensland graduate recruitment project and lastly, Tony McGillion from the Victorian Department of Health and Human Services presented on the collaborative graduate programs which have been implemented in Victoria. The afternoon session of the roundtable involved a lively panel discussion. The panel members were: Janine Mohamed from the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives; Professor Tracey Moroney, Liz Drew from Churches of Christ Care; and Tianna Camilleri from the Australian Student and Novice Nurses Association. The participants provided many thought provoking questions for the panel. Some of the themes discussed included; support; graduate and transition programs; clinical experience during the undergraduate program; and the ongoing requirement to match employment positions with the number of student nurses and midwives graduating. A number of next step-strategies were agreed for the working group to progress. These included: • how to share information; • understanding and learning across regions and sectors; • continuing to identify and determine numbers and capacity of jobs; and • what ‘work ready’ really means. It is clear from both the roundtables that all participants agreed early career nurses and midwives need jobs and we are all responsible for making this happen.

The working group presented their achievements to date, including the developed data set, the draft myth busters document and an overview of the ANMFs lobbying on this issue.

April 2017 Volume 24, No. 9  15


REFLECTIONS

THE CHANGING FACE OF NURSING UNIFORMS Nursing uniforms have transformed dramatically over the past century on the back of emerging trends, demand for practicality and comfort, and strict workplace policy.

1937

As a fledgling student nurse at the Flinders Medical Centre in South Australia in the late 1980s Kate Dixon remembers donning a yellow pinstriped dress and white stockings and shoes, all topped by a brown cape. A red vest entered her daily work uniform a year later when she advanced up the ladder. “We used to joke that we looked like egg and sauce,” Kate laughs. As a Registered Nurse Kate wore a characteristic white starchy dress with short sleeves and white shoes. “They weren’t very practical. They were see through and my pens always leaked into my pockets.” Like most nurses, Kate’s work uniform has fallen in line with the trends and expectations of the period. In 1993, for example, she wore culottes, loose pants with flaps, and a white shirt.

Staff nurses in 1937 at the Royal Adelaide Hospital with blue check dresses, white stockings and shoes, and the sister’s cap.

1970

Later, while working at a private orthopaedic hospital, the policy dictated staff wear straight skirts and a shirt coupled with navy shoes. Health facilities invariably develop their own unique work uniform policies and Kate recalls being envious of Royal Adelaide Hospital nurses who at the time wore shorts and polo shirts on the job. Kate says uniforms have come a long ways since the days of stiff, starchy white dresses. “It was always quite impractical what they made us wear but over time that has changed.”

A group of nurses outside the Royal Adelaide Hospital in the 1970s.

1996

Senior nursing staff of the Internal Medicine Service at the Royal Adelaide Hospital in 1996.

Veteran Victorian nurse Barbara Hill wore a white button-up dress early in her career, and also remembers veils being phased out around the late 1970s. She suggests every nurse retains a sense of pride each time they put on their uniform.“In many ways a nurse’s identity is wrapped up in their uniform. When you see a police officer they have a sense of standing in the community. I think it’s exactly the same for nurses. A uniform expresses pride and professionalism.” Archives from the Royal Adelaide Hospital’s Heritage Office trace the evolution of nursing uniforms across the state and reveal noteworthy transformations. From 1890 to 1930, strict uniforms saw student nurses wear red and white, and matron and senior nurses don a dark

coloured cotton material. A folded long rectangle cap was pinned to the nurse’s hair. In the late 1930s, staff nurses wore uniforms made of blue and white check material, a button through shift dress with a belt, and white shank buttons from neck to hem. They also wore a red cape and white starchy cap with a deep turned-back brim.The nurse had a choice of wearing fawn stocking and brown shoes, or white stockings and white shoes. As the years have rolled on, nursing uniforms have changed with the times. By the 1980s, nursing staff at the Royal Adelaide were wearing a variety of uniforms. RNs wore a white dress with a zip or button fastening down the front, with three-quarter length sleeves and a white belt with buttons. A green velvet band was attached to the cap of a first year RN for identification purposes. It is clear nursing uniforms have chopped and changed over the years, and even today different states, hospitals and health facilities stick to their own unique policies. However, the prevalence of scrubs in hospitals is on the rise and marks an emerging trend that could become the norm of the future. Ray Lehrer, Managing Director of Advance Design, which manufactures premium Barco scrubs imported from the United States, says demand and interest in more stylish and practical scrubs emerged a few years ago. “I think people are looking for clothing that’s more comfortable than traditional options,” he says. “The fact that scrubs now have a fashionable element, there’s a design flair that makes them more fashion forward and comfortable to wear. There’s no doubt that they’re better suited to the job that care professionals perform. They just haven’t always looked great. So getting that look right and giving them the comfort that’s appropriate for their role seems to be working.” Mr Lehrer says scrubs are more likely to be worn in hospitals but added that the aged care sector is also increasingly turning to the uniform option. “Where we’re noticing a big shift is care workers at aged care facilities are moving away from polo shirts and to scrubs for comfort and durability.”

PHOTOS COURTISY OF ROYAL ADELAIDE HOSPITAL’S HERITAGE OFFICE

16  April 2017 Volume 24, No. 9

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RESEARCH

REFORM PBS FOR CHEAPER DRUGS The cost of prescription drugs in Australia could be cut significantly under proposed reforms, according to a new report. Australians pay more than $500 million each year too much for their prescription medication, according to the Grattan Institute’s ‘Cutting a better drug deal’. The cost of medication in Australia is more than twice as high as in the United Kingdom and more than three times higher than in New Zealand. Patients would pay far less if changes to the way prices were set under the Pharmaceutical Benefits Scheme were introduced by the federal government, according to the report. It recommended the government to benchmark the prices of generic drugs in Australia against prices paid overseas. “This would save $93 million a year and cut the price of 16 commonly prescribed drugs in Australia by an average of $6.43 per pack,” Grattan Institute Health Program Director Professor Stephen Duckett said. Australians on average paid five times the best international price for a group of seven commonly prescribed drugs. The most prescribed drug in Australia, cholesterol lowering atorvastatin was about 1.5 times the best international price. A box of 30 x 1mg tablets of the breast cancer drug anastrozole cost $19.20 in Australia compared with $2.45 in United Kingdom. The Commonwealth government was overpaying for generic medicines that were no longer covered by patents, Professor Duckett said. “Australia is buying and pricing its drugs the wrong way. Fixing this policy mess would give patients a better deal and improve the budget bottom line.” In addition, the government should overhaul the rules for interchangeable drugs that were equally effective and safe for most people, the report recommended. This reform could save a further $445 million a year. Statistics showed about 8% of Australians didn’t buy or delayed getting their prescribed medication due to cost. “The high price doesn’t just hit Australians in the hip pocket, it harms their health,” Professor Duckett said.

18  April 2017 Volume 24, No. 9

FLU VACCINE SAFE IN PREGNANCY DESPITE LOW UPTAKE Pregnant women are safe to be vaccinated against influenza during any trimester, latest research shows. Yet only one in three pregnant women are vaccinated against the flu. The findings published in international journal Vaccine support the current recommendation in Australia for all pregnant women to be vaccinated during the influenza season. The collaborative study led by Menzies School of Health Research involved 7,126 women from Darwin, Brisbane, Sydney, Melbourne, Adelaide and Perth over three consecutive years. Results showed 2,429 women had a flu vaccine during their pregnancy; and the majority were vaccinated during their second trimester. A total of 4,697 women did not have the flu vaccination during pregnancy. “Our results showed no clinically significant differences in infant birthweight or gestational age at birth of the infant for women who received an influenza vaccination during any trimester of pregnancy compared with unvaccinated mothers,” lead author Menzies PhD student Lisa McHugh said. The World Health Organization (WHO) recommends flu vaccination for pregnant women who are at higher risk of severe illness if they do contract influenza infection. “This is due to reduced immunity or if the pregnant woman has a comorbidity or risk factor such as diabetes or a history of respiratory illness like asthma or bronchitis,” Ms McHugh said. Chief Investigator and Chair of the Australian Technical Advisory Group on Immunisation Menzies’ Professor Ross Andrews said the study showed there was still concern by pregnant mothers around the safety of the flu vaccine. “In our study, only one in three women had a flu vaccine during their pregnancy, despite the recommendations. Monitoring safety, uptake and effectiveness is critical for any vaccine program but particularly for vaccines given in pregnancy.” The FluMum Study was funded by the National Health and Medical Research Council.

EARLY PUBERTY LINKED TO GESTATIONAL DIABETES Early menstruation could indicate an increased risk of developing gestational diabetes in pregnancy, research shows. University of Queensland (UQ) researchers found that girls who had their first period at age 11 or younger were 50% more likely to develop gestational diabetes than those who experienced their first period at age 13. “This finding could mean that health professionals will start asking women when they had their first period to identify those at higher risk of gestational diabetes,” researcher in the UQ School of Public Health Danielle Schoenaker said. “Not adding early puberty to an antenatal checklist which is quite long already but the need to look at early life factors during pregnancy which may explain why some women develop gestational diabetes.” Data was analysed from more than 4,700 women from the long-running Australian Longitudinal Study on Women’s Health. “Research into this topic is of particular public health importance due to global trends of girls starting their menstrual cycles at a younger age,” Australian Longitudinal Study on Women’s Health Director Professor Gita Mishra said. Early puberty in girls had now been shown to be a significant marker for several adverse health outcomes, including gestational diabetes, type 2 diabetes and breast cancer. The significant association with gestational diabetes risk remained after researchers accounted for body mass index and childhood, reproductive and lifestyle factors. “A large proportion of women who develop diabetes during pregnancy are overweight or obese, and encouraging those with an early start of puberty to control their weight before pregnancy may help to lower their risk of gestational diabetes,” Ms Schoenaker said. While a healthy weight was important, it was also plausible that the higher risk was linked to hormonal changes and genetics. Other early childhood factors and stressors such as abuse, neglect or parental divorce had yet to be explored.

anmf.org.au


LEGAL

Linda Starr

WHAT IS THE CRIMINAL REGISTRATION STANDARD? Linda Starr

Section 109 of the National Law requires practitioners to disclose any change to their criminal history during the preceding period of registration (or upon initial registration). Criminal history that must be declared is every conviction for an offence, every plea of guilty or finding of guilty by a court and every charge against the practitioner for a relevant offence as above.

Under the Health Practitioner Regulation National Law Act (2009) in each Australian jurisdiction registered health practitioners, and in some instances students are required to provide their National Board with certain information when applying for registration.

Whilst a failure to provide such written notice is not an offence, practitioners and students who contravene this section may be subject to health, conduct or performance inquiries regarding their behaviour. This was the case in the Psychology Board of Australia v Cameron where the practitioner received a reprimand for unprofessional conduct for breaching sections 109 and 130.

National Boards have developed registration standards designed to inform practitioners of the necessary requirements when applying for initial or re-registration. There are five core standards that apply to all 14 professions: English Language skills, regency of practice, continuing professional development, professional indemnity insurance and criminal history registration standard. These standards provide a level of consistency across Australia (although slightly varied for some disciplines) and are relied upon by the Boards when a report is made about a practitioner’s health, performance or conduct. Hence, it is important that practitioners are familiar with and understand the registration standards relevant to their own discipline and why their Board relies on full and frank disclosures and accurate information from practitioners when applying for registration.

Reference Psychology Board of Australia v Cameron [2015] QCAT 227

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 anmf.org.au

A standard common to all National Boards and thus practitioners is the criminal history standard that relates to sections 109 and 130 of the National Law (this standard does not apply to students during their course of study) requiring health practitioners to give their National Board written notice within seven days of certain events defined in the law as being where the practitioner or student has been charged: whether in a participating jurisdiction or elsewhere, with an offence punishable by 12 months imprisonment or more; or is convicted of or the subject of a finding of guilt for an offence, whether in a participating jurisdiction or elsewhere, punishable by imprisonment (s 130)

Here the practitioner was charged and later convicted of seven traffic offences in relation to driving without a licence, driving whilst disqualified and driving under the influence or over the prescribed alcohol limit over a twelve month period. Under the National Law the practitioner was required to notify the Board within seven days that she had been charged with these offences and subsequently of her convictions. The practitioner applied to renew her registration in 2011 however, at the time did not disclose any changes to her criminal history. In 2012 AHPRA contacted the practitioner after they became aware of her criminal history, where she admitted breaching ss 109 and 130 of the National Law. Ms Cameron claimed that her failure to notify was more a mistaken belief of her obligation under the Act rather than a deliberate attempt not to disclose as she considered her offences to be traffic offences rather than serious criminal offences and so not something that warranted a report to the Board.

misapprehension of her obligations concerned a number of convictions each of a different character. Considering the practitioner’s conduct the tribunal was of the view that any misrepresentation in an application for registration to be a very serious matter. The tribunal considered that a failure to make such disclosures could reflect on the poor character of the practitioner and leave the Board without ‘ …a complete picture of the registrant’s work history [where the Board] may lose the opportunity to act prospectively to avoid problems, rather than retrospectively to pick up the pieces of a registrant’s career.’ However, taking into consideration the practitioner’s insight, early admissions, full cooperation and that her behaviour was not deliberate the tribunal found this to be a case of unprofessional conduct. Nonetheless, given the nature of the offences – excessive alcohol consumption and driving whilst disqualified/under the influence the question of the practitione’s fitness to practice was raised but not dealt with further as the Board advised the tribunal that following an investigation they were satisfied that the practitioner did not have a health impairment. Given that the scope of deliberations was confined to the issue of nondisclosure the tribunal felt that a reprimand would have sufficient preventative effect for the practitioner regarding future conduct and serve as a deterrent to other practitioners not to be tempted to omit unfavourable information in their disclosures when applying for registration. This case reminds us of the need to understand our registration standards and that conduct that occurs outside of employment may well fall within the scope of scrutiny by the Board should it raise questions of fitness to practice or public safety.

The Board accepted that the practitioner’s failure to notify them of her convictions was not a deliberate act, but a mistaken belief as to what she was obliged to report. The question for the tribunal was - is this a case of professional misconduct or unprofessional conduct? The practitioner had failed to make a disclosure of her criminal history on five separate occasions – although counsel for the practitioner argued that this should be seen as one course of conduct. The Board opposed this position which was supported by the Tribunal who accepted that the failure to notify the Board of the charges whilst due to the same April 2017 Volume 24, No. 9  19


FEATURE

ON THE FRONT LINE

THE REWARDS OF LIFE AS A MILITARY NURSE The brave men and women of Australia’s military put their lives on the line to defend the country at home and abroad. Behind the scenes, military nurses work alongside troops to provide support across the gamut of healthcare. At any given time, military nurses could be working in field hospitals, supporting training exercises across Australia, or deployed overseas in war zones. Filled with adventure and unique challenges, Robert Fedele explores the highs and lows of life as a military nurse.

A

ustralia’s military outfit, run under the banner of The Australian Defence Force (ADF), comprises the Royal Australian Navy (RAN), Australian Army, and Royal Australian Air Force (RAAF).

The ADF boasts a rich and colourful history and today retains almost 80,000 members made up of full-time active-duty personnel and part-time reservists. Nursing and the military are inextricably linked. A military nursing career invariably involves nurses caring for troops in dangerous settings. While it can be stressful and heartbreaking, it can also offer unrivalled adventure and unique challenges. Despite the drawbacks, many nurses who take up a career in the military never look back.

LIEUTENANT NURSING OFFICER ALISON PICKERSGILL AT THE LAVARACK BARRACKS IN TOWNSVILLE. PHOTO: AL GREEN, AUSTRALIAN DEFENCE FORCE.


