ANMJ August 2015

V O LU M E 2 3 , N O. 2 / A U G U S T 2 0 1 5

STAND

BY ME Nurses and midwives putting a stop to domestic violence

www.anmf.org.au

NEPAL EARTHQUAKE VOLUNTEERS REQUIRED World Youth International (WYI) is a family run, Australian charity that has been deploying volunteers to developing countries since 1988.

On April 25, Nepal was struck down by a 7.8 magnitude earthquake.

In response to this disaster, WYI are seeking volunteers to join our programs and help us deliver a range of vital health care services to some of the most severely affected areas of Nepal.

NURSES IN ACTION

(For Allied Health Professionals 18+) A team of up to 12 volunteers will be led by a fully trained Australian registered nurse. Accompanying the group will be a Nepalese support team consisting of local medical staff, translators, security staff and a chef. The Nurses in Action Program will run over 30 days and the program fee covers ALL in-country expenses including meals, accommodation, transportation, orientation, placements, medical / school health camps and a range of other activities. Places are limited, but we do have availability on the following dates: October 20 to November 18, 2015 January 5 to February 3, 2016 March 5 to April 3, 2016

(6 places left) (5 places left) (7 places left)

OVERSEAS ACTION PROGRAM

(For people aged 18 – 30 years)

This program is identical to our NIA program in regards to the structure, time frame, cost and location. Volunteers will be based in the mountain community of Jwentar and the team will help to rebuild vital infrastructure projects such as schools, medical centres, orphanages and community centres. Our next program will commence on November 28, 2015.

WYI launched the ‘Nepal Earthquake Appeal’ on April 27 and has raised a significant amount of money for the people of Nepal. A large portion of this funding will be kept aside to be used on these program. All volunteers will receive training in disaster zone deployment and crisis management as part of their preparation.

The program fee is $3995 and volunteers can fundraise their fees if they choose!

Email admin@worldyouth.org.au for a comprehensive brochure pack.

For more information, go to www.worldyouth.org.au or call 08 8340 1266

EDITORIAL

Editorial Lee Thomas, ANMF Federal Secretary I was surprised and astonished when it became evident the Australian Border Force Act had been passed in Federal Parliament in May this year.

The Act effectively gags health professionals from unauthorised disclosure of information about the conditions, health, welfare or human rights abuses occurring in detention facilities.

As a consequence this outrageous Act represents an exceptional assault on the moral integrity of our professions. It directly contradicts the duty of care that all nurses and midwives have for their patients in their everyday practice. In addition, the government is using the law to prevent the Australian public from knowing what really goes on in detention centres.

DOMESTIC VIOLENCE IN AUSTRALIA IS A SERIOUS ISSUE THAT HAS BEEN BROUGHT TO THE FORE SINCE ROSIE WAS NAMED AUSTRALIAN OF THE YEAR.

Many nurses and midwives have contacted us about this, fearing the potential consequences of the Act and their ability to continue to undertake their roles. Consequently I wrote to the Minister for Immigration and Border Protection, Peter Dutton, asking him to urgently respond to these concerns.

Specifically the letter asks for clarification: • Who should nurses report to if they witness abuse or violence?

• What guidelines are in place to ensure nurses, midwives and other healthcare workers can exercise their duty to advocate for best patient care?

• What regard is given to current laws relating to the obligations of professional health workers, for example mandatory reporting regulation?

Once the Minister has addressed these issues, I will be sure to advise you of his response.

@AustralianNursingandMidwiferyFederation

anmf.org.au

@anmfbetterhands

To read more about the Australian Border Force Act and the consequences on nursing ethics see Professor Megan Jane Johnstone’s article on page 15 and the ANMJ’s lead news story on page five.

As many of you are aware, the ANMF has partnered Rosie Batty in her Never Alone campaign. To date more than 20,000 people, many of whom are nurses, have signed up to this campaign.

Domestic violence in Australia is a serious issue that has been highlighted since Rosie was named Australian of the Year.

It is an issue that affects many nurses and midwives personally and professionally as highlighted in this month’s feature.

We are proud to stand by Rosie and support the victims of domestic abuse. If you have not done so already, I encourage you to support Rosie too and sign up to the campaign through our website: http://anmf.org.au/campaign/entry/ never-alone-campaign Before I sign off I would like to pay tribute to, Pam Wright, who passed away last month. Pam had a long and distinguished career, committed to the nursing profession and to the union.

Pam held the role of ANF Federal Vice President in 1983-84 and was then Federal President from 1987 to 91. She was elected as Tasmanian Branch Secretary in 2000. RIP Pam.

www.anmf.org.au

August 2015 Volume 23, No. 2 1

Canberra

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

FRONT COVER: PHOTOGRAPHER THOM RIGNEY / FAIRFAX SYNDICATION

Editorial

Melbourne & ANMJ

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

Federal Secretary Lee Thomas

Assistant Federal Secretary Annie Butler

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

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

Design and production Design: Daniel Cordner Printing: AIW Printing Distribution: D&D Mailing Services

Australian Capital Territory Branch Secretary Jenny Miragaya Office address 2/53 Dundas Court, Phillip ACT 2606 Postal address PO Box 1995, Woden ACT 2606 Ph: (02) 6282 9455 Fax: (02) 6282 8447 E: anmfact@anmfact.org.au

Northern Territory

South Australia

Victoria

Branch Secretary Yvonne Falckh

Branch Secretary Elizabeth Dabars

Branch Secretary Lisa Fitzpatrick

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

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

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 August 2015 Volume 23, No. 2

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

144,496

TOTAL READERSHIP

Based on ANMJ 2014 member survey pass on rate Circulation: 98,970 BCA audit, March 2015

anmf.org.au

News 4

16 STAND BY ME

Ethics 15 Feature

16

Professional 23 Research 24

NURSES AND MIDWIVES PUTTING A STOP TO DOMESTIC VIOLENCE

Legal 25 Clinical update

26

World 29 Issues 30 Working life

31

Viewpoint 32 Wellbeing 33 Focus – Education part 2 34 Calendar 47 Annie 48

FEATURE

NURSES AND MIDWIVES PUTTING A STOP TO DOMESTIC VIOLENCE

04

24 NEWS

RESEARCH

26

34 CLINICAL UPDATE anmf.org.au

RISK OF INJURY

FOCUS

EDUCATION: PART 2

August 2015 Volume 23, No. 2 3

NEWS

ALANNA MAYCOCK

ANMF slams new laws silencing nurses and midwives The Australian Nursing and Midwifery Federation (ANMF) has condemned new laws that place health workers and humanitarian staff who speak out about poor conditions and abuse occurring in Australian run detention centres at risk of jail time.

The Australian Border Force Act came into force on 1 July, introducing a new disclosure offence that carries a penalty of up to two years’ jail for nurses, midwives, and other health professionals and humanitarian workers, who publically reveal their experience at detention centres including Manus Island and Nauru.

In June, registered nurse Marianne Evers spoke about working on Nauru at the ANMF Victorian Branch delegates conference, exposing unsanitary conditions and poor mental health, and describing the environment as “the definition of a concentration camp”.

Delegates subsequently voted to develop campaigns to fight for the rights of asylum seekers and the stance has continued to spread across the country.

The ANMF wrote to Immigration Minister Peter Dutton raising its concerns about the implications the Border Force Act places on proper duty of care and ethical obligations.

It also requested clarity on the appropriate channels nurses and midwives should follow if they suspect issues including sexual abuse, violence, and illegal activity taking place.

ANMF Federal Secretary Lee Thomas labelled the sanctions implemented by the government as “outrageous”.

“We’re horrified the government is using this new law to prevent the Australian public from knowing what 4 August 2015 Volume 23, No. 2

really goes on inside detention centres by trying to silence nurses and other health professionals who work there,” Ms Thomas said.

In the aftermath of the Border Force Act being given the green light, a collective of more than 40 health workers and humanitarian staff, either current or former workers at Australia’s detention centres, challenged the government by releasing an open letter defying the new rules while highlighting the absence of adequate child protection and a legal obligation to report abuse.

Alanna Maycock, a Sydney-based registered nurse, was involved in editing the letter and signed the document.

Alanna runs a clinic for refugees and asylum seekers and spent five days on Nauru after being engaged as a consultant by International Health and Medical Services, the private organisation charged with supplying healthcare at detention centres.

After being exposed to horrendous conditions, Alanna felt compelled to write about her experience earlier this year, despite the contract she had signed explicitly banning such action.

“The threat of going to jail was really worrying but then you’re kind of caught in a trap. If we don’t [speak out] then what’s going to change and what’s going to happen to the children,” she said.

When the opportunity presented once more in the wake of the Border Force Act

WE’RE HORRIFIED THE GOVERNMENT IS USING THIS NEW LAW TO PREVENT THE AUSTRALIAN PUBLIC FROM KNOWING WHAT REALLY GOES ON INSIDE DETENTION CENTRES

being introduced, Alanna said she initially felt frightened about penning her name to the list of healthcare professionals but said she was then comforted by the security of voicing opposition as part of a powerful group.

Alanna still remembers her time on Nauru intensely and recalls dreadful incidents like handling the rape of a mother and witnessing a guard assaulting the father of a child she was caring for.

“We saw a six-year-old girl there that was attempting to hang herself with fence ties.

What do you do as a clinician? Do you not report something like that?”

Alanna said the collective had sought legal advice and was informed they could be prosecuted under the Border Force Act. She said the group had received enormous support and was determined to continue fighting. “A lot of the stories you hear are kind of anecdotal because the other person is telling you a story about what happened to them. This wasn’t the case on Nauru. We actually saw the abuse happening and it was so frightening.

“Australia is the only country in the world that does this, that mandatory detains children on arrival indefinitely.” anmf.org.au

NEWS

New Chief Nurse and Midwifery Officer named Territory, teaching nursing/health management at Sydney’s University of Technology, and the position of Chief Nurse and Midwifery Officer in both South Australia and New South Wales.

In her new position, she will act in an advisory capacity with government, advocating nursing issues and offering an informed perspective regarding the development of future strategies and policies.

“I have a varied background and I’ve worked both in metropolitan and rural areas so I think I bring a broad understanding of where nursing and midwifery operates and what I can bring to healthcare,” she said.

Ms Thoms said Australia was facing considerable health challenges in coming years, listing an increasing demand for healthcare from an ageing population, healthcare costs, and a looming workforce shortage in nursing and midwifery as major priorities.

She said it was pleasing to see the government’s ongoing support of the role of Chief Nurse and Midwifery Officer.

“It’s really important that we have nurses at every level of government and that

they are providing that input and those insights that nurses and midwives bring to healthcare.”

Ms Thoms recently attended the International Council of Nurses (ICN) conference in Korea exploring the importance of globally furthering the nursing profession.

“It was a great opportunity to hear what’s going on internationally and to reconnect with your international colleagues and gain that one-to-one knowledge of what’s going on overseas,” she said.

“From my perspective, the most important thing is getting the message out there about the contribution nursing makes, particularly in that broader primary healthcare arena.

“Healthcare delivery needs to move away from acute focus and we need to be doing more in community based services.”

She said nursing had been a significant part of her life and still produces a great reward. “What’s really special about nursing is the opportunity to connect with people and the fact that nurses and midwives are with people at some of the most critical, some of the most exciting, but also some of the most challenging times in their lives. To be with people in those situations is a real privilege.”

Ms Thoms officially begins her new role on 31 August.

Health Minister Sussan Ley said breast screening saved lives.“It’s the second most common cause of cancer-related deaths among women in Australia, however if detected early and managed, nine out of 10 cases can be treated successfully.”

While the overall percentage of women being screened for breast cancer fell, the demographic of women aged between 70 and 74 rose sharply from 25.9% in 2011/12 to more than 40% in 2013/14.

BreastScreen encourages women in

the target age group to undergo free screening mammograms every two years.

The target age group was originally 50 to 69 years, but was extended to those aged 70-74 in mid-2014, and is also available to women between 40 and 49, and those aged 75 and over.

The new data follows recent major international analysis from the International Agency for Research on Cancer (IARC) which confirmed the lifesaving benefits of screening.

The CEO of the Australian College of Nursing, Debra Thoms, has been appointed Australia’s new Commonwealth Chief Nurse and Midwifery Officer.

Ms Thoms is taking over the reins from predecessor Dr Rosemary Bryant, who held the position for seven years and was the first person to assume the nation’s top nursing and midwifery post.

“Hopefully I can build on the good work that she’s done to try and get the voice of nursing and the contribution that nurses and midwives can make to healthcare even more understood, appreciated and valued,” Ms Thoms said.

Ms Thoms’ career in nursing and health management spans more than 40 years. Her roles include working as a remote area nurse in the Northern

Breast cancer screening rates drop The number of Australian women proactively screening for breast cancer continues to tumble, new figures show.

The worrying downward trend has been revealed in statistics contained in the Australian Institute of Health and Welfare’s latest report into national government funded program BreastScreen.

Figures show participation in the program has continued to fall since the last national campaign was rolled out in 2001.

The participation rate for women aged between 50 and 69 in 2013/14 was 53.7%, down from 54.4% in 2012/13, and a significant decrease from a national high of 57.6% in 2001/02.

The results have triggered calls for more women aged between 50 and 74 to get screened for breast cancer to ensure early detection. The Australian government has committed $55.7 million to a new national campaign and expanded services to improve awareness about the critical subject.

anmf.org.au

August 2015 Volume 23, No. 2 5

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NEWS

Flu cases up amidst poor vaccination uptake Flu cases in Australia are up by almost 50% this year as compared to the same time last year, new statistics show.

Nurses Memorial Centre scholarships up for grabs

JOHN BULLWINKEL AND 2014 SCHOLARSHIP RECIPENT MARGARET FLOOD

Nurses and midwives undertaking post-graduate study are being encouraged to apply for annual scholarships offered by the Nurses Memorial Centre (NMC).

The “living memorial” pays respect to the sacrifice of Australian nurses who died or spent years in Japanese prisoner-of-war camps during World War II, and also aims to support the next generation of nurses through scholarships to help fund further education.

Applications for the 2015 scholarships, for studies to be undertaken next year, close on 31 August.

The NMC was established by two key figures, nurses Vivian Bullwinkel and Betty Jeffrey.

In February, 1942, just prior to the fall of Singapore, 65 Australian nurses and some civilian women and children, were evacuated on the SS Vyner Brooke ship.

In the middle of the month the ship was bombed by the Japanese and it sank shortly after.

Of the 65 nurses on board, 12 were killed during the attack, 21 were massacred on Banka Island, and 32 became prisoners-of-war, with eight of those later succumbing to disease and malnutrition.

At Radji Beach, on Banka Island, 22 nurses were ordered to march into the sea

by Japanese soldiers before they were gunned down. Vivian Bullwinkel was the sole survivor after pretending to play dead.

Another survivor of the period, Betty Jeffrey, kept a diary during three years of captivity and her notes were later turned into the book ‘White Coolies”.

On return home, Jeffrey and Bullwinkel established the Nurses Memorial Centre in a bid to remember the fallen.

Today the NMC offers four key scholarships, including two named after the inspiring women. NMC board

anmf.org.au

member Arlene Bennett, a registered nurse and President of the Graduate Nurses Association of the Royal Melbourne Hospital, described their tale of survival as uplifting and an important piece of history.

“Had she not survived we would have never known the story and the brutality,” she said of Vivian Bullwinkel.