FEATURE


FEATURE “I THINK IT’S IMPORTANT WE CONTINUE TO GROW THE WORKFORCE TO FOLLOW ON BEHIND. THERE’S NO POINT IN ME DOING SOMETHING FOR 20 YEARS AND THEN THERE BE A GAP AFTER I LEAVE. I THINK IT’S A RESPONSIBILITY, PROBABLY FOR ALL NURSES, TO CONTINUALLY TRAIN NEWER, YOUNGER PEOPLE AS THEY COME ON. BECAUSE SOMEBODY’S GOT TO CONTINUE THE LEGACY.” Air Commodore Jenny Lumsden CSC literally have a tent with a stretcher, a few boxes of equipment, and a couple of things like a defibrillator and a ventilator and that’s it. So we don’t have access to imaging. We have very limited access to pathology. It’s like a whole new world and it’s probably similar to what remote and rural nurses have to deal with on a daily basis.” A large contingent of Army nurses work within Australia supporting troops during training operations. Soldiers are largely young, fit males, and unsurprisingly there is less chronic illness and disease and greater acute trauma injuries like head, spinal and musculoskeletal issues. WING COMMANDER SHARON BOWN (RET’D) INTERACTING WITH EAST TIMORESE CHILDREN WHO WOULD OFTEN STOP AT THE HOSPITAL TO SAY HELLO.

ENLISTING IN DFENCE

Lieutenant Nursing Officer Alison Pickersgill plotted a pathway into the Australian Army while studying nursing at Perth’s Curtin University. Alison was recruited through the Army’s undergraduate scheme, which signs up prospective members and funds the remainder of their degree. Alison’s sister was in the British Army at the time and hearing her accounts of adventure sparked the interest. “After a few placements from university I decided I kind of wanted a little bit more from my nursing role. The more I read the more I liked. It was pretty much an immediate decision for me.” Army nurses undertake two years’ experience in a civilian setting to consolidate their skills prior to joining the fold. Alison learnt the ropes at the Royal Perth Hospital in Western Australia before she received her maiden post to Brisbane. New recruits undertake a range of courses on arrival covering general military skills, weapons handling, leadership, and specific military nursing skills such as incubation and ventilation. 22  April 2017 Volume 24, No. 9

Army nurses can work in units, field hospitals, treatment teams on Army bases providing primary healthcare, and on deployments in peace-keeping and humanitarian relief operations. Nursing Officers usually spend two to three years at a post before being re-assigned. They also maintain their clinical skills by regularly undertaking secondments at major metropolitan hospitals. Alison recently took on a new role providing combat first-aid training to three brigades. The three-week course teaches soldiers how to deal with traumatic combat injuries like amputations, how to cannulate, and how to administer IV fluids and medication. Based at the Lavarack Barracks in Townsville, Alison is also responsible for training clinicians including doctors, nurses, medics, and physios, via large-scale exercises held throughout the year. Alison describes military nursing as a constant challenge. “When we’re out treating patients in a treatment team we

Alison acknowledges trauma as the common theme but says Army nursing is not purely about patching up bullet wounds. “There is a wide range of things that you’ll do as a nurse and it changes every day. If you’re supporting a training activity you’re out in the middle of nowhere providing resuscitation care. When you’re not on a training activity you could be stationed at the medical centre on base just providing everyday GP practice kind of care. You can do what I’m doing, which is coordinating military training for combat medics. There’s instructor roles. You could be in a managerial position. It’s just so different.” Alison has yet to be deployed overseas but says she would jump at the chance. “It’s something that every nurse wants to do. It’s the culmination of all the training that you do and the main reason you probably join. I don’t know of any nurse who doesn’t want to.”

DUTY FIRST

Air Commodore Jenny Lumsden CSC has been a member of the Royal Australian Air Force (RAAF) for more than three decades. Her decorated career has included roles as a nurse clinician, personnel manager, administrator and military leader both in Australia and overseas. Jenny’s deployments span East Timor, as anmf.org.au


FEATURE part of a United Nations military hospital, the Australian Defence Force’s response to the second round of Bali Bombings, and Iraq with the United States Air Force’s hospital overseeing medical evacuations from around the world. Currently, Jenny splits her time between her role as Director General Health Reserves – Air Force, and working as a Clinical Consultant in Intensive Care at the Royal Melbourne Hospital. Her military position entails looking after all Health Reserves in the Air Force, about 500 people, including nurses, doctors, dentists, and physiotherapists. Wider responsibilities extend to strategic management focused on recruiting, retention, and training. Jenny, whose last

TOP LEFT – LIEUTENANT NURSING OFFICER MADELEINE FERGUSON-O’DEA (LEFT) WITH LIEUTENANT ELIZABETH DALY (ROYAL AUSTRALIAN ARMY MEDICAL CORPS) WHILE ON RECENT DEPLOYMENT IN AFGHANISTAN. BOTTOM LEFT – AIR COMMODORE JENNY LUMSDEN TENDS TO A BABY WHILE ON DEPLOYMENT IN IRAQ.

not for everyone but neither is working in intensive care for everyone or working in communities or aged care and I guess people get attracted probably personality wise to certain areas of health and I think that’s the same with the military.”

deployment took place in Iraq in 2005, says working alongside nurses and health professionals from other nations helped her become a better nurse. “The work is very rewarding. You’re helping people in a time of crisis often and I guess you feel like you’re making a difference.” Looking back on her deployments, Jenny paints a vivid picture, from dealing with major heart attacks in the desert in Iraq to being part of the relief effort during the second round of Bali Bombings where Australians were injured and killed. The overarching ethos surrounds physically caring for people as part of a team. “In East Timor, basically we were working as part of a United Nations Hospital and they took over what was a museum and cleaned the building up, which is often what you have to do, start off with a blank canvas and empty room. You have to clean it up and anmf.org.au

then try and set it up to meet your needs, create wards, or create operating theatres.” Throughout her career Jenny has always divided her time between the Air Force and mainstream nursing. “I really like Intensive Care. It’s probably combined some of the things that maybe attracted me to the military. Being challenged. Being put in situations where hopefully you can make a difference.” She says Bali ranks among her most rewarding deployments due to the nature of the disaster and high-intensity effort. “I guess I was asked [to go to Bali]. That’s the thing. You know there’s a need. You know that someone needs to go and if I feel like I’ve got the skills where I can contribute to that I think that’s my duty if I’m going to be part of the Reserve.” Jenny credits her career in the military with encouraging her to step outside her comfort zone and expand her skills. “It’s probably

While she misses the excitement of deployments she is now content imparting her vast knowledge onto the next generation. “I think it’s important we continue to grow the workforce to follow on behind. There’s no point in me doing something for 20 years and then there be a gap after I leave. I think it’s a responsibility, probably for all nurses, to continually train newer, younger people as they come on. Because somebody has to continue the legacy.”

RISK AND REWARD

Retired Australian Defence Force Nurse Sharon Bown came inches from death while serving in the Royal Australian Air Force (RAAF). The experience left her emotionally scarred for life and suffering post-traumatic stress disorder (PTSD). In 2004, the RAAF Wing Commander was deployed to East Timor to work as an aeromedical evacuation nurse, transporting people back home to Australia and also from around East Timor back to Dili to receive healthcare. The relief effort ended precariously when the helicopter Sharon was travelling in lost April 2017 Volume 24, No. 9  23


FEATURE control during a thunderstorm and plunged to the ground while trying to land in the remote village of Same. “When I realised it wasn’t ok there was this incredible fear that I was either about to die or be very seriously hurt,” she recalls. “Sitting in the back of the aircraft you have no control. There’s nothing that you can do. But there’s also a sense of peace in that I said goodbye to my friends and family.”

our experiences and tell these stories so that fear of the unknown and fear of the unfamiliar starts to subside and with that the stigma as well.”

The account is just one of many penned in Sharon’s gripping autobiography, One Woman’s War and Peace, released last year, that documents a 16-year career with the RAAF in which she served in East Timor, Bali during the second round of Bombings, and Afghanistan.

Suicide, the leading cause of death in Australia, remains problematic among veterans, with a Senate Report into the Mental Health of Australian Defence Force members revealing that since 2000, 108 ADF personnel have been suspected or confirmed to have died as a result of suicide. The National Mental Health Commission is tackling the problem by reviewing suicide and self-harm prevention services available to Australian Defence Force Personnel members and veterans.

In her early career, Sharon worked at the Calvary Hospital in Hobart for three years, before seeking a new challenge. “I was quite intrigued at what the Air Force speciality of nursing is or of healthcare, being aviation medicine. The ability to deliver health rapidly to other parts of the world but also to be able to care for people in the back of an aircraft as well.” Sharon describes deployments as incredibly rewarding and a chance to test one’s nursing skills. “Our resources can be quite limited so it’s very different to working in a large inner city hospital where you have access to many specialists and teams and equipment and the next shift is coming on. In terms of limited resources it tested our ability to provide high standards of care within a very constrained environment.”

“IT’S SOMETHING THAT EVERY NURSE WANTS TO DO [BE DEPLOYED]. IT’S THE CULMINATION OF ALL THE TRAINING THAT YOU DO AND THE MAIN REASON YOU PROBABLY JOIN. IT HASN’T HAPPENED FOR ME YET BUT IT’S DEFINITELY WHY YOU JOIN. I DON’T KNOW OF ANY NURSE WHO DOESN’T WANT TO.” Lieutenant Nursing Officer Alison Pickersgill

After sustaining horrific injuries during the helicopter crash in East Timor, including a broken back and fractures to her jaw, Sharon miraculously returned to work within five weeks. “I was determined not to lose my career,” she explains. “I loved my job. I felt that I had lost my health and my fitness at a very young 24  April 2017 Volume 24, No. 9

Sharon, who now lives in Canberra and sits on the Australian War Memorial Council, has become a mental health advocate in a bid to improve awareness within the ADF. Her motivation stems from a desire to expose the hidden toll of war.

“[MILITARY NURSING] PROVIDES AN OPPORTUNITY. IT’S A DIFFERENT WAY OF PRACTICING. IT’S A DIFFERENT WAY OF NURSING AND IT CAN ALLOW YOU TO ADVANCE YOUR CLINICAL SKILLS. I THINK IT’S AN IDEAL LIFESTYLE.” Postgraduate Course Co-ordinator (Nursing) Kathleen Tori age. I was 29. I didn’t feel like I’d seen the world. I hadn’t any children. I felt robbed of that part of my life and I wasn’t about to give up my career as well.” Her ultimate return to operational service occurred in 2008 when she spent three months in Afghanistan in the thick of war, providing intensive care as the Commander of a Critical Care Team. “We saw the outcome of combat in that we treated NATO soldiers. We treated Afghan forces who had been involved in fighting. “It’s very different to peacekeeping but still incredibly rewarding. To deal with that trauma, particularly in a place like Afghanistan, it calls upon everything that you’ve ever learnt, everything that you’ve ever done in your career, to be able to care for people in war zones.”

MENTAL HEALTH

The fateful helicopter crash that unfolded in East Timor triggered Sharon’s PTSD and left her with nightmares, flashbacks, and ongoing suffering. “I think it was happening all along. I think I fought against it for a very long time,” she reveals. “I was very aware of the stigma surrounding mental health within Australia and the Australian Defence Force at the time. We must continue to talk about

“I don’t believe that anybody is unaffected by their service. It’s just the way in which that impacts upon their life. Everyone that serves is changed by their service. For some people that change is difficult and develops into conditions like PTSD. But I still believe we can emerge from that with the right support.” A recent documentary produced by the Australian War Memorial details the accounts of members of the military who fought in Afghanistan. Titled Afghanistan: The Australian Story, the documentary traces the stories of men and women who served during the 12-year fight against the Taliban. Sharon is among the brave young men and women who bared their souls. “Military nurses experience service themselves because we’ve deployed and experienced war in our own right. But we care for those who experience it as well. So our insight into service is two-fold. It’s that of our own service and that of those whom we provide care for.” Reflecting on her military career, Sharon says she has no regrets and would do it all over again. “I miss the war because it was an environment and a situation where I felt valued. I felt useful. And I felt that I was ultimately making a very positive impact.”

BUILDING PATHWAYS

Academic and Emergency Nurse Practitioner Kathleen Tori spent 18 years in the military working across a variety of settings. Kathleen enlisted in the Army in 1983 and worked her way through the ranks, starting anmf.org.au


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FEATURE want to work in the acute care hospital setting or they want to work in midwifery or paediatrics. That seems to be the three predominant focus areas that we see from our students.

“I DON’T BELIEVE THAT ANYBODY IS UNAFFECTED BY THEIR SERVICE. IT’S JUST THE WAY IN WHICH THAT IMPACTS UPON THEIR LIFE. EVERYONE THAT SERVES IS CHANGED BY THEIR SERVICE. FOR SOME PEOPLE THAT CHANGE IS DIFFICULT AND DEVELOPS INTO CONDITIONS LIKE PTSD. BUT I STILL BELIEVE WE CAN EMERGE FROM THAT WITH THE RIGHT SUPPORT.”

“[Military nursing] provides additional opportunities. It’s a different way of practicing. It’s a different way of nursing and it can allow you to advance your clinical skills – skills that are transferable to the civilian sector. I think it’s an ideal lifestyle.”

LASTING LEGACY

Undoubtedly, the military nurses of today continue to build on the traditions of those that have gone before them. Lieutenant Nursing Officer Madeleine Ferguson-O’dea returned home from her first deployment at the start of the year after spending six months in Afghanistan.as part of a medical team working in a Coalition hospital providing healthcare to Coalition and Afghani forces. She says she was trained up medically but that nothing could have prepared herself for the experience. “Medically, it was a steep learning curve. I was exposed to different illnesses and injuries that I wouldn’t see back here.”

Wing Commander Sharon Bown (Ret’d)

WING COMMANDER SHARON BOWN (RET’D) REFLECTS ON HER CAREER IN THE RAAF. PHOTO: CONWAY BOWN.

in the Nursing Corps under the direction of an RN, moving to the Medical Corps as a medic, and then upon completing her nursing degree was granted a commission and worked in the role of Nursing Officer. She describes military nursing as like nothing else, evidenced by makeshift environments where periodically on exercises, wards usually have to be created. “A lot of it was primary care and could be classed as being a little mundane but the way and the manner in which you’re actually trained in the military sector is unbelievable.” When Kathleen returned to the civilian sector, taking up a post in a large regional hospital as an ED nurse, she quickly became frustrated by the newfound lack of autonomy. “There were things I was used to treating, for example, bites, stings, and minor wounds, that I was able to assess, treat, suture and everything else within the military. I found I could no longer do it due to state legislations and regulatory laws that governed my practice.”

and Midwifery, and also coordinates the Nurse Practitioner study stream, believes that nurse practitioners could provide a great addition to the military. She is currently in the process of trying to trigger a feasibility study to see whether more nurse practitioners could increase the health capabilities of the Australian Defence Force. Kathleen contends that nurse practitioners could alleviate the shortage of medical officers currently faced by the military and provide more effective, accessible, and timely healthcare. Establishing the pathway would also help enhance career progression for prospective military nurses, she adds.

The setback spurred Kathleen to embark on becoming a nurse practitioner in order to extend her scope.

“The nurses in the military are actually working at an advanced level anyway. So they’re able to integrate their theory, their practices and experiences, and they have increased autonomy. They can initiate interventions. They can make judgements. They can do the decision making. It’s shown and proven in the civilian sector that NPs are positive and competent practitioners.”