“The history is a very important history and it’s an Australian story. It’s a story of courage and it’s a woman’s story and I think that we can’t afford to just lose it.”

Betty Jeffrey was also an inspiration, Ms Bennett said. “She was very courageous. She had a lot of ingenuity and determination and her will to live was very important too,” The establishment of scholarships was intended to help educate future nurses.

Dr Liz Lavender, who worked at La Trobe University for many years in the field of nursing and midwifery, is on the scholarship committee and believes the awards can assist nurses in making significant contributions to the community.

“Getting one of these scholarships is quite prestigious. If you can put on your CV that you’ve received a Vivian Bullwinkel scholarship I think that shows you’re a pretty well-rounded post-graduate nurse.”

Dr Lavender has been on the interviewing panel for the past two years.

“I’ve been extraordinarily impressed with the quality of applicants,” she said.

“To interview some of the people, especially the ones who are in specialist nurse practitioner areas, they are really impressive women and men and really out to make a difference to patient care.”

To apply for scholarships visit www.nursememorialcentre.org.au

To the end of May there had been 9,132 laboratory- confirmed cases, which represented a 47% increase of influenza cases compared with the same period last year and the highest number of recorded cases for the period since the current form of recording began in 2001.

The latest Influenza Specialist Group (ISG) survey also showed many Australians remained unprotected because of the late availability of vaccine this year and difficulty in arranging vaccination. The survey revealed one in five people who intended to get a flu shot this year are currently unprotected. Thirty three percent stated they could either not get a suitable GP appointment or the vaccine was not available at their GP.

The release of vaccines was delayed over a month this year due to two strain changes from the 2014 vaccine that required time to formulate.

Chair of the Influenza Specialist Group Dr Alan Hampson, urged people who could not afford to get the flu because of health or other reasons to get a flu shot now. “The high early numbers may well be suggestive of a severe season to follow. With peak of the influenza season usually expected between July and September there is still a short window for most people wanting protection to be vaccinated.

August 2015 Volume 23, No. 2 7

NEWS “Based on typical staffing rates, the loss of 840 beds would result in the loss of up to 170 doctors and 620 nurses.”

The Australian Nursing and Midwifery

WE WILL CONTINUE TO STRONGLY OPPOSE THE CLOSURE OF ANY BEDS UNTIL IT IS CLEAR THAT THERE IS NO LONGER A NEED FOR THEM

South Australia facing potential hospital bed closures An outlook of reduced hospital bed numbers in South Australia is considered inevitable but uncertainty remains over the amount of beds that could be stripped from the state’s health system.

Health Minister Jack Snelling confirmed in Parliament late June the government’s view that achieving a more efficient health system would demand cutting unrequired beds.

“Our ratio is 2.6 (per 1,000 people) and the national average is about, I think from memory, 2.1. So we have significantly more hospital beds for our population size – acute hospital beds – than other states and, in fact, any other Australian state or, indeed, territory,” he told Parliament.

“I make no secret of the fact that I would like to see that brought down to

closer to what the national average is.”

Opposition leader Steven Marshall claimed the admission added up to 840 acute hospital beds being cut from South Australia’s stretched hospital system.

“South Australians needing hospital care will face longer waiting times for a bed, in a system with fewer doctors, nurses and orderlies, at a time when our ageing population needs more hospital resources, not less,” Mr Marshall said.

“The Institute of Health and Welfare shows there are 4,700 beds in South Australian hospitals. That will produce the loss of 840 beds.

Federation’s (SA Branch) hosed down the prospect and pointed to the government’s pledge to not reduce any bed numbers unless it is clear there is no need for them under its transforming health plans.

The program was established in direct response to federal budget cuts and aspires to build a more efficient system and boost patient outcomes.

ANMF (SA Branch) CEO/Secretary Adj Assoc Professor Elizabeth Dabars said the union expected the government to keep its promises.

“We are strongly opposed to any reduction in bed numbers until the system-wide efficiencies that Transforming Health has set as targets are achieved,” she said.

“We will continue to strongly oppose the closure of any beds until it is clear that there is no longer a need for them; which is not foreseeable in the immediate future.”

Ms Dabars said she was aware of reductions in bed numbers at some sites due to local health networks (LHNs) shifting to their budgeted bed levels, but that beds and staffing could be increased to cater to demand.

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NEWS

Paid Parental Leave changes on the nose

Australian parents are unanimously opposed to the Abbott government’s planned cuts to Paid Parental Leave (PPL), a new survey has found.

Fight to keep registered nurses on duty in aged care Debate over the requirement for a registered nurse to be on duty at nursing homes at all times will be the primary focus of recently launched Parliamentary inquiry investigating aged care in New South Wales.

Discussion surrounding nursing staff levels in residential aged care has been a contentious topic for some time in the face of potential changes to legislation under the Aged Care Act. The General Purpose Standing Committee has been charged with investigating the role of registered nurses in the state’s nursing homes, as well as exploring further regulation and minimum standards for personal carers.

Submissions to the inquiry closed in July and a public hearing is set for later this year.

The parliamentary inquiry was prompted by concerns from a number of organisations over the potential impacts

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of a change to current standards.

Over the past year, the NSW Nurses and Midwives’ Association (NSWNMA) has undertaken a public campaign in a bid to prevent the removal of registered nurses at aged care facilities.

The Insist on Registered Nurses 24/7 campaign yielded more than 10,000 signatures to a petition presented to Parliament in June.

NSWNMA General Secretary Brett Holmes said preserving registered nurses in aged care facilities was crucial to maintaining a high level of care. “It’s vital for quality of care that these requirements are placed permanently into NSW legislation.”

Conducted by parent advocacy group, The Parenthood, the findings revealed a whopping 94% of the 1,400 parents surveyed were firmly against the proposed changes, which threaten to strip away access to 18 weeks of government funded parental leave for almost 80,000 parents.

The government justified its plans by suggesting the current system, where parents can access parental leave from both their employer and the government, had created a situation of “double dipping”.

The tag was rejected by many parents, with 40 % of those surveyed claiming the label “misrepresents what the government’s PPL scheme is designed to do”.

Other survey findings included: 26% of parents believing the label “implied that they or their partner had done something wrong or rorted the system” and almost half the parents quizzed declaring they felt “anxious” or “angry” as a result of the government’s tinkering with the system.

The Parenthood’s Executive Director Jo Briskey said 86% of survey respondents who had accessed PPL were able to extend their parental leave by consolidating their employer and government entitlements.

“Parents aren’t trying to rort the system or exploit a legal loophole. They’re simply accessing paid parental leave as it was designed to be accessed so they can spend as much time as possible with their newborn child.”

Public submissions to the Senate Community Affairs Committee closed at the end of July, with a hearing imminent.

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ANMF remembers inspirational leader The Australian Nursing and Midwifery Federation (ANMF) is mourning the loss of one of its most notable leaders, former Federal President and Tasmanian Branch Secretary Pam Wright.

In a long and distinguished career committed to furthering the nursing profession, Pam held numerous positions within the union. Pam took up the role of Federal Vice President from 1983-84, then held the role of Federal President from 1987-91.

State government promises to deliver The Victorian government has reiterated it will deliver on all its pre-election promises to nurses and midwives, including mandated nurse to patient ratios enshrined in law.

The state government was in the final stages of preparing the staffing legislation for introduction to Parliament Victorian Health Minister Jill Hennessy told nurses and midwives at the recent ANMF Victorian Branch annual delegates’ conference. “We know how important this is in order to enable nurses and midwives to provide better care for patients.”

Ms Hennessy said it would be landmark legislation – the first of its kind in Australia. “Once passed, no longer will nurses and midwives have to negotiate nurse to patient ratios as part of their EBA. No longer will nurses and midwives have to trade down pay and conditions to

anmf.org.au

In 2000, she was elected the Tasmanian Branch Secretary.

Pam was known as a straight-talking individual who spoke her mind when advocating on behalf of Tasmania’s and the country’s nurses.

She was originally from New South Wales, but grew to love Tasmania after driving down in a four wheel drive for a visit.

She completed her general training at the Royal Alexandra Hospital for Children, then ventured to Broken Hill to complete her midwifery, and finally to the Armidale College of Advanced Education to study for a Diploma of Nurse Education.

In Tasmania, Pam held various positions, including posts at the Royal Hobart Hospital and St John’s Hospital, and as night nursing coordinator at the Repatriation General Hospital in Hobart.

Pam was driven by the chance to make an impact on nursing and health, and to a larger extent, everyday people.

One of her most passionate pursuits was providing grief counselling to police, teachers, students, prisoners, and anyone who needed it.

In an article in the February edition of the 1996 Australian Nursing Journal, Pam said helping others was simply part of her makeup. “I’m not too keen on martyrs. We all do things in life that make us feel worthwhile in life. I recognise in me, and in other nurses,

a need to be needed and feel useful.

It makes me feel worthwhile to do the things I do.”

Pam left the ANF Tasmanian Branch in 2001 after a quarter of a century in elected positions. Her biggest achievements included securing the financial stability of the branch, increasing membership, and developing strong working relationships with nurses, other unions, and people from all walks of life.

improve patient safety.”

The Andrews Government would also deliver on increasing opportunities for new graduates; take action on the ANMF Victorian Branch’s occupational violence 10-point plan; and reverse the “sickening statistics on domestic violence”.

“We made a number of important promises. I am here to give you assurance we intend to deliver on every single one,” Ms Hennessy said.

Health Service Violence Prevention fund and provide advice on how health services will need to publicly report violent incidents at hospitals.

“The Andrews Labor Government is committed to reducing violence against our doctors, nurses, midwives and mental health workers, and we want to work with them to make our hospitals safer,” Ms Hennessy said.

The taskforce will be chaired by WorkSafe new Chief Executive Claire Amies and include representatives from the ANMF Victorian Branch, Australian Medical Association, Health and Community Services Union and health services.

ANMF Victorian Branch Secretary Lisa Fitzpatrick said creation of the taskforce confirmed the government’s commitment to its election promise and WorkSafe’s commitment to the issue. “There is an unacceptable level of occupational violence and aggression in Victoria’s public hospital system.”

NO LONGER WILL NURSES AND MIDWIVES HAVE TO TRADE DOWN PAY AND CONDITIONS TO IMPROVE PATIENT SAFETY. The Minister announced a new Occupational Violence Taskforce to address violence in Victorian hospitals.

The taskforce will be charged with the rollout of the government’s $20 million

PAM WAS DRIVEN BY THE CHANCE TO MAKE AN IMPACT ON NURSING AND HEALTH, AND TO A LARGER EXTENT, EVERYDAY PEOPLE. ANMF Tasmanian Branch Councillor Andrew Ostler described Pam as a warm and generous person. “The result of her work was improved working conditions, wages and a rise in the profile of the nurses’ voice in Tasmania and Australia.

There is no doubt that Pam led her life in the service of her profession and community.”

Pam died at the Royal Hobart Hospital among the nurses she cared for so much. Her legacy lives on and her passion to the cause remains embedded in the next generation of nurses and midwives.

August 2015 Volume 23, No. 2 11

NEWS

Boost for nurse to patient ratios in Queensland Queensland will become just the second Australian state to legislate nurse to patient ratios under bold new plans announced last month by the state government.

L TO R: AMY WATSON, ALLISON KENWOOD AND PIPPA VAN PAAUWE

Domestic violence training model for hospitals A toolkit to help hospitals train staff to appropriately identify and respond to family violence will be available in coming months.

The Royal Women’s Hospital in Melbourne is currently working with Bendigo Health to develop the toolkit based on the Victorian Government’s Strengthening Hospital Responses to Family Violence project. The project has been trialled at the Women’s and Bendigo Health for six months.

The project, to be evaluated by Our Watch, is aimed at ensuring health professionals are equipped and hospitals are a safe place if women disclose family violence. Women will be supported with appropriate referrals to services available in the integrated family violence sector.

‘It’s a toolkit that other hospitals can pick up and start with. It’s a model by hospitals for hospitals,” Preventing Violence Against Women Project Manager Pippa van Paauwe said.

A preliminary study of 88 cases at the Women’s where women had disclosed family violence from November 2014 to the end of February 2015, showed: 30% had a family violence intervention order in place; and 4% were in the process of getting one.

Ms van Paauwe said family violence was a significant health issue. “It’s really about getting violence seen as a health care issue.

“We have based our training model and policies, procedures and guidelines on WHO recommendations teaching staff on the frontline how to respond when women choose to disclose, from meeting their immediate needs to referral to external agencies.”

The ethos of the program is on sensitive enquiry not mandatory questioning. Education sessions for health professionals include: on the prevalence and health impacts of family violence; and sensitive inquiry and positive disclosure – how to ask and where to go from there, including referral to appropriate agencies or services. anmf.org.au

The Women’s Emergency Department (ED) Associate Nurse Unit Manager Amy Watson said it was not uncommon to come on at 7am to a busy ED where a woman has stayed in overnight with pelvic pain that has been treated with Nurofen.

“It’s those little alarm bells – this woman may have come in just for safety and respite. It might not be blankly right in front of you.”

For some women in controlling relationships they are not allowed to see a GP, Ms Watson said. Having pregnancy appointments may be the first time with a health professional without their partner or the first time they are asked the question around domestic violence.

“It’s about widening the lens of how we practice to give a woman the best and most optimal care. It’s about a shift in practice. Women can present with any range of symptoms that could be signs of domestic violence – pelvic pain, vaginal bleeding, recurrent UTI, unplanned pregnancy, decreased foetal movements.”

Research shows women who experienced family violence had an increased burden of disease such as cardiovascular disease and diabetes which had a huge impact, including repeated admissions, unplanned pregnancy, Ms Watson said.

The project builds on work done at the Women’s, including its Acting on Warning Signs that provides women with an integrated pathway for healthcare, social work support and legal advice.

“A lot of the time women just want to know what their legal options are, general information,” Executive Director of Planning & Strategy at the Women’s Allison Kenwood said. “They may choose to not do anything and there may not be any action – it’s just supporting the woman.”

The Palaszczuk government outlined the legislation when unveiling its blueprint to inject a further $212.3 million from the state budget to increase nurse numbers.

The new laws will make it mandatory to provide one nurse to every four patients during the day, and one nurse to every four patients during the evening.

Similar nurse to patient ratios have been introduced by only a handful of governments around the world.

The Queensland Nurses’ Union (QNU) has long campaigned for safer nurse to patient ratios and hailed the announcement as a significant step towards improving healthcare. “Few people realise there are currently no laws governing how many patients can be safely allocated to a single nurse in public, private, or aged care facilities,” QNU Secretary Beth Mohle said.

“Throughout Australia and around the world there are over worked nurses seriously concerned for the wellbeing of their patients. We are there when patients are recovering from illness, injury or surgery, and we know the quality of care they receive can mean life and death.”

The nurse ratio legislation is expected to be introduced into Parliament in coming months. The government has advised the QNU that it will provide interim funding to address extreme nursing shortfalls ahead of the legislation.

As part of the budget boost, an extra $110.7 million was also pledged towards funding up to 4,000 new nurse and midwifery graduate places over the next four years.

As well, a new statewide Schools and Hospitals Fund sets out to provide a lift to communities with a focus on health refurbishment and education.

About $180 million has been allocated over the next four years for vital upgrades and repairs to the Roma, Hervey Bay, Gladstone, and Caloundra Hospitals through the Enhancing Regional Hospitals program.