Kathleen, who is the Postgraduate Course Coordinator (Nursing) at La Trobe University’s Department of Rural Nursing

Kathleen, who regularly deals with undergraduate nurses, says military nursing is often overlooked as an option. “They

26  April 2017 Volume 24, No. 9

Originally from Sydney, Madeleine signed up to the Army while in her third year of nursing at Notre Dame University. She undertook two years of training at Liverpool Hospital before joining the Army full-time. Madeleine is currently based in Sydney as part of the 1st Close Health Battalion. The team provides integral support and aid to soldiers from the front line, forward of field hospitals, strategically placed to deliver emergency care within an hour. Madeleine says the thing she values the most about being in the Army is being pushed to her limits and beyond. “I’ve loved every moment. I’ve had some great opportunities. I’ve been deployed and worked with some great people. The thing about Defence, particularly the Army, is it pushed me and challenged me and I’ve done so much that I thought I could never do.” Madeleine counts the camaraderie and interesting people you meet along the way as the best parts of working overseas on deployment. At the moment, she doesn’t have children or a family so is fairly flexible and available to serve both in Australia and overseas. “I love my job and I love looking after the troops and supporting them medically when required. “I constantly work in different areas, both physically and medically. Overseas, it made me realise how lucky we are in Australia with our healthcare and standard of living because it’s a completely different world over there day to day. They’re not as lucky as us.” anmf.org.au


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CLINICAL UPDATE

ANMF’S AGED CARE STAFFING AND SKILL MIX PROJECT Rob Bonner, ANMF (SA Branch) Director of Operations and Strategy The Australian Nursing and Midwifery Federation (ANMF) recently published the National Aged Care Staffing and Skills Mix Project Report 2016 – Meeting residents’ care needs: A study of the requirement for nursing and personal care staff, it commissioned. Conducted over the past two years the results have been integral to building the foundation of the ANMF’s national aged care campaign. WHY DID ANMF COMMISSION A NATIONAL AGED CARE STAFFING AND SKILLS MIX PROJECT?

Safe staffing and skills mix in the residential aged care sector has been both elusive and problematic for a very long period of time. Successive reviews by the Productivity Commission, Parliamentary Inquiries and other investigations have raised the issue as requiring action and resolution. Successive reports have identified the need to establish the staffing ínputs’ required to deliver an appropriate standard of care to residents. Funding provided to the sector should then be sufficient to ensure that they are able to provide this level of care to their communities. Having urged consideration of the issue over at least two decades, the ANMF Federal Executive decided to act and commissioned a research team to undertake the work. The team included ANMF (SA Branch) staff, and researchers from both Flinders University and the University of South Australia. They were charged with the job of developing a sustainable staffing methodology that would provide an answer to the vexed question: what is the ‘right’ number and the ‘right’ mix of staff for the residential aged care sector across the country. Importantly, the investigation needed to develop a methodology that would be ‘dynamic’ and the capacity to respond to the changing residential care population needs.

Figure 1: Research scheme Stage 1 Literature review

Stage 6 National Delphi study to verify

Stage 2 Resident profiles

Stage 5 Focus groups to validate

Stage 3 Undertake observation/ timings study Stage 4 Assign time to assessments, plans, interventions

The review was undertaken over a two year period from 2016 and 2017 and involved registered, enrolled nurses and assistants in nursing/care assistants across the nation working in the aged care sector.

WHY WE NEED CHANGE?

There is very little argument against the case for change. Residents in aged care facilities have growing needs for care and support given the change in admission criteria over the last 20 years. The growth in community based care and providing services to older people at home mean that people entering residential care are increasingly frail and have many more (and more complex and diverse) healthcare issues and needs. Despite the growth in residents care needs, the staffing levels and type of staff available, has failed to keep pace with them. Not only have the number of staff failed to grow to match the increase in the number and the needs of residents, and spectrum of care now provided in residential care settings, (previously provided in the acute care) but the proportion of nursing care staff who are registered or enrolled nurses has actually fallen at the same time.

Stage 1 Literature review

The literature review gave compelling reasons to align the nursing care needs of residents and the availability of nursing staff. Some fast facts and information from the literature include: (figure 2) Figure 2: Literature review findings

Improved RN hours positively impact on pressure ulcers, decreased hospitalisation and mortality

THE RESEARCH UNDERTAKEN

So how did we go about the research? The short answer is that we used a variety of methods and approaches to develop the model and then test and validate the outcomes nationally. Broadly the approach could be represented as: (figure 1) 28  April 2017 Volume 24, No. 9

54% of people entering aged care are within their last year of life POSITIVE RELATIONSHIP BETWEEN STAFFING NUMBERS AND CARE OUTCOMES

This is despite overwhelming evidence about the relationship between the quality of care and (patient) outcomes on one hand and nurse staffing levels and mix on the other. Put simply the evidence clearly demonstrates that inadequate staffing (either the number or mix of nursing staff) leads to poorer health outcomes (eg. increased rates of adverse events, urinary tract infections, increased rates of pressure ulcers, increased rates of falls, medication errors) and even increased mortality.

Use of aged care increased by over 36% between 2002-03 and 2010-11

Increased acuity due to hospital avoidance strategies

Good staffing levels led to reduced incidence of missed care Increased admissions for residents in higher ACFI classifications

anmf.org.au


CLINICAL UPDATE Stage 2 Resident profiles

After reviewing the existing literature we went about developing residents’ case profiles that would be representative of the wide spectrum of care needs in the sector. We sought information about residents across the ACFI based categories.De-identified assessments and care plans were collected and analysed to come up with our sample six ’resident’ profiles. Our profiled ‘residents’ were:

RESIDENT PROFILE 1: VOULA

Significant medical history: Dementia, hypertension (well controlled on medications), and osteoarthritis (regular pain management and therapy). Alerts/allergies: Nil. Resident profile 1: care needs Care category

Assessment

Cognition/psychosocial

Alert, some confusion (needs re-orientation and re-direction) – language barrier – reverting to native language at times. ‘Sun downer’. Wanders at night (variable).

Nutrition

Generally good. Needs assistance with setting up for meals due to arthritic hands.

Hydration

Offer and encourage fluids – prefers black coffee.

Activities of daily living

Shower one assist Walks without aids

Elimination bladder and bowels

Continent most of the time – needs assistance with toileting Has regular aperient for constipation

Skin health

Falls history

Pain management Medication

Intact but fragile, bruises easily Nil Requires regular analgesia + prn Daily regular medications + prn

Resident profile 1: care provided across shifts AM:

PM:

NIGHT:

Shower - minimal assistance

Diversional activities supervised

Sleep patterns observed

Oral hygiene, including dental care

Meals set-up

Fluids - assist and/or provide

Toileting - minimal assistance

Fluids - assist and/or provide

Toileting - minimal assistance

Oral medication ≤ 6 medications

Pain assess +/- scale

Reassured and supported

Meals set-up

Pain - oral analgesia administered

Fluids - assist and/or provide

Pain - assess analgesia effect Toileting - minimal assistance

Resident Profile 1: evidence based resident and personal care hours per day Total Time (minutes) direct + indirect care time

RCHPD (hours)

150.00

2.50

RESIDENT PROFILE 2: GWEN.

Significant medical history: Atrial fibrillation (well- controlled on digoxin), asthma (inhaler with spacer) and depression. Alerts/allergies: Nil. Resident profile 2: care needs Care category

Assessment

General

When asthma exacerbated – shortness of breath and distressed Deaf – wears hearing aids

Cognition/psychosocial

Alert, anxious and withdrawn at times

Nutrition

Hydration

Activities of daily living

Elimination bladder and bowels Skin health

Falls history

Pain management

Generally good – Needs assistance with setting up for meals Offer and encourage fluids – prefers tea, milk, and sweetener Shower - one assist (breathless and safety). Walks with frame for short distances (tires easily) Continent most of the time Intact – very dry Nil Requires regular analgesia (in oral medications) and prn

Resident profile 2: care provided across shifts AM:

PM:

NIGHT:

Shower - minimal assistance

Toileting - minimal assistance

Sleep patterns observed

Denture hygiene

Meals supervision

Reposition in bed or chair

Supply/fit hearing aid

Fluids - assist and/or provide

Toileting - minimal assistance

Toileting - minimal assistance

Oral medication ≤ 6 medications

Inhaled - nebuliser

Oral medication ≤ 6 medications

Inhaled - nebuliser

Inhaled - nebuliser

Resident support for depression provided

Meals supervision Fluids - assist and/or provide anmf.org.au

April 2017 Volume 24, No. 9  29


CLINICAL UPDATE Resident Profile 2: evidence based resident and personal care hours per day Total Time (minutes) direct + indirect care time

RCHPD (hours)

180.00

3.00

RESIDENT PROFILE 3: GEORGE

Significant medical history: right CVA, hypertension, behaviour – agitation, TIAs, back pain (musculoskeletal). Alerts allergies: Penicillin Resident profile 3: care needs Care category

Assessment

General

Maintaining health and reassurance – behaviour support

Cognition/psychosocial Nutrition

Hydration

Activities of daily living

Alert, agitated at times – needs reassurance and support Special soft diet – partial assist Offer and encourage fluids – supervise and assist Shower two assist. Walks with tripod

Elimination bladder and bowels

Variable continence/incontinence

Falls history

Nil recent – risk of falls

Skin health

Pain management Medication

Requires regular analgesia (oral and DDA patch + prn) Daily regular medication and prn

Resident profile 3: care provided across shifts AM: Shower - minimal assistance

PM: Toileting - minimal assistance

NIGHT: Sleep patterns observed

Shave resident

Toileting - pad check and change

Toileting - minimal assistance

Oral hygiene and denture care

Meals partial assistance

Toileting - pad check and change

Toileting - minimal assistance

Fluids - assist and/or provide

Fluids - assist and/or provide

Toileting - pad check and change

Oral medication ≤ 6 medications

Distress management and treatment

Oral medication ≤ 6 Medications

Distress management and treatment

DDA patch Meals partial assistance Distress management and treatment Fluids - assist and/or provide

Resident Profile 3: evidence based resident and personal care hours per day Total time (minutes) direct + indirect care time

RCHPD (hours)

210.00

3.50

RESIDENT PROFILE 4: WALTER

Significant medical history: diabetes type 2 (oral hypoglycaemics now on daily s/c insulin - stable), osteoarthritis, and hypertension. Alerts/allergies: Aspirin. Resident profile 4: care needs Care category

Assessment

General

Maintaining health, safety, reorientation, and reassurance – behaviour support

Cognition/psychosocial

Needs re-orientation, anxious++

Nutrition

Hydration

Diabetic diet – partial assist and supervise Offer and encourage fluids – supervise and assist

Activities of daily living

Shower moderate assist (difficult at times) Has frame – needs reminder to use

Elimination bladder and bowels

Variable incontinent – regular toileting+

Skin health

Falls history

Pain management Medication

Diabetes management

30  April 2017 Volume 24, No. 9

Intact but at risk Nil recent falls but has hip protectors as a preventative measure Requires regular oral analgesia Daily regular medications + prn + daily s/c insulin Diabetic diet, BD BGL checks

anmf.org.au


CLINICAL UPDATE Resident profile 4: care provided across shifts AM:

PM:

NIGHT:

Shower - minimal assistance

Toileting - minimal assistance

Sleep patterns observed

Shave resident

Toileting - pad check and change

Toileting - minimal assistance

Oral hygiene and denture care

Meals partial assistance

Toileting - pad check and change

Toileting - minimal assistance

Fluids - assist and/or provide

Fluids - assist and/or provide

Toileting - pad check and change

Oral medication ≤ 6

medications

Distress management and treatment

Oral medication ≤ 6 medications

Agitation behaviour management

Subcutaneous medication

Diversional activities supervised

Meals partial assistance

Assess blood glucose level

Reposition resident in bed or chair

Agitation behaviour management Fluids - assist and/or provide Hip protectors applied and maintained Assess blood glucose level

Resident profile 4: evidence based resident and personal care hours per day Total time (minutes) direct + indirect care time

RCHPD (Hours)

240.00

4.00

RESIDENT PROFILE 5: SARAH.

Significant medical history: rheumatoid arthritis (30 year history), renal impairment, anaemia, reflux oesophagitis, bilateral knee replacements, and fractured right neck of femur + redo (10 years ago). Alerts/allergies: Morphine Resident profile 5: care needs Care category

Assessment

General

Maintaining health, safety, reorientation, and reassurance – behaviour support

Cognition /psychosocial Nutrition

Hydration

Needs re-orientation and re-orientation. Sundowner Normal partial assist and supervise (arthritis) Offer and encourage fluids – supervise and assist

Activities of daily living

Shower maximum assist + lifter Needs regular repositioning in chair and bed

Elimination bladder and bowels

Variable continence, needs aperients (constipation and immobility)

Skin health

Falls history

Pain management Medication

Intact – at risk – closely assess and monitor Nil recent falls, but has hip protectors as a preventative measure Has had falls 2 months ago – nil recent falls – has hip protectors (preventative measures) Requires regular analgesia (oral + DDA)

Resident profile 5: care provided across shifts AM:

PM:

NIGHT:

Shower - moderate assistance (2 people)

Meals set up

Sleep pattern observed

Oral hygiene and denture care

Meals supervise

Toileting - moderate assistance

Transfer maximum assistance (3 people) with lifting machine

Oral medication ≤ 6 medications

Toileting - pad check and change

Meals set up

Fluids - assist and/or provide

Fluids - assist and/or provide

Meals supervise

Transfer maximum assistance (3 people) with lifting machine

Reposition resident in bed or chair

Oral medication ≤ 6 medications

Toileting - minimal assistance

Pressure area care

DDA patch

Toileting - pad check and change

Toileting - minimal assistance

Diversional activities supervised

Toileting - pad check and change

Reposition resident in bed or chair

Fluids assist and/or provide Pressure area care

Resident profile 5: evidence based resident and personal care hours per day Total time (minutes) direct + indirect care time

RCHPD (hours)

270.00

4.50

anmf.org.au

April 2017 Volume 24, No. 9  31


CLINICAL UPDATE RESIDENT PROFILE 6: NORMA.

Significant Medical History: Norma has had bilateral mastectomies, chemotherapy, and radiotherapy. Breast cancer (recurrent) and hypertension. Has pressure sore right buttock. Alerts/allergies: Morphine. Resident profile 6: care needs Care category

Assessment

General

Palliative, debilitated, cachexia

Cognition /psychosocial Nutrition

Hydration

Activities of daily living

Elimination bladder and bowels Skin health

Falls history

Pain management Medication

Delirium Small sips of fluids/food. S/C fluids 24/7 Offer as assessed and tolerated Sponge in bed, pressure care, repositioning Incontinent Pressure ulcer – wound management and care Nil – risk due to delirium – family with Norma 24/7 s/c DDA analgesia (Graseby - 1/24 pump) Subcutaneous prn

Resident profile 6: care provided across shifts AM: Sponge in bed

PM: Pressure area care

NIGHT: Pressure area care

Oral hygiene and denture care

DDA subcutaneous

DDA subcutaneous

DDA subcutaneous

Pain assess +/- scale

Pain assess +/- scale

Pain assess +/- scale

Pain assess analgesia effect

Pain assess analgesia effect

Pain assess analgesia effect

IV/SC fluids maintained

IV/SC fluids maintained

IV/SC fluids maintained

Counselling and support provided

Counselling and support provided

Spiritual comfort

Toileting - pad check and change

Toileting - pad check and change

Wound dressing attended

Reposition resident in bed or chair

Reposition resident in bed or chair

Pressure care attended

Oral medication ≤ 6 medications

Oral medication ≤ 6 medications

Toileting - continence pad check and change

Fluids assistance and/or provide

Fluids assistance and/or provide

Assess family and social support Fluids assistance and/or provide

Resident profile 6: evidence based resident and personal care hours per day Total time (minutes) direct + indirect care time

RCHPD (hours)

300.00

5.00

Looking at the resident’s assessment led to assigning interventions/ care that would flow from them. Gwen for example, with her history of depression and recurrent cardiac incidents along with asthma, required care on a regular basis including medication via nebuliser, support related to her depression, monitoring of fluids and assistance with meals, assistance with mobilising and showering (activities with exertion).

nurse time. The frequency of the interventions were calculated for each shift and then aggregated over the day (or 24 hour period).