August 2015 Volume 23, No. 2 13

NEWS

Leading nursing scholar spearheads book on ethics Prominent Australian nursing academic Professor Megan-Jane Johnstone has steered the creation of an innovative new reference work charting the international development of nursing ethics.

The three-volume work, titled Nursing Ethics, spans more than a 1,000 pages and compiles a collection of pioneering articles covering ethics and the nursing profession.

Professor Johnstone was selected to prepare the major literary work by Sage Publications as part of its Library Nursing Series. The significant project involved selecting articles across the discipline from the past 127 years and introducing each volume with a 10-15,000 word editorial detailing key issues and concepts.

The idea behind creating the reference work was to chart the history of nursing ethics and its evolution in a bid to highlight the significance of the subject as a worthy field of analysis. Professor Johnstone is the Academic Chair in Nursing at Deakin University in Melbourne. She said she felt honoured to have been granted the opportunity to edit the book.

“The project, as a whole, afforded an incredibly unique opportunity to capture, preserve, and bring to a wider audience articles and ideas that were at risk of being lost to history,” Professor Johnstone said.

Professor Johnstone said such a book had been long overdue and that she believes it has the potential to provide the catalyst for more robust global conversation and intellectual debate about nursing ethics.

“Despite the maturation of the field, nursing ethics remains very much a ‘work in progress’ and one that is unlikely to be completed in one lifetime,” she said.

“To ensure its ongoing relevance and practical use to the nursing profession, those working in the field need not only to be continually responsive to the issues arising in the social-cultural and political contexts in which nurses work, but must enable nurses to engage in ongoing ‘critical conversations’ about what nursing ethics is.”

A distinguished author in her own right, the 6th edition of Professor Johnstone’s eminent book Bioethics: a nursing perspective, will be released in September and launched at the upcoming National Enrolled Nurses Association of Australia conference in Adelaide in October.

For more information on the book visit - www.elsevierhealth.com.au/ bioethics-9780729542159.html 14 August 2015 Volume 23, No. 2

Two indigenous communities building stronger foundations A project designed to empower two Aboriginal and Torres Strait Islander communities to strengthen identity, family, and wellbeing, has been praised for its positive effect on shaping their future.

The National Empowerment Project, supported by the Ngoonbi Co-operative Society, has focused on the Queensland communities of Cherbourg and Kuranda in a bid to drive community-led change, over the past two years.

On the back of NAIDOC Week, Queensland Mental Health Commissioner Dr Lesley van Schoubroeck said the program deserved considerable recognition.

“This is a program that recognises that change can only take root if it is strengthsbased, grounded in the community, owned and guided by the community,” Dr van Schoubroeck said.

Mrs Glenis Grogan, of the Ngoonbi Co-operative Society, said the training program had incorporated guidance from more than 300 Aboriginal people across the country. “Just knowing it comes from Aboriginal people, for Aboriginal

people and more often delivered by Aboriginal people, I believe it makes a difference. I’ve seen it. It actually makes a big difference.”

The program is focused on examining family and community and undertaking steps to make positive changes where issues such as drugs and alcohol exist.

Bronywn Murray, the NEP consultant at Cherbourg, said talking about serious issues was a great step forward. “They’re working on family. They’re setting rules in family and boundaries, and building stronger foundations, and better communication with family. It takes a community to build a community.”

The Queensland Mental Health Commission has invested $510,000 towards the NEP during its lifespan to provide support services, community worker training and healing program development.

anmf.org.au

ETHICS

A disgraceful assault on nursing ethics Megan-Jane Johnstone

References: Isaacs, D & Maycock, A. 2015. Degrading treatment of asylum system reflects poorly on Australia. The Sydney Morning Herald. 8 February [online] Johnstone, M-J. 2016.

Bioethics, a nursing perspective, 6th edn.

Churchill Livingstone/ Elsevier, Sydney.

Sim, S. 2004.

Fundamentalist world: the new dark age of dogma. Icon Books, Cambridge UK Whyte, S. 2015.

Whistleblower gag on detention centres. The Age, 4 June, p. 6.

Megan-Jane Johnstone is Professor of Nursing in the School of Nursing and Midwifery at Deakin University in Victoria.

Professor Johnstone has extensive interest and expertise in the area of professional ethics in nursing. anmf.org.au

On 1 July, 2015, the Australian Border Force Act (No. 40, 2015) came into effect. Passed quietly in May 2015 with the support of both major political parties, this Act contains provisions that represent a disgraceful assault on the ethics of the nursing profession. Of particular concern is Part 6 of the Act, which sets out the prohibition on the unauthorised disclosure of certain information obtained while working in immigration detention facilities.

Under Part 6 of the Act, a person is regarded as having committed an offence if: a. the person is, or has been, an entrusted person; and b. the person makes a record of, or discloses, information; and c. the information is protected information (Part 6: 42(1)).

Although exceptions apply, lawyers are of the considered view that personnel (including doctors and nurses) who are working in – or who have worked previously in – immigration detention centres, and who raise concerns about the health, welfare, and human rights abuses of people held in these centres, risk up to two years jail if they speak out publicly. This is so even if their disclosures are in the public interest and, in the case of doctors and nurses, are in keeping with the agreed practice and ethical standards of their respective professions. For example, consultant paediatrician Professor David Isaacs and registered nurse Alanna Maycock could risk jail time under the new rules because of disclosing publicly the appalling living conditions and human rights abuses they have directly observed on Nauru. In various media outlets, Isaacs and Maycock (2015) have, for example, revealed that women have not had a sufficient supply of sanitary pads, and women and children have sometimes been forced to shower behind ‘a flimsy curtain that often flew open in front of male guards’ (Whyte 2015).

Alarmed by the new law, on 1 July 2015, Isaacs and Maycock courageously joined 38 other current and former workers at Australia’s detention centres on Nauru and Manus Island in co-signing an open

letter challenging the government to prosecute them under the new secrecy laws for making unauthorised disclosures about the ‘substandard and harmful care’ they had witnessed in their roles. On the same day, the ANMF Federal Office released a media statement condemning the new ‘gag’ order on nurses and midwives, pointing out that: ‘It’s important that nurses working in detention centres are allowed to meet their Codes of Ethics and Professional Practice Standards in the provision of proper, basic healthcare and not be working under the fear that they themselves could be jailed for trying to deliver proper, basic health services’ http://anmf.org.au/ news/entry/anmf-condemns-newgag-order-on-nurses-and-midwives

IT’S IMPORTANT THAT NURSES WORKING IN DETENTION CENTRES ARE ALLOWED TO MEET THEIR CODES OF ETHICS AND PROFESSIONAL PRACTICE STANDARDS Question of nursing ethics Provisions contained in the new Border Force Act, which could see nurses imprisoned for speaking out on the substandard treatment and harm of patients they care for, represents an unprecedented assault by a government and opposition party on the moral integrity of the profession. Here questions arise of: How should the profession respond?

And what weight should be given to its contemporary moral standards, which have been devised and adopted by the profession through a process of careful deliberation dating back over 150 years?

The ‘whistleblowing’ of Florence Nightingale In considering these questions it is important to remember that nurses have a distinguished history of speaking out on matters of public interest dating back to the legendary disclosures made by Florence Nightingale during the Crimean war (1853-1856). During this period, using her contacts at The Times, Nightingale made public details

of the way the British Army was treating its wounded soldiers. Of particular note were her reports of the appalling conditions and high mortality rates (42%) that soldiers were experiencing in the military hospitals in Scutari – all of which Nightingale had directly observed.

Whether today Nightingale would face jail for her disclosures, is a moot point; what is clear is that the military hospital conditions and health outcomes for the soldiers would not have improved had it not been for Nightingale’s ‘whistleblowing’.

Campaign to protect asylum seekers Nursing codes of ethics locally and globally make reference to the role and responsibility of nurses to give ‘special attention’ to the needs of people who are ‘especially vulnerable’ and requiring human rights protection (Johnstone, 2016). Refugees, asylum seekers, displaced and stateless people are an ‘especially vulnerable’ population and as such warrant ‘special attention’ by nurses. As positions state ments published by the International Council of Nurses www.icn.ch make clear, in their capacity both as health professionals and as citizens of their own countries, nurses can make a great contribution, as human rights advocates and care providers, to redress the injustices experienced by these groups.

Nurses have a vital role to play in ‘energising dissent’ and re-humanising the men, women and children detained in Australia’s immigration detention centres. To this end, it is appropriate for nurses to embark on a political campaign, such as that recently announced by the ANMF Victorian Branch, for the ‘compassionate treatment of asylum seekers’, and to seek the repeal of laws which serve to silence the morally responsible voices of conscientious health professionals.

Such a campaign must, however, also target the politicians responsible for this state of affairs and hold them to account for the ‘new dark age of authoritarianism’ (Sim 2004) we seem to have descended into.

The ethics of the nursing profession are well grounded and a reliable guide to conduct. To be ‘lawfully’ required to breach the standards of ethical conduct in any context is not only unconscionable, but a despicable act of political treachery that risks corroding the moral fabric of our society.

August 2015 Volume 23, No. 2 15

STAND BY ME NURSES AND MIDWIVES PUTTING A STOP TO DOMESTIC VIOLENCE

FEATURE

PHOTOGRAPHER: THOM RIGNEY / FAIRFAX SYNDICATION

The scale and atrocity of domestic and family violence in Australia has come under the spotlight in 2015 largely due to the voice of Australian of the Year and family violence campaigner Rosie Batty. The implications of family violence are far reaching for many nurses and midwives, professionally and personally. Natalie Dragon reports.

In recognising the seriousness of family violence in Australia the ANMF recently joined Rosie in becoming a founding partner of the Luke Batty Foundation’s Never Alone campaign launched recently that has already seen soaring support of thousands of Australians, including nurses and midwives. www.neveralone.com.au “Something is going drastically wrong when nurses are left to keep patching people up again and again; meanwhile the real problems are never addressed,” says Rosie.

“We need to talk about where we are going wrong. And we need to understand family violence as both a health problem and a social problem. And we need to join these problems together and make sure no one is ever alone.”

Jann, 58, lived in an abusive relationship for many years with her two children. “The steps I took to give a healthier and safer life to my children is very troubling but also nothing has changed.

In her submission to the Senate Inquiry into family violence due to report this month, she says there were unbelievable road blocks put in front of her. “If at least one person took the steps and looked at this situation from the eyes of the mother, then and only then, would they see that this is not an easy fix that questions and great soul searching of a nation needs to be addressed.”

Rosie Batty says almost all onus remains on the victim to be responsible for their safety and the safety of their children.

“This total onus on women is expressed through the expectations that women will bear the total responsibility to take out intervention orders, simultaneously deal with police and child protection agencies and potentially not be assisted effectively by any of these agencies to keep her and her children (the victims of violence) safe and protected from violence.”

Statistics In Australia, nearly one woman anmf.org.au

each week dies as a result of family violence.

One woman is hospitalised every three hours because of health effects of family violence. And one in three Australian women will experience physical violence and/or sexual violence during their lifetime, according to the Australian Bureau of Statistics.

In 2010, the UN Committee on the Elimination of Discrimination Against Women highlighted the “unacceptably high levels of violence against women that persist in Australia”.

Health The United Nations Declaration on the Elimination of Violence against Women 1993 defines violence against women as: ‘any act of

ROSIE BATTY SAYS ALMOST ALL ONUS REMAINS ON THE VICTIM TO BE RESPONSIBLE FOR THEIR SAFETY AND THE SAFETY OF THEIR CHILDREN.

sexual assault and stalking - found women more likely to experience mental illness over their lifetime; the risk higher for women with the greatest exposure. The most common mental health issue was for anxiety (77%), mood disorders (52%), substance use (47%), posttraumatic stress disorder (56%) and suicide attempts (35%).

The Australian Domestic & Family Violence Clearinghouse Research shows women affected by intimate partner violence are more likely to have alcohol abuse, smoke and use non-prescription drugs.

Griffith University’s Senior Lecturer in Midwifery with research expertise in domestic violence Dr Kathleen Baird, says often the effects of domestic violence can be under-estimated. “I do not think health professionals comprehend the massive effects on health, not just the physical and psychological effect of domestic violence. Often women drink alcohol, smoke and take prescribed and illicit drugs to help cope with what they are living with each day.”

“Some people think if it’s that bad, why don’t women just leave?

A lot of the time, women don’t want to leave, they just want the violence to stop. Often this is much more complex.”

Screening gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.’

Domestic violence and sexual assault is more damaging to the health of Victorian women aged 15 to 44 years than any other well-known risk factors, including high blood pressure, obesity and smoking, VicHealth research shows.

A 2011 study of 1,218 Australian women who had experienced gender-based violence - partner violence, rape, other forms of

Dr Baird has provided education for GPs, practice nurses and midwives in the UK and now in Queensland around domestic and family violence. She says health professionals often do not feel confident asking such sensitive questions of those who might be experiencing domestic violence.

There are three to four key messages for health professionals when with victims who disclose domestic violence, she says: “Thank you for telling me; I believe what you are telling me; this is not your fault; and what can I do to help you?”

“It doesn’t have to be complex,” says Dr Baird. What health professionals need to know

THE MOST COMMON MENTAL HEALTH ISSUE WAS:

77% ANXIETY

52% MOOD DISORDERS

47% SUBSTANCE USE

56% POST-TRAUMATIC STRESS DISORDER

35% SUICIDE ATTEMPTS

August 2015 Volume 23, No. 2 17

FEATURE is that there are fantastic community agencies they can refer women to who work with women, whether a woman is with or has left a violent partner.”

Health professionals do not have to solve the problem, she says. “It is not up to them to find a solution - work with other agencies, it is not a one-agency response.”

Training and education can remove some of the anxiety of health professionals, Dr Baird says.

“Women are still good at hiding it if they choose to. But if a woman keeps coming to the hospital, she

WE HAVE TO BE PROACTIVE AND BE RESPONSIVE. IDENTIFYING, ASKING THE QUESTION AND REFERRING APPROPRIATELY TO AGENCIES ARE THE KEY MESSAGES TO NURSES AND MIDWIVES. DR KATHLEEN BAIRD

might be seeing her GP for antidepressants, has trouble sleeping, these might be indicators to ask the question.

“For midwives, if women are having repeated admissions during pregnancy for non-specific pains – you have to be careful - but if you see a pattern of someone coming in for non-specific abdo pain, it could be they are seeking a place of safety.”

Emergency department (ED) nurses are primly placed to observe where injuries do not fit in with the story, Dr Baird says. “I worked in an [ED] where there were more injuries 18 August 2015 Volume 23, No. 2

due to domestic violence than were accidental, although there is no concrete evidence to support this.”

In UK ED’s, specific domestic violence case workers are employed to work at hospitals due to the scale of the issue, says Professor Baird.

“Hospitals also make it domestic violence aware with posters and leaflets to make it clear if a woman is willing to talk to someone, and men, staff are there to help.

“Asking the question is helping, campaigning is definitely helping.

It’s not something women should feel ashamed of but they do still feel ashamed: we have to be telling them it’s not your fault.”

Every hospital should have guidelines and referral pathways for positive disclosure, she says. “Part of that referral involves children and social services and that often creates a dilemma for women.

Some women do not disclose for fear that their children will be taken off them by social services.

“Unless women choose to disclose there’s very little you can do unless you feel the children are at harm. If there are concerns for the children you have a statutory obligation to tell the child protection agencies. It is really hard and that’s what makes this area complex and difficult.”