Sarah on the other hand with more extensive health impairments including dementia, rheumatoid arthritis, renal condition, knee replacement and a previous fractured neck of femur required a different series of interventions including pressure area care, assistance with transfer and mobilisation (multiple staff), positioning, supervision of meals and fluids, diversional activities and supervision of sleep. She also had more extensive and higher order medication assistance requirements and required two people to assist with showering.

The process of Stages 2 and 3 can be represented as: Total Residential Aged and Restorative Care Staffing and Skills Mix Model©

The results of the time taken for the interventions was then added for each day of the residents care to come up with a proposed time for all direct nursing and personal care work associated with the ‘typical’ resident

Resident Profiles Demographics Past Medical History Social Situation

Stage 3 Assigning time

We had access to a ‘timings database’(created following direct observation of interventions being carried out in a variety of workplaces and timing that work using a standardised process to ensure statistical validity) which provides a repository of validated interventions, associated timings and indicative class of staff, for each of the interventions. For example the time allocated to assess vital signs was 3.94 minutes of enrolled nurse time. In the case of transfer resident from bed to chair, two personal care workers/assistants in nursing which totalled 9.95 minutes of time to complete the work. For a resident requiring an insertion of indwelling catheter was 31.81 minutes of registered 32  April 2017 Volume 24, No. 9

Aged Care Major Categories and Intervention Master List Direct Nursing Care

Consequences

Diagnosis

Major ACFI

Aged Care Environmental “Task”List Master List Indirect Nursing Care

Actions

Assessment

Care Plan and Document

Reassessment and Follow-Up

Figure 3: Process flow for development of model anmf.org.au


CLINICAL UPDATE Resulting in a methodology which can be shown as:

Assessment (and reassessment of each resident)

Direct nursing (and personal) care time per intervention per resident

BUILDING TO THE TOTAL NURSING (AND PERSONAL) CARE TIME PER DAY

Indirect nursing (and personal) care time per intervention per resident X Frequency per shift

x Frequency per shift

Figure 4: Illustration of Methodology for timings Stage 4 Validating ‘typical’ resident profiles, interventions and timings Of course it was critical that the profile of residents that we created and the interventions that flowed from the assessments were representative and valid. The University teams undertook a series of focus groups comprised of nurses, care workers and directors of care across the country. Each of the groups were asked to review the ‘residents’ and whether the profiles that we had created were representative of residents in their own facilities. Next they were asked to review the assessments and interventions that had been selected as a result of those assessments. Were the interventions appropriate? Were there interventions that were not identified that should be included? Were there interventions that had been included that should not have been? What were the frequency of the interventions? Who provided the intervention? At this stage participants did not have access to the time associated with the proposed care plan so as to avoid that influencing their consideration of the care plans. Only after the care plans had been discussed, reviewed and agreed were they asked to consider the timings: were they seen to under or overstate the total demand for care? Were the staff assigned appropriate for the interventions? Was any adjustment required? And if so, why? The research team undertaking the conduct of the groups and the analysis were surprised by the consistency of the discussions between the groups and the outcomes of their consideration. In all cases the resident profiles were validated – although the resident with the lowest level of care needs – ‘Voula’- was seen as being unlikely to be admitted to residential care and was more likely to receive care in the community. The interventions were adjusted marginally and some additional time was added by the groups to cover ‘indirect care’ activities - such as handover, drug counts which are not attributable to the care of a specific person. The groups identified the growing intensification of work in the sector, particularly issues associated with end of life care which was seen as increasingly intensive and dominant in their working lives.

Stage 5 Expert sign off – national Delphi study

The final stage of the research was aimed at the nominees of the proprietors/CEOs. The University teams developed a survey that asked this expert group to once again evaluate the care profiles, interventions and anmf.org.au

timings developed in the earlier stages of research.

So what did we learn and what is supported by a firm evidence base? The review recommends very significant change to both staffing numbers and mix if we are to meet the needs of residents in care.

We need action to increase the number of staff: From an average staffing level at around 2.5 hours per resident per day the care required would see staffing of nursing care grow to 4.3 hours per resident per day (based on the current resident profiles). We also need to address the mix of staff and the skills they bring to resident care: Presently about 70% of the care is provided by assistants in nursing (AIN)/care workers with 15% provided by registered nurses and th e balance made up by enrolled nurses. The research suggests that the needs of residents means that this should change to registered nurses forming 30% of the nursing team, enrolled nurses 20% and AIN/care workers 50%. Does that mean replacing AIN’s and care workers with RNs and ENs? Whilst this change in mix sounds alarming for AIN/care workers it needs to be remembered that the overall nursing workforce will also grow – so 50% of the required future workforce is actually an increase of approximately 15,000 jobs in the sector even though the proportion of AIN’s/care workers is reducing from 70% at present. Work still to be completed The level of change to the workforce in the aged care sector is significant. It will take time and resources to implement. We are now working to establish the costs and benefits arising from implementation of the recommended staffing levels and mix and how that can be funded. We expect that this work will be completed by May 2017.

The need for action

It now falls to all of us to work towards acceptance of the need for change. We now know that staffing levels and mix are not able to meet the care needs of residents who should be entitled to safe and appropriate care. We now know that residents are missing out on care that should be provided in large measures due to inadequate staffing. We also know that nursing staff at all levels are struggling with their workloads, juggling the demand for care and are dissatisfied with their capacity to meet residents’ needs. The full report is available on the ANMF website: www.anmf.org. au/documents/reports/National_Aged_Care_Staffing_Skills_Mix_ Project_Report_2016.pdf

Acknowledgements

Thank you to: ANMF Federal Executive for funding the research project and all branches for their assistance through each phase. Flinders University Research Team: Professor Eileen Willis Dr Julie Henderson Dr Ian Blackman University of South Australia: Dr Terri Gibson Associate Professor Kay Price Dr Luisa Toffoli ANMF SA Branch CEO/Secretary Adjunct Associate Professor Elizabeth Dabars AM Project Team: Rob Bonner Jennifer Hurley Trish Currie

April 2017 Volume 24, No. 9  33


EDUCATION

CPD

HOURS

WORKPLACE BULLYING The ANMF’s CPE website has had a major makeover including the inclusion of new topics for you to utilise towards your CPD requirements for registration in May. All existing topics have been audited and updated so you can be sure you are getting the latest information. Our new topics include:

• Falls Prevention • Crystal methamphetamine- Ice- A

Tutorial for Nurses and Frontline Workers

• Workplace Bullying • Food Safety and Patient Controlled

Analgesia We are very excited about these new additions to our topics menu.

Workplace bullying is something we have all either witnessed or been involved in, unfortunately, so this excerpt is from our new Workplace Bullying tutorial written by Sally Moyle. To access the entire course go to: http://anmf.cliniciansmatrix.com Workplace bullying can occur in any 34  April 2017 Volume 24, No. 9

workplace, in any location, to any person, at any time. It can impact on an individual’s physical and psychological health and also affect their ability to perform their job. There is an abundance of evidence indicating that for many nurses and midwives their workplace can be both a violent and hostile environment. These environments can cause problems such as violence and aggression against nurses and midwives which occur not only from patients and the wider community, but also from their colleagues. Workplace bullying affects roughly 11% of all workers, which is quite a substantial amount. Studies have also found that bullying occurs more often in certain areas of work (such as community and social service areas of employment) than others (like finance and manufacturing). The British Medical Association found that in Britain, one in seven National Health Service staff had reported being bullied by another staff member. It was also found that nurses, midwives and physicians who were younger and less experienced were more likely to experience bullying behaviours than others.

A relationship has been found to exist between workplace bullying and employees who work with clients and patients. This means that nurses and midwives are at an increased risk of experiencing workplace bullying compared to other occupations. Therefore, we need to be able to identify any bullying behaviours and implement strategies to cease these behaviours. We hear about bullying all the time, in the media, through friends… But what actually is workplace bullying? Workplace bullying is defined as: ‘repeated and unreasonable behaviour directed towards a worker or a group of workers that creates a risk to health and safety’. By this definition, not all behaviours that make an individual feel upset at work are classed as workplace bullying. Behaviours are classified as workplace bullying only if they are repeated, unreasonable and create a risk to the health and safety of an individual or group of people. There is no specific number of incidents required for the behaviour to be considered anmf.org.au


EDUCATION

EARN UP TO TWO HOURS OF CPD By reading this article in its entirety and doing the associated learning activity online you can receive two hours of continuing professional development (CPD). For more information go to http://anmf. cliniciansmatrix.com

as workplace bullying, however there does need to be more than one occurrence. The same specific behaviour also does not need to be repeated, there may be different behaviours occurring but it is still classified as workplace bullying. Although a single incident of unreasonable behaviour is not considered to be workplace bullying, it can have the potential to escalate to workplace bullying and should not be ignored. Bullying behaviours may often only occur in isolation and not as a repeated behaviour, this can then be interpreted as ‘office politics’ or ‘a clash in personalities’ rather than a legitimate claim of bullying. Workplace bullying behaviours can also evolve over time. During the early stages they may be indirect and it might be hard to pinpoint the negative behaviours towards a specific individual. However, as time passes, the perpetrator may become more overtly aggressive. This can lead to the target becoming further isolated and humiliated. The risk to the health and safety of an individual from workplace bullying includes both a risk to the psychological, psychosocial and physical health of an individual. Healthcare is an environment with high work demands, places an emphasis on performance and is rapidly changing. It is a culture that can be tolerant of workplace bullying when it shouldn’t be. Workplace bullying can come in many different forms and an individual can experience different types of bullying at the same time. It is important to recognise that the workplace bullying occurring in healthcare is often not conflict based but instead can involve tactics that undermine and isolate an individual. There are specific terms used regarding workplace bullying depending on who is the perpetrator and who is the victim. These are discussed in detail throughout anmf.org.au

the tutorial. Whenever there is a group of people working together, there is a risk of workplace bullying occurring. Therefore employers need to implement measures to control that risk. These measures will help eliminate or reduce the incidence of workplace bullying as far as reasonably practicable. This includes the use of policies and procedures, providing information and training and the monitoring and review of prevention strategies.

BULLYING BEHAVIOURS MAY OFTEN ONLY OCCUR IN ISOLATION AND NOT AS A REPEATED BEHAVIOUR, THIS CAN THEN BE INTERPRETED AS ‘OFFICE POLITICS’ OR ‘A CLASH IN PERSONALITIES’ RATHER THAN A LEGITIMATE CLAIM OF BULLYING.

Often talking about bullying and bullying behaviours is seen as taboo in the workplace and life in general. This makes it more difficult to identify and manage bullying problems and address any psychological effects it may have on the victim. This can lead to the victim not seeking help or talking about their bullying encounters, which can then make the bullying become worse and more difficult to manage. Organisations need to have a zero tolerance position in regards to workplace bullying. Sixty eight percent of executives consider it a serious problem and it has been found that up to 40% of victims do not report bullying to their employers. All allegations should be taken seriously and investigated promptly. There are many reasons underreporting of workplace bullying may occur, such as perceived stigma, fear of reprisals, lack of support and inadequate procedures, to

name a few. Many employees who have reported workplace bullying found that they were not supported by their organisation and at times made to feel they were at blame for the situation. This should not occur and processes need to be in place to prevent this. Work Health and Safety laws (WHS) ensure employers eliminate (as far as is reasonably practical) any risks to the health and safety of their employees. If it is not reasonably practical to eliminate risks to health and safety, then the employer must reduce these risks as far as reasonably practical. For the employees, WHS laws place duties on them to take reasonable care for their health and safety, and that of those around them who may be affected by their acts or omissions at a workplace. They must also cooperate with their employer’s actions taken to comply with the WHS Act. Workplace bullying can breach the WHS Act when: • It has created a risk to an employee’s (or another individual’s) health and safety and the employer has failed to take all reasonable practicable steps to prevent and address it; and • An employee has acted in a way that fails to take reasonable care for the health and safety of others at a workplace. You have a right as an employee to work in a safe environment that is free from bullying. If you find that this right is being violated, steps must be taken to ensure the health and safety of yourself and others is maintained. If you would like to know more about the types and forms of workplace bullying, strategies to prevent it and what to do if you are the victim of workplace bullying then go to the new CPE website to read the tutorial in its entirety. If you have any questions please contact us via education@anmf.org.au

April 2017 Volume 24, No. 9  35


ISSUES

IMMERSIVE MENTAL HEALTH SIMULATION HELPS STUDENTS WITH CHALLENGING CONVERSATIONS By Karen-Ann Clarke, Patrea Andersen and Jo Loth Simulation within nursing education is becoming a popular means of facilitating competency, where there is a tendency for this to focus on the acquisition and development of clinical and technical skills. IMMERSIVE MENTAL HEALTH SIMULATION: STUDENTS PRACTICE WAYS OF RESPONDING TO PEOPLE IN EMOTIONAL DISTRESS

As a result, the use of immersive simulation as a learning strategy in mental health education is not commonly used (Robinson-Smith, Bradley & Meakin, 2009). Health curriculum does not routinely assist students to develop communication and assessment skills above a foundational or theoretical level.

is learned from foundational theory. Mental health academics help to prepare students before they engage in the simulated activity by discussing the expected learning outcomes and practicing some of the hypothetical ways of responding to emotional distress in the classroom prior to students engaging in the simulation.

Mental health settings can often be sensitive, unpredictable and at times hostile, which makes it difficult to provide students with high quality experiences involving mental health issues. Consequently, students may experience significant anxiety before they engage in mental health placements, as they anticipate managing clinically difficult or challenging conversations with people experiencing different levels of emotional distress (Hermanns, Lilly & Crawley, 2011).

Throughout the scenario, students are given opportunities by the standardised patients to think, process, react and take action.

Immersive mental health simulation however, can help teach students about complex real world problems found in highly vulnerable patients whom they will routinely encounter in clinical practice, yet in ways that minimises this anticipatory stress. As part of a campus-wide mental health course at the University of the Sunshine Coast, immersive simulation is provided as an opportunity to address the learning needs of students in a variety of disciplines such as nursing, paramedicine, psychology, education, tourism, sports studies, and nutrition. Using standardised patients, students are provided with a safe and supportive space, as they experience ways of responding to a person in significant emotional distress from a variety of internal and external causes. It is here where students are able to practice the use of advanced and effective communication skills beyond what 36  April 2017 Volume 24, No. 9

Academic staff also assist students to connect theoretical concepts relating to the experience within the debriefing session following the simulation, and students are encouraged to critically think and reflect on their emotional reactions to the experience. More than 1,000 students have undertaken this immersive mental health experience since it was first introduced into the curriculum at the end of 2014. The Satisfaction with Simulation Experience Scale (Levett-Jones et al. 2011) and course evaluation data have been used to evaluate the learning experience of students (n=131) and has demonstrated a significant and consistently positive attitude towards the simulation experience. Ninety-eight percent of students agreed or strongly agreed that the simulation was a valuable learning experience, and a further 93% of students reported that they felt significantly more prepared for a clinical placement and more confident in their ability to communicate effectively with someone in overwhelming emotional distress. Students frequently articulated their desire to repeat the simulation a second time, wanting to practice with their newly found skills and heightened confidence.

Qualitative course evaluations demonstrated that students perceive the immersive simulation to be highly effective and a rich and rewarding experience. One student commented, “I learnt so much, it was so realistic I forgot it was a simulation.” Another student described the debriefing as “a safe space to talk about difficult issues before going out into the real world.” The mental health simulation was reported to be “one of the most powerful learning experiences I have ever been involved in.” Students commented on how well the simulation allowed them to manage their anxiety. As one student described, “I was so scared before I went in. But then I saw how upset she was, and I forgot all about me. I just wanted to help”. Immersive mental health simulation can safely bring to life situations that often cause great anxiety for students and prepare them for real world experiences (Szpak & Kameg, 2013). Students are able to develop and enhance their skills within a safe, calm and caring learning environment. In learning to manage the complexities of a novel situation and develop the use of advanced communication skills, immersive mental health simulation is quickly becoming a valuable and transformative experience for students. Dr Karen-Ann Clarke is a Lecturer in Nursing (Mental Health) at the University of the Sunshine Coast Associate Professor Patrea Andersen is an Academic Director Simulation and Visualisation and Associate Professor of Nursing at the University of the Sunshine Coast Dr Jo Loth is a Lecturer in Drama at the University of the Sunshine Coast

References Hermans, M., Lilly, M., & Crawley, B (2011). Using clinical simulation to enhance psychiatric nursing training of Baccalaureat students. Clinical Simulation in Nursing, 7, e41-e46 Levett-Jones, T., McCoy, M., Lapkin, S., Noble, D., Hoffman, K., Dempsey, J., Arthur, C. and Roche, J., 2011. The development and psychometric testing of the Satisfaction with Simulation Experience Scale. Nurse Education Today, 31(7), pp.705710. Robinson-Smith, G., Bradley, P., & Meakin, C. (2009). Evaluating the use of standardized patients in undergraduate psychiatric nursing experiences. Clinical Simulation in Nursing, 5, e203-e211. Szpak, J., & Kameg, K. (2013). Simulation decreases nursing student anxiety prior to communication with mentally ill patients. Clinical Simulation in Nursing, 9, e13-e19.

anmf.org.au


Indigenous Health FOCUS

UNITING CULTURAL PRACTICES AND SAFE SLEEP ENVIRONMENTS FOR VULNERABLE INDIGENOUS AUSTRALIAN INFANTS By Jeanine Young, Karen Watson, Leanne Craigie, Stephanie Cowan and Lauren Kearney (Pepi-Pod Program Champions at our participating sites) Sudden unexpected death in infancy (SUDI) is four times higher for Aboriginal and Torres Strait Islander babies compared to non-Indigenous babies (Commission for Children and Young People and Child Guardian 2014). Co-sleeping is a culturally valued practice used by many Indigenous families however is associated with an increased risk of infant death in hazardous circumstances (Venneman et al 2012; Blair et al. 2014). Risk factors associated with co-sleeping are more common in the Aboriginal and Torres Strait Islander population and are frequently associated with social determinants of health. Portable sleep spaces that allow for a separate surface adjacent to close parental contact on the adult sleep surface have been used successfully in high risk populations in New Zealand (NZ), with infant mortality reductions observed (Cowan et al. 2013; Mitchell et al. 2016). Indigenous communities identified this area as a priority for investigation (Dodd 2012). This study aimed to determine: 1) safety and feasibility of the New Zealand PēpiPod® Program within Queensland Aboriginal and Torres Strait Islander families identified at higher risk for SUDI; 2) effectiveness of Pēpi-Pod® Program in achieving safer sleep environments for vulnerable infants as measured by use of a separate infant sleep surface in the context of shared sleep with identified risk. The Pēpi-Pod® Program comprised a portable sleep space, safe sleeping parent education and safety briefing; and a family commitment to share safe sleeping messages within social networks. The NZ Program (Cowan et al. 2013) was adapted for an Australian context and delivered to consenting Aboriginal and Torres Strait Islander families with identified SUDI risks, recruited through government and non government maternal child health services (n=11 services, 27 communities) who undertook PēpiPod® competency training, across Queensland’s metropolitan, regional and rural/remote areas. Parent questionnaires were administered face-to-face or by telephone within two weeks of receiving the Pēpi-Pod®; then monthly thereafter until Pēpi-Pod use ceased. Data collection continues with over 260 families recruited to date. Of 208 respondents with complete datasets at current time, all (100%) had SUDI risk factors; 76% (n=158) had ≥2 known risks including smoking during pregnancy (53%), LBW (15%), prematurity (14%), alcohol use (8%), recreational (3%) and prescription drugs (4%), anmf.org.au

crowded living conditions (35%). Most families intended to co-sleep (79%); shared infant sleep with a maternal smoker was common (41%). Responses to Pēpi-Pod related to three key themes: safety, convenience and portability. Safe sleeping awareness was raised within families (99%) and through community social networks (90%). Most families utilised the pod beyond infant age four weeks (71%); 14.5% beyond >17 weeks. Pēpi-Pod use reduced co-sleeping with known risk factors including: smoking, drug and alcohol use, multiple bed-sharers, prematurity, low birth weight. Health professional feedback relating to implementation indicated that the Pēpi-Pod® Program was feasible, accessible, sustainable, and built local workforce capacity with integration into current service models. This is the first evaluation of a safe sleep enabler in Australia. The Pēpi-Pod® Program was accepted and used appropriately by parents living in Queensland Indigenous communities and reduced the risk of SUDI in the context of co-sleeping with known risk factors. Program principles are applicable to mainstream maternal and child health services which care for vulnerable families. Innovative nursing and midwifery strategies which allow for co-sleeping benefits, respect cultural norms and infant care practices, whilst enabling safe sleep environments are necessary to further reduce SUDI.

Professor Jeanine Young, PhD is at the University of the Sunshine Coast and Sunshine Coast Hospital and Health Service in Brisbane. Mrs Karen Watson, PhD Candidate is at the University of the Sunshine Coast. Ms Leanne Craigie, BSc is at Children’s Health Qld Hospital and Health Service in Brisbane. Mrs Stephanie Cowan, MEd is at the Change for Our Children Ltd in Christchurch New Zealand. Dr Lauren Kearney, PhD is at the University. of the Sunshine Coast and Sunshine Coast Hospital and Health Service in Brisbane. Pepi-Pod Program Champions at our participating sites.

NATASHA AND BABY ZELICIAH

“THIS INNOVATIVE PROGRAM WILL REDUCE INFANT MORTALITY BY MOVING HEALTH SERVICE DELIVERY FROM SAFE SLEEPING ADVICE FOR BABIES TO SAFE SLEEP ACTION” Professor Jeanine Young

References Blair, P.S., Sidebotham, P., Pease, A., Fleming, P.J. 2014. Bed-sharing in the absence of hazardous circumstances: is there a risk of sudden infant death syndrome? An analysis from two case-control studies conducted in the UK. PLOS One. Sept 2014 9(9): e107799. Commission for Children and Young People and Child Guardian (CCYPCG). 2014. Annual Report Deaths of Children and Young People 2013-14. Brisbane: Queensland Government. Cowan, S., Bennett, S., Clarke, J., Pease, A. 2013. An evaluation of portable sleeping spaces for babies following the Christchurch earthquake of February 2011. Journal of Paediatrics and Child Health. 49(5):364-8. doi: 10.1111/jpc.12196. Epub 2013 Apr 11.

Dodd, J. 2012. Evaluation of the Department of Health Western Australian Operational Directive State-wide Co-sleeping/ Bed-sharing Policy for WA Health Hospitals and Health Services. Collaboration for Applied Research and Evaluation: Telethon Institute for Child Health Research under contract with the Department of Health, WA. Mitchell, E.A., Cowan, S., Tipene-Leach, D. 2016. The recent fall in post-perinatal mortality in New Zealand and the Safe Sleep Programme. Acta Paediatrica. 105(11):1312-1320. DOI: 10.1111/apa.13494. Venneman, M., Hense, H., Bajanowski, T., Blair, P., Comlojer, C., Moon, R., Kiechl-Kohlendorfer, U. 2012. Bedsharing and the risk of Sudden Infant Death Syndrome: Can we resolve the debate? The Journal of Pediatrics. 160(1): 44-48.

April 2017 Volume 24, No. 9  37


FOCUS Indigenous Health

ARE CLOSING THE GAP TARGETS BEING MET? By Linda Deravin, Karen Francis and Judith Anderson Long term strategies to improve the health and wellbeing of communities need to remain the central focus of government despite any changes in political power and political priorities. The Closing the Gap national agreement between Australian governments (2008) has been heralded as the solution to resolve the health disparities between Aboriginal and Torres Strait Islander people and non-Indigenous Australians. The question what outcomes have been achieved to date, is the focus of this short report. Initially six targets were identified in the ‘National partnership agreement on closing the gap in Indigenous health outcomes’ (Council of Australian Governments 2008). Annual reports produced by the federal government provide a veiled overview of progress that has been made. It is not however until all reports are reviewed and compared that the reader develops a picture of authentic outcomes (Australian Government 2010-2016). Success has been demonstrated in increasing the numbers of Aboriginal

IMPROVING THE MENTAL HEALTH OF EXPECTANT AND NEW INDIGENOUS MUMS A new study into improving mental health of expectant and new Aboriginal and Torres Strait Islander mums living in remote communities is being launched.

38  April 2017 Volume 24, No. 9

and Torres Strait Islander children accessing early childhood education, improving literacy and numeracy competency and numbers are increasing that demonstrate more Indigenous students are completing year 12 education. This is a good sign for the future as education is one acknowledged intervention that impacts positively on social determinants of health. Mortality rates in children under five have also improved which may be attributed to increase access to pre and post-natal care, and parenting programs within Indigenous communities. The target to reduce the gap between mortality rates between Aboriginal and Torres Straight Islander People and non-Indigenous people has reduced yet the gap remains significant at 10.6 years for males and 9.5 for females.

report (Australian Government 2016), declined which is an area of significant concern. Obviously more needs to be done in this area if the national agreement is to be upheld. What remains to be seen is whether the national agreement, which expired in June 2016 (Australian Indigenous HealthInfoNet 2015), to improve the health status of Aboriginal and Torres Strait Islander people will continue to remain a focus of government and healthcare providers. If not, is an alternative planned and if so will it align with the Closing the Gap initiative that has achieved positive outcomes? The authors declare no conflict of interest Linda Deravin is a Lecturer in Nursing at Charles Sturt University in the School of Nursing, Midwifery and Indigenous Health Professor Karen Francis is Adjunct Professor of Nursing at Charles Sturt University Dr Judith Anderson is Course Director/Senior Lecturer at Charles Sturt University in the School of Nursing, Midwifery and Indigenous Health

Employment rates for Indigenous people have, according to the last

The study will examine how Kimberley Mum’s mood scale (KMMS), a culturally appropriate mental health screening tool for pregnant and new mums, developed in the Kimberley, works in remote regions. The purpose of the study is to re-evaluate the KMMS in the larger Kimberley population, test for applicability in other remote regions and develop a locally appropriate version if necessary. The study entitled, Improving mental health screening for Aboriginal and Torres Strait Islander pregnant women and mothers of young children, is being undertaken by researchers from the Rural Clinical School of Western Australia, The University of Western Australia (UWA), Murdoch University and James Cook University, and working with the Kimberley Aboriginal Medical Services Inc., Western Australia Country Health Service and Apunipima Cape York Health Council.

Lead Investigator UWA Professor David Atkinson from the Clinical School of WA said it was estimated that around one quarter of Aboriginal and Torres Strait Islander women living in remote communities experienced high levels of anxiety and depression. “Perinatal mental health is a big issue for Aboriginal and Torres Strait Islander women, current approaches to screening are not working well and this funding is to support real world testing of the KMMS in WA and to adapt this screening approach to the Pilbara and Cape York.” Lead investigator Professor Rhonda Marriott, Murdoch University’s Professor of Aboriginal Health and Wellbeing said the project would have significant impact. “Research that improves Aboriginal Women’s perinatal health and empowers Aboriginal women and their families in the transitions to parenting will flow on to have far reaching effects in society.”

References Australian Government. 2010. Closing the gap Prime Minister’s report 2010. Canberra: Commonwealth Government of Australia. Retrieved from http://generationone. org.au/uploads/assets/ closingthegap2010.pdf Australian Government. 2011. Closing the gap Prime Minister’s report 2011. Canberra: Commonwealth of Australia Australian Government. 2012. Closing the gap Prime Ministers report 2012. Commonwealth of Australia. Retrieved from www.iaha. com.au/IAHA%20 Documents/000173_ austgovreportglos ingthegap.pdf Australian Government. 2013. Closing the gap Prime Minsters report 2013. Retrieved from www.dss.gov. au/sites/default/files/ documents/02_ 2013/00313-ctg-report_ fa1.pdf Australian Government. 2014. Closing the gap Prime Minister’s report 2014. Canberra: Commonwealth of Australia. Retrieved from www.dpmc.gov. au/sites/default/files/ publications/closing_ the_gap_2014.pdf Australian Government. 2015. Closing the gap Prime Ministers report 2015. Commonwealth of Australia. Retrieved from www.dpmc.gov. au/sites/default/files/ publications/Closing_ the_Gap_2015_Report. pdf Australian Government. 2016. Closing the gap Prime Minister’s report 2016. Canberra. Retrieved from http:// closingthegap.dpmc. gov.au/assets/pdfs/ closing_the_gap_ report_2016.pdf Australian Indigenous HealthInfoNet. 2015. What is the history of Closing the gap? Retrieved from www. healthinfonet.ecu.edu. au/closing-the-gap/keyfacts/what-is-the-historyof-closing-the-gap Council of Australian Governments. 2008. National partnership agreement on closing the gap in Indigenous health outcomes. Australian Government. Retrieved from www. federalfinancialrelations. gov.au/content/npa/ health_indigenous/ ctg-health-outcomes/ national_partnership.pdf

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Indigenous Health FOCUS

INDIGENOUS NURSING WORKFORCE, TO ACHIEVE EQUALITY IN HEALTHCARE SERVICES By Carol Piercey and Melanie Robinson Inequities and poor health outcomes of Aboriginal people in Western Australia are well documented. Indigenous Australians continue to experience poorer health and higher death rates than non-Indigenous Australians (AIHW 2008). They experience the highest levels of chronic diseases compared to other cultural groups in Australia. It has been suggested that there are a variety of reasons underlying this problem. One such reason is the lack of culturally secure healthcare services. It has been proposed that employing an Indigenous nursing workforce, could achieve equality in healthcare services. The rationale for this proposal is that registered nurses can align their clinical skills and knowledge with their cultural skills and knowledge (Goold & Usher 2006; Peiris et al. 2008; Usher et al. 2005; West et al. 2010; West et al. 2013). Aboriginal registered nurses can provide cultural understanding and can communicate more effectively with Aboriginal patients and families. They can often speak the language, translating diagnosis and treatment into English and linking individuals with services in the community. Indigenous nurses can also work in partnership with their non-Indigenous colleagues, in role modelling culturally safe nursing care.