There are also very real safety concerns for a woman and when she chooses to disclose, Professor Baird says. “It takes 35 times before a woman reports it (DV) to police. I like to think it is changing and there are better responses to it.”

Dr Baird says while there have been improvements in health in dealing with family violence there is still a long way to go. “We are dealing with the consequences of domestic violence, family violence and inter-partner violence - there is a financial and emotional cost to deal with. We have to be proactive and be responsive. Identifying, asking the question and referring appropriately to agencies are the key messages to nurses and midwives.

Education A 1800RESPECT survey of nurses found that: • 56% suspect a patient may be experiencing sexual or domestic violence; • 63% have had patients that have made voluntary disclosure of domestic violence or sexual assault; and

Maternal and child health nurses Research shows for women that pregnancy is often the first experience of domestic violence, or pre-existing violence may increase in severity and intensity.

Victorian Association of Maternal and Child Health Nurses President Kim Howland says there is a big role for maternal and child health nurses (MCHN).

“It is universal - we see 100% participation rates following birth, everyone is still in the service.”

Maternal and child health nurses routinely ask the question (Common Risk Assessment Framework) CRAF around domestic and family violence. The question is simple, Ms Howland says: “Is it safe at home?”

Nurses now feel comfortable asking the question, acting on physical signs and comfortable to go there and then refer, set up a safety plan, etc, Ms Howland says.

While CRAF was done in line with crisis management and now MCHN‘s know what they need to do, it is more prevention and education skills that nurses are now requesting, rather than the crisis situations, Ms Howland says. “Nurses are on the coalface and seeing it in the community and not knowing how to deal with it and call it. We need to get that balance right. Its baby steps, we need not to isolate a woman further. Feeling that intuition, often they cannot pinpoint what it is but something’s happening that’s not quite right.”

IT’S A RANGE OF PHYSICAL, PSYCHOLOGICAL AND EMOTIONAL STUFF THAT REALLY DAMAGES, INCLUDING LOSS OF SELFBELIEF AND SELF-ESTEEM THAT IS SO HARD TO TALK ABOUT.

ANMF Federal Vice President Maree Burgess, a maternal and child health nurse of more than 30 years, says nurses have probably had the conversation, but need to formalise it. “Domestic violence is obvious if there is a bruise or physical injuries, but it is so much lesser if it is emotional, financial, or psychological. Women may not see it so it’s about having that conversation and you need to have it with every woman.

“There is a whole range of responses people can experience, low self-esteem, powerlessness, shame.

It’s a range of physical, psychological and emotional stuff that really damages, including loss of self-belief and self-esteem that is so hard to talk about.”

Ms Burgess says this is why Rosie Batty’s Never Alone campaign is so critical. “It’s so important to raise the profile so people know they are not alone.

It’s about consequences, professional relationships and networks – you are not alone, we are here for you.”

anmf.org.au

FEATURE

• 88% reported they felt they

would be able to manage a patient disclosure, almost all wanted more support responding to patients who are experiencing a sexual assault or domestic violence.

University of Melbourne PhD researcher and sexual health counsellor Elizabeth McLindon says next to a close friend, victims are very likely to disclose violence to their health professional. “If nurses and midwives ask and receive a disclosure, it is a really critical time in that victim’s life in order to make choices and be safe. Nurses and midwives have a critical role that’s different from other health professionals in that spectrum.

“When talking to nurses and midwives understandably there are concerns about what do I need to do, do I need to do counselling?

There are real concerns when they receive a disclosure that they know what to do with that.”

“Nurses and midwives need to know that there are services that work with women in counselling and advocacy and that do a thorough risk assessment and tackle issues, such as housing.”

South Australian Flinders University Associate Professor Linda Starr in the School of Nursing and Midwifery and lawyer says domestic anmf.org.au

and family violence, as well as other abuse, such as elder abuse should be part of undergraduate curriculum for nurses and midwives to be able to identify and manage situations appropriately.

“I absolutely believe every health professional should have an undergraduate forensic focus to be aware of what’s needed and how to identify a pattern indicative of nonaccidental injury, and interpret and record and to make those records able to stand up in court.”

Law While every state and territory has mandatory reporting for child abuse, only the Northern Territory has mandatory reporting for domestic violence.

While domestic violence is criminal conduct, there is no standard definition of domestic and family violence across all jurisdictions in Australia. There is also no standard way for counting the number of police callouts to situations related to domestic violence.

Professor Starr says all nurses and midwives have a common law duty of care, they have to have a reasonable belief there is a risk of domestic violence, a risk of harm to take appropriate steps and appropriately document injuries

and ask the question.

She also says it is covered in nurses’ and midwives’ code of conduct and professional obligations to make sure people are safe. Recording injuries appropriately is critical for nurses and midwives in their documentation, says Professor Starr.

Mandatory reporting for nurses and midwives in the NT can put health staff in a difficult position where there is potential for payback, says CRANAplus Chief Executive Officer Christopher Cliffe.

“The health professional is not part of the problem but becomes part of the consequence of the problem.

Quite a few years ago a woman took shelter with nurses who went into lockdown. They hunkered down as it took quite a while for the police to arrive. The partner, his family and the community ran riot, set fire to the clinic – it was very frightening. As a consequence the two nurses had to leave the town.”

Mr Cliffe wants to see research as to whether the communal nature of rural, regional and remote communities is a protective or a risk factor for domestic violence. “There are big challenges where there is no police or they are a distance away.

In a crisis the clinic may be the only place women can seek safety and that’s a challenge.”

NORTHERN TERRITORY LAUNCHED A DOMESTIC AND FAMILY VIOLENCE ‘NO MORE’ BUS WRAP CAMPAIGN IN JUNE. THE BUS SIGNAGE IS AIMED TO INCREASE AWARENESS THROUGH ITS SHEER SIZE AND HIGH VISIBILITY ON THE STREETS EVERY DAY.

August 2015 Volume 23, No. 2 19

FEATURE A difficulty remote area nurses (RANs) face is accessing and getting people out of isolated communities safely. Therefore one of the risks of mandatory reporting is the physical safety of all concerned, says Mr Cliffe. But on the flipside you cannot work in an environment that is complicit to domestic and family violence. “RANs come to know people in the community well. For remote areas nurses and nurses working in isolated area they see women coming back, they know where the families problems are – where the man has lost his job in the local mine, know the kids are struggling at school – they have that insight, which is fantastic, but it can be difficult. Family and domestic violence is very complex.”

Never Alone campaign Rosie Batty launched the Never Alone campaign in June, which is aimed to support and stand with victims of family violence. “The women and children who have experienced family violence are often alone. My vision is that Luke’s memory will help give a voice to victims and drive change so that they are supported and never ever alone.”

Nurses are the ones who often have to start the difficult and challenging conversations, Rosie said to almost 700 nurses and midwives at the recent ANMF Victorian Branch annual delegates’ conference. “They see women and children who are very guarded, who don’t want to answer questions clearly, who won’t look them in their eye, and who can’t quite explain what has happened to them physically. And sometimes victims of violence will start to open up and talk to nurses, who are in that caring role, and who can be less confronting to deal with than the police.”

“We stand by you and we will work with you to make sure the government, political leaders and powerful organisations can no longer ignore and sweep away this topic,” she said.

Nurses and midwives The ANMF is proudly supporting the Luke Batty Foundation. ANMF Federal Secretary Lee Thomas said nurses and midwives witnessed family violence first hand and were often the first port of call for women and families. “And our members who are predominantly women, 20 August 2015 Volume 23, No. 2

also experience family violence, so it’s time we build a movement that lets all victims know that they are never alone.”

Unpublished research was presented at the ANMF Victorian Branch annual delegates’ conference of the experiences of violence of 527 health professionals in a tertiary hospital in Melbourne.