UNFORTUNATELY, THE NUMBER OF ABORIGINAL AND TORRES STRAIT ISLANDER REGISTERED NURSES REMAINS LOW COMPARED TO THEIR NON-INDIGENOUS COUNTERPARTS IN AUSTRALIAN UNIVERSITIES. IN 2014, THERE WERE 3,036 NURSES AND MIDWIVES EMPLOYED IN AUSTRALIA WHO IDENTIFIED AS AN ABORIGINAL OR TORRES STRAIT ISLANDER. Unfortunately, the number of Aboriginal and Torres Strait Islander registered nurses remains low compared to their non-Indigenous counterparts in Australian universities. In 2014, there were 3,036 nurses and midwives employed in Australia who identified as an Aboriginal or Torres Strait Islander. This represents 1% of all employed nurses and midwives who acknowledged their Indigenous status. In Western Australia the figure is 0.8% (AIHW 2014). Significantly, although schools of nursing have a large number of Indigenous students enrolling, completion rates are inconsistent with the commencement rates (West et al. 2013). Nursing students continue to struggle to achieve success. This problem is often associated with family, finance and academia. A study currently underway in Western Australia is examining the experiences of third year Aboriginal nursing students and newly graduated Aboriginal nurses, to identify commonalties between their experiences particularly what enabled or inhibited them to complete their studies. It is anticipated that the researcher, who is an Aboriginal woman, will be able to investigate these experiences from an Aboriginal person’s perspective and translate them into recommendations for supporting Aboriginal students to complete their studies. Dr Carol Piercey is Senior Lecturer in the School of Nursing at The University Notre Dame in WA Melanie Robinson is a Registered Nurse anmf.org.au

References Australian Institute of Health and Welfare (AIHW) 2014, ‘Australia’s health 2014’, Australia’s health series no. 14. Cat. no. AUS 178, AIHW, Canberra. Goold, S.S & Usher, K. 2006. Meeting the health needs of Indigenous people: How is nursing education meeting the challenge. Contemporary Nurse. 22, (2), 288-293. Peiris, D., Brown, A. & Cass, A. 2008. Addressing inequities in access to quality health care for indigenous people. Canadian Medical Association Journal. 179 (10), 985-986. Usher, K., Miller, M., Turale, S. & Goold, S. 2005. Meeting the challenges of recruitment and retention of Indigenous people in nursing: outcomes of the Indigenous Nurse Education Working Group Meeting. Collegian. 12 (3), 27- 31. West, R., Usher, K. & Foster, K. 2010. Increased number of Australian Indigenous nurses would make a significant contribution to ‘closing the gap’ in Indigenous health: What is getting in the way. Contemporary Nurse. 36 (1-2), 121-130. West, R., Usher, K., Buettner, P.G., Foster, K. & Stewart, L. 2013. Indigenous Australians participation in preregistration tertiary nursing courses: A mixed methods study. Contemporary Nurse. 46 (1), 123-134.


FOCUS Indigenous Health

COLLABORATION AND CULTURAL SAFETY: SAFE SLEEP SPACE ALTERNATIVES WITH ABORIGINAL FAMILIES By Julian Grant, Janiene Deverix, Casey Nottage, Nina Sivertsen, Nicola Spurrier, Alice Steeb and Deanna Stuart-Butler Despite a marked reduction in Aboriginal and Torres Strait Islander infant deaths from 1998 to 2012 (AIHW 2015) Aboriginal and Torres Strait Islander infants remain over-represented in sudden and unexpected infant death rates. Co-sleeping has been recognised as a contributing factor in many of these deaths along with other complex and hazardous circumstances (Mitchell & Blair 2012; Gill 2015). Despite bed-sharing and co-sleeping being a cultural norm in many Indigenous communities (Young et al. 2013), the current South Australian Safe Infant Sleeping Standards state that ‘there is currently no evidence…. that clearly shows that parents/caregivers can safely share a sleep surface with an infant whether this is by modifying the bedding or their own behaviour’ (Government of South Australia 2016). Aboriginal Cultural Consultants (ACCs) working in the South Australian Child and Family Health Service (CaFHS) identified the Pēpipod Program from New Zealand as a potentially culturally acceptable way to enhance the safety of Aboriginal infants during sleep. Importantly, this program includes relationshipbased family education in addition to provision of a robust plastic ‘pod’ (Change for our Children 2017). The pod provides infants with their own safe sleep surface which can be placed on the parent or caregiver’s bed during sleep. The use of portable sleep spaces to reduce the risk of SUDI for families with identified risk factors has been previously reported in New Zealand and more recently in Australia (Cowan 2015; Young et al. 2013; Young 2014; Watson et al. 2014; Mitchell 2014). A working group was established with representatives from CaFHS, the Women and Children’s Health Network (WCHN), SA Health Public Health Services, Kidsafe SA, Aboriginal Health Council SA, and SIDS and Kids SA. A pilot study is now being undertaken as a joint project between the WCHN, Flinders University and the SA Department for Health and Ageing. The study will assess the cultural safety of the Pēpi-pod Program and the ability to embed the program into existing models of care in the Adelaide metropolitan context. The pilot

40  April 2017 Volume 24, No. 9

involves existing Aboriginal Maternal and Infant Care (AMIC) workers, ACCs and Maternal, Child and Family Health Nurses (MCaFHNs). It provides a unique opportunity to strengthen partnerships between these individuals and organisations, and Aboriginal families in the community.

DESPITE BED-SHARING AND CO-SLEEPING BEING A CULTURAL NORM IN MANY INDIGENOUS COMMUNITIES (YOUNG ET AL. 2013), THE CURRENT SOUTH AUSTRALIAN SAFE INFANT SLEEPING STANDARDS STATE THAT ‘THERE IS CURRENTLY NO EVIDENCE…. THAT CLEARLY SHOWS THAT PARENTS/ CAREGIVERS CAN SAFELY SHARE A SLEEP SURFACE WITH AN INFANT WHETHER THIS IS BY MODIFYING THE BEDDING OR THEIR OWN BEHAVIOUR’ (GOVERNMENT OF SOUTH AUSTRALIA 2016).

The pilot will recruit 10 families who will be provided with safe sleep education and a Pēpi-pod in the antenatal period with joint education from the ACC and AMIC workers. Families will receive regular followup postnatally and be asked to take photographs of their Pēpi-pod use and other sleep arrangements. The research team will interview families at pre and post intervals to yarn about their photos and perceptions of the safe sleep education and Pēpi-pods. Focus group data will also be collected from all health and care professionals and a community advisory group established within the research project. The results will assist our understanding of whether the

Pēpi-pod program is a culturally safe approach for Aboriginal families living in South Australia. For more information please contact julian.grant@flinders.edu.au Associate Professor Julian Grant is in the Faculty of Medicine, Nursing and Health Sciences in the School of Nursing and Midwifery at Flinders University Ms Janiene Deverix is Manager Aboriginal Services, Early Child Parenting Service, Child and Family Health Service at the Women’s Children’s Health Network Dr Casey Nottage is Public Health Medicine Registrar, Public Health Partnerships Branch in the Department for Health and Ageing, Government of South Australia Dr Nina Sivertsen is in the Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery at Flinders University Associate Professor Nicola Spurrier is Paediatrician and Public Health Physician, Public Health Services, SA Health, Public Health Services in the Department for Health and Ageing Ms Alice Steeb is Clinical Practice Consultant, Child and Family Health Service at the Women’s and Children’s Health Network Deanna Stuart-Butler is Manager of Aboriginal Family Birthing Program, Aboriginal Health Division, Acute Services at Women’s and Children’s Health Network

References Australian Institute of Health and Welfare (AIHW). 2015. The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples Cat. no. IHW 147. Canberra: AIHW. Change for our Children. 2017 Pepi-pod sleep space program, www. changeforourchildren.nz/ pepi_pod_programme Accessed February 2017 Cowan, S. 2015. Their first 500 sleeps – Pēpipod Report: 2012-2014, Change for our children limited 2015, ISBN 978-1-877512-14-8 Government of South Australia. 2016.Safe Infant Sleeping Standards Policy Directive, www.sahealth. sa.gov.au/wps/wcm/ connect/Public+Content/ SA+Health+Internet/ Clinical+resources/ Clinical+topicsChild +healthSafe+Infant+ Sleeping+ Standards Accessed February 2017 Change for our Children. 2017. Pepi-pod sleep space program, www. changeforourchildren.nz/ pepi_pod_programme Accessed February 2017 Gill, J.R. 2015. Co-sleeping and suffocation. Forensic Science, Medicine, and Pathology, 11(2): 279-280 Mitchell, E. & Blair, P.S. 2012. SIDS prevention: 3000 lives saved but we can do better. NZ Medical Journal, 125 (1359): 50-57. Watson, K., Young, J., Craigie, L., Cowan, S., & Kearney, L. 2014. Acceptability and feasibility of a safe infant sleep enabler for Aboriginal and Torres Strait Islander families of high risk for Sudden Infant Death: Pilot of the Pēpi-pod Program. In 2014 International Conference on Stillbirth, SIDS and Baby Survival Program and Abstracts Book. First Candle. Young, J., Craigie, L., Watson, K., Kearney, L., Cowan, S., & Barnes, M. 2013. Promoting safety and supporting culturally valued infant care: the Pēpi-pod Program, proceedings of the 13th National Rural Health Conference: People, Places, Possibilites…, Darwin, Australia 24-27 May 2015 Young, J. 2014. Safe sleep advice to safe sleep action: Pilot of the Pēpi-Pod Program in Indigenous communities. Sigma Theta Tau International’s 25th International Nursing Research Congress

anmf.org.au


Indigenous Health FOCUS

CHALLENGES TO INDIGENOUS HEALTH CURRICULUM DESIGN – BRINGING THE ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH CURRICULUM FRAMEWORK TO LIFE By Nina Sivertsen, Monica Lawrence and Dennis McDermott While it is our responsibility to produce culturally safe graduates with a nuanced grasp of Aboriginal and Torres Strait Islander health needs, there are central challenges in curriculum writing for Indigenous health today. These include pressure to: work ‘less expensively’; to cater for much larger student cohorts in smaller time-periods to fit around restricted placement availability; and to deliver a considerably higher percentage of teaching online. The authors have designed an Indigenous health curriculum for first year nursing students as a joint project between the Poche Centre for Indigenous Health and WellBeing and the School of Nursing and Midwifery at Flinders University. Given cultural safety is a core element of good Indigenous health outcomes, it is imperative that both curriculum and pedagogy is informed by Indigenous perspectives. We also have a statutory responsibility to meet accreditation body standards. Additionally, institutions have a responsibility to support students to navigate successfully a

CALL FOR INDIGENOUS SKILLS TO ASSIST PRIMARY HEALTH NETWORKS

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journey of engagement with, and incorporation of, a challenging curriculum. Considering the increasing casualisation of nursing school teaching staff, we face a particular challenge in attempting to foster both an aligned curriculum and continuing student engagement. To facilitate a necessary transformative (un)learning, we need motivated, skilled teaching staff ready to teach in the complex space across cultures, racism and colonisation. Such teaching is not an easy task and educators need a firm grounding in the effects of colonisation on Aboriginal and Torres Strait Islander peoples. With integrated curricula, Indigenous health and cultural safety may be presented – not by content experts, but, rather, by the general cohort of teaching staff. Moreover, particular aspects of Indigenous health or cultural safety, in practice, are likely to be encountered within general nursing topics (subjects), given the burden of disease borne by Indigenous Australians. Although, there is then an expectation of staff to facilitate Indigenous health and cultural safety across the nursing curriculum, yet there is little professional development available for staff to ensure such readiness. Core subject status, for Indigenous health and cultural safety, is mandated by accreditation requirements, but only becomes a reality where university leadership accepts the mandate, along

Primary Health Networks are being encouraged to consider the skills of the National Aboriginal Controlled Community Health Organisation and Aboriginal Community Controlled Health groups to assist delivering innovative health programs to Close the Gap in health outcomes. Broadening the range of member organisations involved in the Primary Health Networks, and ensuring an appropriate range of skills on their boards, would help ensure the specific needs of the diverse groups in our community are considered when commissioning health services the Minister for Indigenous Health, Ken Wyatt said. “Primary Health Networks across the country

with the role of strong Indigenous representation in design, development and implementation. At Flinders, such arises from the imperative of the Flinders Indigenous Engagement Framework and the ongoing involvement of the Poche Centre for Indigenous Health and Well-Being. The recently published Aboriginal and Torres Strait Islander Health Curriculum Framework supports higher education providers to implement Aboriginal and Torres Strait Islander health curricula. Such support assists academics to decolonise nursing practice, but requires augmentation - by measures to build criticality and combat stereotyping and unconscious bias - to achieve full pedagogical effectiveness, particularly in the face of teaching constraints. This project has found a strengthsbased approach and strong collaborations are key drivers to the success of a core topic’s development and implementation. This focus on positive aspects of Indigenous health’s success stories has resulted in innovation around assessments and classroom engagement, particularly through using team-based student assessments and weekly preparation in Wikis, personal blogs and a deconstruction exercise. For more information about the project, please contact nina. sivertsen@flinders.edu.au

DR NINA SIVERTSEN

Dr Nina Sivertsen is a Lecturer in Nursing in the Faculty of Medicine, Nursing and Health Sciences in the School of Nursing and Midwifery Ms Monica Lawrence is Senior Lecturer and Professor Dennis McDermott is Director at the Poche Centre for Indigenous Health and WellBeing All are at Flinders University in South Australia

are charged with increasing the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes, and improving coordination of care services to ensure patients receive the right care, in the right place, at the right time. “Improving the health of Aboriginal and Torres Strait Islander peoples is a key priority for all Primary Health Networks. They should consider whether their current member organisaions and boards have the appropriate mix of skills, knowledge, experience and capabilities to deliver the best health outcomes and if this could be improved.”

April 2017 Volume 24, No. 9  41


FOCUS Indigenous Health by 2031. In Australia, Aboriginal and Torres Strait Islander clients commonly access healthcare for treatment of chronic diseases such as diabetes, heart and renal disease (AIHW 2010). The incidence of which is marginally higher in Indigenous populations often requiring this population to be treated with prescribed pharmaceuticals, sometimes starting at a younger age and continuing for longer periods of time (NITV, 2016).

HOW CAN SCHOOLS OF NURSING AND MIDWIFERY PREPARE THEIR GRADUATES TO ENCOURAGE MEDICATION ADHERENCE FOR AUSTRALIAN ABORIGINAL AND TORRES STRAIT ISLANDER CLIENTS? By Lynne Stuart and Brian Sengstock Research undertaken in mainstream Australian studies show that the overall rate of medication non-adherence has been reported to be high, for Aboriginal and Torres Strait Islander peoples of Australia leading to adverse and critical health outcomes (AIHW 2010). These poor statistics, and associated poor health outcomes, have their roots in historical and contemporary healthcare which discounts traditional healing practices, historical mistreatment of Indigenous people including pharmacological trials without informed consent, poor treatment of Indigenous people by health professionals, and poor identification of Indigenous clients (Lovett 2014). These factors have resulted in a lack of trust in white man’s medicine, which is exacerbated by the high admissions and death rates of Aboriginal and Torres Strait Islander peoples in Australian healthcare facilities. This cycle continues with the use of culturally inappropriate communication from health professionals where Aboriginal and Torres Strait Islander clients are ‘shamed’ and thus do not ask for important information about their medication and continues to result in poor medication literacy in Indigenous peoples. This is due to Indigenous peoples of Australia still 42  April 2017 Volume 24, No. 9

being subjected to the ‘culture of blame’ where the person is ‘blamed’ for their poor health, and when coupled with institutional racism, this further exacerbates their already poor health status (Barclay and Wilson 2014; Larson et al. 2007). A recent television news report highlighted the attention given to medication safety for older people, children, and pregnant women in Australia, however, Indigenous Australians were not included (NITV 2016). This makes it imperative for nurses and midwives, as the largest health workforce engaging with Indigenous clients, to be educated about the cultural barriers specific to this population in relation to medication adherence, and to ensure that they are provided with the knowledge to proceed and promote culturally responsive healthcare ensuring safe medication practices (PSA 2014). One target area for ‘Close the Gap’ in 2017 that is not currently on track is closing the gap in life expectancy

ONE OF THE CURRENT ISSUES THAT ESCALATES THE INCIDENCE OF CHRONIC DISEASE IN INDIGENOUS POPULATIONS IS NON-ADHERENCE TO MEDICATION REGIMES.

To highlight the seriousness of this issue, the incidence of diabetes has been cited by the World Health Organization (WHO), with rates as high as 26% for Australian Aboriginal and Torres Strait Islander people, which is six times higher than the general Australian population (WHO 2007). One of the current issues that escalates the incidence of chronic disease in Indigenous populations is non-adherence to medication regimes. This means that if adherence to medication regimes to treat chronic conditions are intermittent or absent, the clients’ disease symptoms can worsen, causing additional hospital admissions and longer hospital stays, resulting in further stress on the affected clients, their families and communities. To this end, nursing and midwifery students need to be educated about working with their Aboriginal and Torres Strait Islander clients with chronic diseases, in ways that can improve medication adherence, and therefore support Close the Gap targets by promoting Indigenous peoples and their communities’ overall health and wellbeing. Lynne Stuart, (Mandandanji) is Senior Lecturer in Nursing, School of Nursing, Midwifery and Paramedics at the University of the Sunshine Coast. Dr Brian Sengstock is Lecturer in Paramedicine, School of Biomedical Science at Charles Sturt University.

PHOTO: ELISE DERWIN

References Australian Institute of Health and Welfare (AIHW). 2010. The health and welfare of Australia’s Aboriginal and Torres Strait Islander people – an overview. Canberra. www. aihw.gov.au/WorkArea/ DownloadAssett.aspx? id¼ 10737418955 (Acc essed 17 February 2017) Barclay, L., Wilson, S. 2014. Can a white nurse get it? ‘Reflexive practice’ and the non-Indigenous clinician/researcher working with Aboriginal people. Rural and Remote Health (Internet) 2014; 14: 2679. www.rrh.org. au/articles/subviewnew. asp?ArticleID=2679 (Accessed 17 February 2017) Larson, A., Gillies, M., Howard, P & Coffin, J. 2007. It’s enough to make you sick: the impact of racism on the health of Aboriginal Australians, Australian and New Zealand Journal of Public Health, vol 31, pp. 322-329. Lovett, R. 2014. A history of health services for Aboriginal and Torres Strait Islander people, YATDJULIGIN, Aboriginal and Torres Strait Islander Nursing & Midwifery Care, edited by Odette Best & Bronwyn Fredericks, Cambridge University Press, Chapter 2, pp. 31-48. National Indigenous Television (NITV) News 18 January 2016. Absence of data on safety of medications for Indigenous community putting health at risk. www.sbs.com.au/nitv/nitvnews/article/2016/01/18/ absence-data-safetymedications-indigenouscommunity-puttinghealth-risk (Accessed 17 February 2017) Pharmaceutical Society of Australia (PSA). 2014. Guide to providing pharmacy services to Aboriginal and Torres Strait Islander people. Canberra. www.psa. org.au/wn-content/ uploads/Guide-toprovidingpharmacyservices-to-Aboriginaland-Torres-StraitIslander-people-2014.pdf (accessed 17 February 2017) Who Health Organization. 2007. Health of Indigenous peoples, Fact sheet No.326, October 2007. Cited from Diabetes in Indigenous Populations, Anthony J. Hanley, Medscape Today. www.who.int/ mediacentre/factsheets/ fs326/en/ (Accessed 17 February 2017)

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Indigenous Health FOCUS

USING MAPPING TOOLS TO IMPROVE ABORIGINAL PATIENT JOURNEYS By Janet Kelly

Unique communication, coordination and continuity of care challenges exist for Aboriginal patients and for staff when patients travel across multiple geographic and healthcare locations (Kelly et al. 2016a).

Nurses and midwives play a central role in ensuring effective healthcare for Aboriginal patients in urban, rural and remote locations. However, at times they feel underequipped to fully support Aboriginal patients and their families with the skills and knowledge and resources available (Dwyer et al 2014).

The Managing Two Worlds Together Project (MTWT), funded by SA Health and the Lowitja Institute (2008–2015) brought together perspectives of Aboriginal patients, family members and multidisciplinary staff from primary care and hospital sites across South Australia and Northern Territory. Nurses and midwives worked closely with researchers, Aboriginal and allied health staff to develop a set of patient journey mapping tools and case studies that could accurately record the entire patient journey from home to hospital to home. Used for quality improvement and education, these case studies were compared to standards of care to identify service gaps, effective strategies and actions for improvement (Kelly et al. 2016a). Nurses and midwives in renal, cardiac and maternity clinical practice found that the mapping process enabled thv em to better understand the complexities of care and their own role in the entire patient journey, and to identify issues before they led to serious adverse outcomes. Case studies were utilised as site specific resources for reflective practice, service review, and audit data (Kelly et al. 2016a). Nursing and midwifery educators incorporated the mapping tools and case studies (which are freely available on the Managing Two Worlds Together website) into sessions, workshops and assignments. A clinical and cultural framework was created to identify nurses’ progress along a continuum of skill level clinically from beginner to competent to expert, and culturally from awareness, to competency and safety (Kelly et al. 2016b). The next projects will focus on wider implementation and evaluation of the tools, case studies and framework, with emphasis on both the process of implementation, and the effectiveness of these innovations in improving care in a range of healthcare sites (Harvey and Kitson 2015).

ONE ABORIGINAL WOMAN’S RENAL PATIENT JOURNEY

OUM’s innovative teaching style is fantastic and exciting. Truly foreword thinking, OUM allows the student to benefit from both local and international resources. Brandy Wehinger, RN OUM Class of 2015

Acknowledgements: We would like to acknowledge the many Aboriginal patients and their families, nurses, midwives, Aboriginal health and other health professionals who shared their experiences and worked together to develop the mapping tools and clinical and cultural framework.

References Dwyer, J., Willis, E. & Kelly. J. 2014. Hospitals caring for rural Aboriginal patients: holding response and denial. Australian Health Review. 38: 546-551. Harvey, G. and Kitson, A. 2015. Implementing evidence-based practice in health care, London: Routledge. Kelly, J., Dwyer, J., Mackean, T., O’Donnell, K. & Willis, E. 2016. Coproducing Aboriginal patient journey mapping tools for improved quality and coordination of care. Australian Journal of Primary Health. Open access: pp. A-G. Kelly, J., Wilden, C., Chamney, M., Martin, G., Herman, K. & Russell, C. 2016. Improving cultural and clinical competency and safety of renal nurse education. Renal Society of Australasia Journal. 12(3):106-112.

Janet Kelly is a Research Fellow and Course Coordinator at the University of Adelaide and affiliated with Health Care Management, Flinders University and Wardliparinga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute

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FOCUS Indigenous Health

INCORPORATING THE NURSING AND MIDWIFERY ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH CURRICULUM FRAMEWORK INTO A BN PROGRAM By Rebekkah Middleton, Moira Stephens and Maria Mackay Preparing nursing students for authentic person-centred practice demands an awareness and understanding of Australian culture and history and the impact of these things on the health of Aboriginal and Torres Strait Islander peoples. As academics, who play a large part in the preparation of these students, it is imperative that they are authentically engaged with and reflect on the challenges to Aboriginal and Torres Strait Islander people. We as nurses and academics need to open our minds and hearts to hear the stories of the community and our Aboriginal and Torres Strait Islander students. We need to learn in and from practice. Taking ourselves out of our comfort zone will help us to consider the issue of white privilege and how this impacts on us individually, as a profession and as academic staff. It is important to have the courage to do this as we have influence on the next generation of nurses. Recently we attended the CATSINaM Nursing and Midwifery Aboriginal and Torres Strait Islander Health Curriculum Framework workshop. This workshop was designed to increase awareness for academics and challenge us to consider how we structure a curriculum that effectively prepares students to provide culturally safe health services to

Aboriginal and Torres Strait Islander peoples by developing cultural capabilities during their student years. Attending the workshop has served to highlight a number of considerations for our university as we prepare a new curriculum. We have been reflecting on the implications for each of us personally and professionally and have shared some of our key learning below with critical questions that emerged for each of us:

how we use this knowledge and apply it to people who may have a different culture. • How do we as academic staff

ensure we are culturally safe within all aspects of our own practice? • Do I have the flexibility in my approach to do this? • Do I know my own culture and what it means to me? • What about my professional work culture? 3. How do I work with students to reveal the habitus of white privilege? When considering Aboriginal and Torres Strait Islander people’s culture, the appropriate approach with students should be to explore and reflect upon cultural safety initially followed by context, with an overlay of Aboriginal and Torres Strait Islander health throughout. • Learning outcomes should

• How can I communicate with

be reflective of this process throughout a curriculum – novice, intermediate and entry to practice, developing complexity throughout a degree to increase understanding and application. • Using the CATSINaM Nursing and Midwifery Aboriginal and Torres Strait Islander Health Curriculum Framework will facilitate progression and integration into curriculum. • How can I develop Aboriginal and non-Aboriginal partnerships to cocreate curriculum content?

2. Cultural safety is about examining our own culture and then

These are some of our key learnings that each of us will be taking into the development of a new curriculum. We would challenge readers to consider the implications for yourself in your practice and in the approaches taken to cultural safety. Consider how would you create consciousness raising of the issues facing Aboriginal and Torres Strait Islander people who are undertaking undergraduate nursing studies in your equational or your healthcare facility.

1. The receiver of services is the one who determines if care is culturally safe or not. people so I am informed and know this? • How can I encourage students to do the same? • How can I shift the focus of control from the healthcare practitioner to the receiver of care as the judge? • This is the essence of personcentredness as a culture – how can I enable students to see the links?

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Rebekkah Middleton and Moira Stephens are Senior Lecturers and Maria Mackay is Senior Lecturer and Director of Clinical Learning. All are in the School of Nursing at the University of Wollongong


WORKING LIFE

HOW AN EVERYDAY NURSE CRACKED COMEDY By Robert Fedele British nurse Georgie Carroll moved to Australia seeking adventure and inadvertently discovered a hidden talent for making people laugh. In 2009 British nurse Georgie Carroll packed up her bags, and with family in tow, moved to Australia. “I came for adventure. I’d had the children. I got a husband. I was a nurse. And I thought ‘Is this it forever now?’” Settling in Adelaide, Georgie began working as an intensive care nurse at one of the state’s major hospitals. She had worked as a nurse for a decade back in Manchester in England and quickly eased into her new work routine. A year later she stumbled upon comedy after taking the plunge and venturing along to an Open Mic Night to perform stand-up for the first time.

“ADVERSITY JUST MAKES HUMOUR DOESN’T IT? TRAGEDY PLUS SAD, EQUALS COMEDY. AND THERE’S A FAIR BIT OF THAT IN NURSES. IF WE DIDN’T LAUGH WE’D GO MAD.”

“I just watched some comedy and it was awful and I thought I’m funnier than that,” she quips when asked what sparked her motivation. On the night, Georgie struck a chord with the audience and soon had her believing she could make a living out of comedy. “I came here to nurse and then I ended up doing comedy,” she recalls. “I love that feeling of people laughing at you. I never really looked back.” Georgie’s rise to prominence on the comedy circuit now sees her perform at festivals around the world, including the Edinburgh Comedy Festival and the Melbourne International Comedy Festival.She normally writes a show and performs it over three years while juggling shift work as an Emergency Department nurse, and raising children and running a family. Most of her comedy is based on storytelling and anecdotes. anmf.org.au

“All I’m doing is talking about the stuff that we talk about on night-shift. The stuff that we’re laughing about at four in the morning. That’s what I’m talking about. “Most of my humour comes from work as a nurse or my kids. So I do have another brand to my comedy where I talk about family and just general things.” Georgie says the nursing profession and overarching health sector provides a great backdrop of inspiration to create comedy. “It’s a human thing to care. It’s a human thing to laugh at adversity. Everybody’s got somebody in their family that’s struggling with something health wise. “Adversity just makes humour doesn’t it? Tragedy plus sad, equals comedy. And there’s a fair bit of that in nurses. If we didn’t laugh we’d go mad.” Fortunately, Georgie’s nursing colleagues have now become both a sounding board and invaluable resource. “Pretty much every shift starts with a nurse trying to tell me a funny story that’s happened to them. So then I have to work out confidentiality wise where I can take that story.” Georgie unveiled her latest show, Gauze & Affect, at the recent Adelaide Fringe Festival, and will perform it at the Melbourne International Comedy Festival and Sydney Comedy Festival in coming months. “I like to make it look easy but there’s a fair bit of cramming for an exam. You want to make sure everybody has a good night so on the

run up to it you get fairly focused and tetchy and then it’s all just worth it on the night. “I get total dopamine, serotonin highs when I’m on stage. I’ve got arthritis in my knees and they just don’t hurt when I’m on there. It’s a crazy good feeling.” Still, Georgie admits the lifestyle of a comic isn’t always fun and games. “I miss nursing when I’m not in it, when I’m doing comedy. Comedy is quite lonely and competitive whereas nursing is teamwork and anything but lonely. You’re part of everything.” Reflecting on her accidental rise to comic star, Georgie, who took up comedy at age 36, says she is still pinching herself over the lucky turn of events. “Nursing has been brilliant to have alongside because the hospital never shuts. Even when I’m touring I’ll do an early shift at the hospital and then work a gig at night. The two gigs work very well together.” Yet despite her venture into comedy paying dividends, Georgie still plans to continue nursing for as long as she can and says she will always remain in roles caring for people. “It’s in me. I’m as much a nurse as I am a comic. I couldn’t live without it really.” Nurse Georgie Carroll – Gauze & Affect Playing at Fort Delta during the Melbourne International Comedy Festival (MICF) from 29 March to 1 April, and 1-4 April. Tickets: $17-25 www.comedyfestival.com.au April 2017 Volume 24, No. 9  45


CALENDAR

APRIL International Sexual Assault Awareness Month www.nsvrc.org/saam/sexual-assaultawareness-month World Autism Awareness Day (Go Blue for Autism) 2 April. www.goblueforautism.com.au/ 15th World Congress on Public Health Voices Vision   Action 3-7 April, Melbourne Convention and Exhibition Centre. www.wcph2017.com/

ANMF Vic Branch Health and Environmental Sustainability Conference 28 April, Melbourne Convention and Exhibition Centre, Vic. http://bit.ly/ANMFevents 14th World Organisation of Family Doctors (WONCA) World Rural Health Conference 29 April–2 May, Cairns Convention Centre, North Qld. www.aworldofruralhealth.org.au/

MAY

International Nurses Day Nurses: A Voice to Lead, Achieving the Sustainable Development Goals 12 May. www.icn.ch/ World Hypertension Day 17 May. http://ish-world.com/public/ world-hypertension-day.htm Australian College of Critical Care Nurses Paediatric Conference Basics to bizarre 19 May, Mantra Bell City, Preston, VIC. www.acccn.com.au/

7th Biennial Leaders in Indigenous Medical Education (LIME) Network Conference The Future of Indigenous Health Education: Leadership, Collaboration, Curriculum 4-7 April, Melbourne. www.limenetwork.net.au

Prader-Willi Syndrome awareness month http://praderwilli.org.au/

ANMF Vic Branch Undergraduate Student Nurse and Midwife Study Day 19 May, Melbourne Town Hall, Vic. http://bit.ly/ANMFevents

Kiss Goodbye to MS Day 1 May. Wear red lipstick and help kiss goodbye to MS. www.kissgoodbyetoms.org

Helping Older People to Avoid Hospital Admissions 25-26 May, Sydney NSW. www.changechampions.com.au

World Health Day 7 April. www.who.int/campaigns/worldhealth-day/2017/en/

Lung Health Promotion Centre at The Alfred Respiratory Course (Modules A & B) 1–4 May Respiratory Course (Module A) 1–2 May Respiratory Course (Module B) 3–4 May Asthma Update 26 May P: (03) 9076 2382 E: lunghealth@alfred.org.au

National Sorry Day 26 May. www.reconciliation.org.au/ news/national-sorry-day-an-importantpart-of-healing/

Australian Pain Society 37th Annual Scientific Meeting Expanding Horizons 9-12 April, Adelaide Convention Centre, SA. www.dcconferences.com.au/aps2017 Lung Health Promotion Centre at The Alfred Managing COPD 20–21 April Spirometry Principles & Practice 27-28 April P: (03) 9076 2382 E: lunghealth@alfred.org.au International Mother Earth Day 22 April. www.un.org/en/events/ motherearthday/ ANZAC Day 25 April 14th National Rural Health Conference A World of Rural Health in Australia... 26-29 April, Cairns Convention Centre, North Qld. www.ruralhealth.org.au/14nrhc/ ANMF Vic Branch Nurses and Midwives Wellness Conference 27 April, Melbourne Convention and Exhibition Centre, Vic. http://bit.ly/ANMFevents Australian Telehealth Conference Beyond telehealth to the world of virtual care 27-28 April, Rydges on Swanston in Melbourne. www.hisa.org.au/atc/

NETWORK The Queen Elizabeth Hospital, South Australia, Group 3/86 reunion Please contact Justine Grant (nee Reddaway) regarding a reunion to be held later this year. E: justine.grant@sa.gov.au

46  April 2017 Volume 24, No. 9

Star Wars Day 4 May. www.starwars.com/may-the-4th International Day of the Midwife 5 May. www.internationalmidwives.org/ Australian Primary Health Care Nurses Association (APNA) National Conference State of the Art 4-6 May, Hobart. http://apnaconference.asn.au/

Gastroenterological Nurses College of Australia National Conference 27-28 May, SeaWorld Conference Centre, Gold Coast, Qld. www.genca.org/ International Council of Nurses (ICN) Student Assembly 27 May, Barcelona, Spain. https:// inscripcion.icnbarcelona2017.com International Council of Nurses (ICN) Congress Nurses at the forefront transforming care 27 May-1 June, Barcelona, Spain. http://www.icnbarcelona2017.com/en/ National Reconciliation Week 27 May-3 June. http://www. reconciliation.org.au/nrw/

Australian College of Dermatology (ACD) Annual Scientific Meeting 6-9 May, International Convention Centre, Darling Harbour NSW. www.adna.org.au/

JUNE

World Ovarian Cancer Day 8 May. http://ovariancancerday.org/

Mabo Day 3 June. Commemorate the anniversary of the 1992 High Court decision in the case brought by Eddie Mabo and others which recognised the existence in Australia of native title rights. The historic court decision buried the legal description of early Australia as ‘terra nullius’, or ‘no man’s land’ www.aboriginalheritage.org/news/2013/ mabo-day/

Holistic Nurses/Midwives Retreat Bali 8-12 May Relax, Recuperate, Renew, Replenish 25 CPD hours (tax deductible) Contact Angeline von Doussa E: angeline@nurses-healing.com http://nurses-healing.com/holisticnurses-retreat-bali-may-2017/

Prince Henry’s Hospital Melbourne 89th PTS April Group 50-year reunion 22-23 April. Contact Lyn Kirby E:lynmkirby@gmail.com Royal Prince Alfred Hospital, PTS March 1976 reunion 7 June. Contact: Trish Walcott M: 0402 159 352 E: reunion.rpa@gmail.com

Bowel Cancer Awareness Month www.bowelcancerawarenessmonth.org/

Prince Henry’s Hospital, 1/73, 45year reunion 27 January 2018. Planning well underway. Trying to locate Carol Ball, Sue Ball, M de Graaf, Barb Gilmore, Sue Gladigau, Hilary Hammond, Barb Dunne, Narelle Harley, Chris Horton, Sue Ramage and Pam Walsh. Contact Jeanne O’Neill (nee Pinder) E: ej_oneill@yahoo.com

Maternal Child and Family Health Nurses of Australia Conference The journey 1-3 June, The Peninsula, Docklands Melbourne. www.mcafhna.org.au/ Lung Health Promotion Centre at The Alfred Theory & Practice of Non Invasive Ventilation (Bi-Level & CPAP Management) 1 June Spirometry Principles & Practice 5-6 June Paediatric Respiratory Update 26 June P: (03) 9076 2382 E: lunghealth@alfred.org.au World Environment Day 5 June. www.un.org/en/events/environmentday/ 10th International Conference on Childhood Obesity and Nutrition To enhance the prevention and treatment efforts for childhood obesity 12-13 June, Rome, Italy. http:// childhoodobesity.conferenceseries. com/ ANMF Vic Annual Delegates Conference 22-23 June, Melbourne Convention and Exhibition Centre, Vic. This two day conference will focus both on exploring occupational health and safety issues for nurses and midwives as well as giving delegates the opportunity to vote on resolutions and help shape the direction of their union for the next 12 months. http://bit.ly/ANMFevents

JULY National Aborigines & Islanders Day Observance Committee (NAIDOC) Week 2-9 July. http://www.naidoc.org.au/ Lung Health Promotion Centre at The Alfred Asthma Educator’s Course 19-21 July Respiratory Update 28 July P: (03) 9076 2382 E: lunghealth@alfred.org.au

SEPTEMBER International Wound Practice and Research Conference 6-7 September, Brisbane Convention & Exhibition Centre. http://iwprc2017.com.au

NDSN Bendigo School 71, 50-year reunion 2018. Seeking students from Bendigo, Castlemaine, Echuca, Swan Hill, Mildura. Contact E: margie_coad@ hotmail.com or M: 0427 567 511

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

anmf.org.au


BOOKS Located in the heart of Surry Hills, Crown Street in Women’s Hospital was the largest women’s hospital NSW. Affectionately known as ‘Crown Street’ it essentially cared for the poorest and most marginalised women in Sydney. Crown Street became internationally famous after its success treating eclampsia; was the centre of the thalidomide scandal and renowned for its care of newborn babies; and contributed both to the grief of forced adoptions and revolutionised birth practices in Australia in its later years. This comprehensive history reflects Sydney’s rich past and shows why Crown Street’s 90 years had an impact on so many.

CROWN STREET WOMEN’S HOSPITAL. A HISTORY 1893-1983 By Judith Godden Publisher: Allen & Unwin ISBN: 978-1-74331-840-9

BRINGING BABY HOME

in RRP:

$45 at

Bringing Baby Home brings together mothercraft nurse Christine Minogue’s 30 years’ experience in providing care and support to parents of newborns, infants and toddlers. Ms Minogue’s easy to read style covers information for a diverse range of Australian families, from single parenting; grandparents; adoption, surrogacy and fostering; to premature babies and multiples. There are clear and concise ‘cheat sheets’ on feeding and sleep for every age, and practical advice on toilet training to travel with a dash of humour. Ms Minogue has been at Sydney’s North Shore Private Hospital for more than 15 years where she is currently an antenatal educator.

By Christine Minogue Publisher: Pan MacMillan Australia ISBN: 978-1-74353-565-3

RRP:

$34.99

B IS FOR BALANCE

Are you a professional perfectionist, a mega multi-tasker, or a people pleaser? If you’re a nurse, chances are you’ve struggled to strike the right professional and personal balance, or know a colleague who has. Fully revised, expanded, and updated, the second edition of B is for Balance delivers more practical tips, tools, and tricks for people looking to get their lives back on track and attain achievable goals. B is for Balance outlines a course of actions to help one build the life and career they want by teaching you how to simplify and reinvent your life, reduce stress, manage exposure to technology and social media, and balance fatigue and sleep cycles. Kathryn Kadilak, President, Innovative Workplace Strategies former US Department of Justice Work-Life Director, describes the book as a holistic approach to RRP: finding a place of peace, purpose, and pleasure.“ Whether you are $34.95 a healthcare practitioner, trial attorney, CPA, or parent and home manager, the pull of 24/7 access to technology and the fast pace of modern life can feel overwhelming.”

12 STEPS TOWARD A MORE BALANCED LIFE AT HOME AND AT WORK By Sharon M Weinstein Publisher: Sigma Theta Tau International Honor Society of Nursing ISBN: 978-1-938-835841

NOT YOUR AVERAGE NURSE FROM 1970S LONDON TO OUTBACK AUSTRALIA, THE TRUE STORY OF AN UNLIKELY GIRL AND AN EXTRAORDINARY CAREER By Maggie Groff Publisher: William Heinemann ISBN: 9780143785347

anmf.org.au

RRP:

$34.99

To a young girl, the life of a student nurse sounds exciting, but long hours can quickly put an end to enthusiasm. After beginning a career as a student nurse at London’s King’s College Hospital, Maggie Groff soon comes to grips with her chosen career and realises it’s sink or swim. Against the backdrop of the rise of feminism, fashions trends, music, and movies of almost half a century ago, Not Your Average Nurse follows Maggie’s highs and lows as she struggles with stern ward sisters and wilful patients, before eventually qualifying as an RN and setting sail for Australia. From nursing at a poor London housing estate and working as an inhouse nurse at glamorous Selfridges to treating injuries on the Great Barrier Reef and becoming an industrial nurse at the iconic Sydney Opera House, Maggie’s story is filled with mistakes and mayhem, tea and sympathy, and life-affirming moments that made it all worthwhile.

April 2017 Volume 24, No. 9  47


ANNIE

STANDING UP FOR AGED CARE Assistant Federal Secretary, Annie Butler

Over the last couple of months the ANMJ has reported on the outcomes of the National Aged Care Staffing and Skills Mix Project, research commissioned by the ANMF in partnership with the ANMF (SA Branch) and independent researchers, the Flinders University and the University of South Australia, into the staffing requirements for residential aged care.

We have discussed how the research clearly shows the urgent need for more staff in residential aged care to meet residents’ care needs. And in this month’s ANMJ Clinical Update, a complete overview of the research and its recommendations by the ANMF (SA Branch) Director of Operations and Strategy, Rob Bonner, confirms that we now have the foundation for a national aged care campaign. Rob couldn’t be more correct – the evidence is in. We now know what is needed to ensure safe staffing in aged care: Guaranteed staff ratios and mandated nursing and care hours for each resident. To most of us, this comes as no surprise. For too long, those working in the aged care sector have known how seriously understaffed and underskilled residential aged care is. But for the first time ever we have academically rigorous evidence to demonstrate how dangerously inadequate current staffing levels are in residential aged care across Australia. We don’t just know in a general sense what’s needed, eg. more staff, we now know exactly what’s needed. We know that we need an increase in all nursing and care staff in aged care: registered nurses, enrolled nurses, and AINs/PCWs – with a skills mix of 30%/20%/50% respectively – to ensure the elderly get the care they need. We also know that residents need 4.3 hours of care per day, but typically receive only 2.84 hours. This means that on average across the country the frail elderly living in aged care only get two-thirds of the care they need every day. We know this from more than 3,000 RNs, ENs and AINs/PCWs participating in the research who indicated that staffing is inadequate in their workplace more than 90% of the time.

What happens next? Register for campaign updates email:

betterhands@anmf.org.au Like us on Facebook:

https://www.facebook.com/ AustralianNursingandMidwiferyFederation/ Read the full report:

http://www.anmf.org.au/documents/reports/ National_Aged_Care_Staffing_Skills_Mix_Project_ Report_2016.pdf

48  April 2017 Volume 24, No. 9

So if your elderly relative, your mum or dad, your grandma or grandad, needs assistance with toileting, and assistance with showering, and assistance with nutrition and hydration, 90% of the time one of those care needs will be missed. Your relative will be left wet or dirty or hungry and thirsty 90% of the time. This is not because nurses and carers working in residential aged care don’t have the knowledge or skills to care for the elderly or because they don’t care about the elderly. No one cares more about the elderly than they do. It is simply because there are not

enough staff. Many of you working in acute care and other areas would know what it’s like to work under-staffed for a shift or even several shifts. Many of you may remember what staffing was like before the introduction of nurseto-patient ratios, how it felt to be constantly ‘rushed off your feet’. For more than 90% of nurses and carers in residential aged care that’s how it feels every day. So, that’s how the staff feel, but what about the residents? I shudder to think what it must be like to be living out the end of your life in those conditions. Despite the enormous effort of those working in residential aged care, the elderly are not treated as individuals, not treated as real people or, on occasion, not even as human beings. Many times they are left to suffer.

WE ALSO KNOW THAT RESIDENTS NEED 4.3 HOURS OF CARE PER DAY, BUT TYPICALLY RECEIVE ONLY 2.84 HOURS.

And it is just getting worse. The number of residents in aged care has almost doubled since 1995 but government after government has failed to do anything to ensure that residential aged care facilities have the right number of staff with the right skills to care for them. Resources in facilities, both human and otherwise, are becoming so scarce that on many occasions it is just not possible for residents to be cared for safely, or even humanely. As a registered nurse, I don’t think we can sit by and watch an entire section of our society be systematically neglected. I think we have a moral and ethical responsibility to act. The ANMF Federal Executive and Branches agree. We now have the case for reforms needed in aged care and we are determined to see action. So the ANMF and our state and territory branches are working to plan a national campaign to achieve these vital reforms. As we know it will be up to us, to all of us, nurses, midwives, assistants in nursing and care workers because we can’t sit back and depend on politicians to act. anmf.org.au


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hesta.com.au/betteroff Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL 235249, the Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. This information is of a general nature. It does not take into account your objectives, financial situation or specific needs so you should look at your own financial position and requirements before making a decision. You may wish to consult an adviser when doing this. Before making a decision about HESTA products you should read the relevant Product Disclosure Statement (call 1800 813 327 or visit hesta.com.au for a copy), and consider any relevant risks (hesta.com.au/understandingrisk). *Past performance is not a reliable indicator of future performance and should never be the sole factor considered when selecting a fund. Comparisons modelled by SuperRatings, commissioned by HESTA. Modelled outcome shows 10 year average difference in net benefit of the main balanced options of HESTA and 75 retail funds tracked by SuperRatings, with a 10 year performance history, taking into account historical earnings and fees – excluding contribution, entry, exit and additional adviser fees – of main balanced options. Outcomes vary between individual funds. Modelling as at 30 June 2016.

ANMJ April 2017  

April issue of the Australian Nursing & Midwifery Federation

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