Doctors, nurses and allied health professionals were asked 121 questions of an intrusive nature about their experiences of domestic violence, sexual assault and family violence and how it impacted on them, their family lives and work.

THE REMAINING 40% THE PERPETRATOR IS KNOWN BUT NOT KNOWN IN A SIGNIFICANT WAY. “THIS IMPACTS ON RECOVERY – IT’S NOT JUST RECOVERY FROM A SIGNIFICANT TRAUMA - BUT SOMEONE YOU LOVE IS THE PERPETRATOR OF THAT TRAUMA.”

“Staggeringly 45% of respondents, the vast majority of who are women nurses and midwives, had experienced IPV or FV outside of a work colleague or patient,” University of Melbourne PhD researcher Elizabeth McLindon says. “If you added a work colleague or patient, that figure increased to 50%.”

The prevalence of violence for those working in the helping professions was higher than the general population, says Ms McLindon. “This is particularly an issue for nurses and midwives, not just because they work with patients but they are predominantly women and they identified at higher risk than the general population.”

Ms McLindon says 60% of sexual assault in Australia is committed by a partner or a family member.

The remaining 40% the perpetrator is known but not known in a significant way. “This impacts on recovery – it’s not just recovery from a significant trauma - but someone you love is the perpetrator of that trauma.”

Research shows it takes women nine times to leave before they make a break permanently, Ms McLindon says. “The first thing nurses and midwives need to know is that it takes a number of go’s for a woman to leave and every time you intervene you are aiding her along that spectrum.”

Work performance The research showed domestic and family violence had a significant impact at work: 19% had to take time off; 29% were affected at work (tired, distracted, unwell); 19% suffered depression or anxiety; and 8% attended work to avoid violence at home.

Work performance might be suffering as a result of experiencing domestic violence, Ms Thomas says. “Nurses and midwives should recognise their colleagues may be victims of domestic violence and be able to provide appropriate support and assistance.”

What the survey respondents reported as helpful or very helpful was: 85% specialist D/SV EAP generalist counsellors; 83% managers trained to respond to staff re VAW; 61% D/SV leave in addition to current entitlements; and 37% D/SV leave within current leave entitlements.

Ms McLindon says health professionals largely wanted more support at work and the opportunity for debriefing and supervision, including training at workplaces with flexible times and that attract CPD. “What they wanted was clear processes in place in organisations they work in, so if women identified a patient or they themselves were experiencing domestic violence they would know quickly where they could go to access support or help.”

Health and aged care facilities and other organisations should have guidelines and protocols which detail action to be taken in the event that a nurse or midwife report domestic violence, ANMF’s Lee Thomas says. “This might include reasonable requests for changes to hours or pattern of work; changes to duties; relocation within the workplace; change to

56% 56% SUSPECT A PATIENT MAY BE EXPERIENCING SEXUAL OR DOMESTIC VIOLENCE

63% 63% HAVE HAD PATIENTS THAT HAVE MADE VOLUNTARY DISCLOSURE OF DOMESTIC VIOLENCE OR SEXUAL ASSAULT

88% 88% REPORTED THEY FELT THEY WOULD BE ABLE TO MANAGE A PATIENT DISCLOSURE

anmf.org.au

FEATURE

THE FIRST THING NURSES AND MIDWIVES NEED TO KNOW IS THAT IT TAKES A NUMBER OF GO’S FOR A WOMAN TO LEAVE AND EVERY TIME YOU INTERVENE YOU ARE AIDING HER ALONG THAT SPECTRUM. ELIZABETH MCLINDON

contact details, including phone number and email address; and any other measures for flexible work arrangements.

“Many nurses and midwives have the dual task of both caring for patients who are victims of family violence as well as being sufferers themselves,” ANMF Victorian Branch Secretary Lisa Fitzpatrick said at the union’s delegates’ conference.

The ANMF Victorian Branch will raise the issue of family violence leave in its next round of employment agreement negotiations in 2016.

Work entitlements Over 1.6 million employees now have access to paid domestic leave in union negotiated workplace agreements.

Rosie Batty supports the Australian Council of Trade Union (ACTU) claim currently before the Fair Work Commission to provide four million workers covered by an award access to 10 days paid domestic violence leave for permanent staff and 10 days unpaid leave for casuals.

This would enable victims to anmf.org.au

attend court appearances, seek legal advice and make relocation arrangements, ACTU President Ged Kearney says. “Domestic violence is a whole of society issue and that includes the workplace and employers.”

ACTU Congress in May called for bipartisan support from all political parties to support the inclusion of paid domestic leave as a minimum safety net entitlement.

The NSW Nurses and Midwives’ Association (NSWNMA) won a family violence clause in the public health sector’s nurses’ award in 2011 after campaigning by the union. Employees who experience domestic violence have access to measures, including use of family and carer’s leave and sick leave entitlements for family violence related incidents. If those entitlements have been used, they are able to access an additional five paid days per year. “The ability to access further leave recognises the needs to workers experiencing family violence, such as requiring time with health, legal, financial, housing, social security and other advisors and support services,” NSWNMA Assistant General

THERE ARE BIG CHALLENGES WHERE THERE IS NO POLICE OR THEY ARE A DISTANCE AWAY. IN A CRISIS THE CLINIC MAY BE THE ONLY PLACE WOMEN CAN SEEK SAFETY AND THAT’S A CHALLENGE CHRISTOPHER CLIFFE

Secretary Judith Kiejda said at the time.

Gender equality The St Vincent de Paul Society has called on government to commit to a national plan on gender equality. “It is high time that we, as a nation, developed concrete steps to achieve true equality between women and men.”

Ms Irene Verins Victorian Health Promotion Foundation (VicHealth) Mental Wellbeing Manager, told the Senate Inquiry into domestic violence that the most significant contributors to violence against women are the unequal distribution of power and resources between men and women; and an adherence to rigidly defined gender roles.

“We know that it is possible to address these issues and to prevent violence before it occurs.”

VicHealth strongly recommends the Commonwealth government’s policy and program responses to domestic violence include a focus on primary prevention.

This includes promoting equal and respectful relationships between men and women; and reducing rigid gender roles and

60% 60% OF SEXUAL ASSAULT IN AUSTRALIA IS COMMITTED BY A PARTNER OR A FAMILY MEMBER.

August 2015 Volume 23, No. 2 21

FEATURE

TO JOIN ROSIE’S NEVER ALONE CAMPAIGN GO TO: HTTP://ANMF.ORG.AU/ CAMPAIGN/ENTRY/NEVERALONE-CAMPAIGN VICTIMS OF DOMESTIC AND FAMILY VIOLENCE AND/OR SEXUAL ASSAULT CAN CONTACT 1800RESPECT 1800 737 732 WWW.1800RESPECT.ORG.AU

A VicHealth National Community Attitudes towards Violence against Women 2013 survey of 17,500 Australians found the main influence on people’s attitudes to violence against women was their understanding of the issue and how supportive they were of gender equality. Younger people aged 16-25 generally had poorer attitudes about sexual assault, although gradually improving, whereas older people, aged 65 and above, were less likely to support gender equality and had stricter views on a woman’s role in a relationship. “Make no mistake to address, and ultimately prevent, violence against women in our community we also have to challenge the sexism, stereotypes and discrimination that women experience every day. To prevent violence we must work together to reject inequality and build a culture of respect,” RMIT University report co-author Dr Anastasia Powell says.

Government stereotypes.

The NSW Government announced last month that domestic violence prevention will be covered in high schools from this year. The syllabus will include how to identify, prevent and respond to domestic violence for students in years 7-10. Domestic Violence NSW Chief Executive Officer Moo Baulch said one million Australian children were growing up in violent households. “Young people have the power to change. We can shift this stuff within a generation.”

Access Economics in 2009 estimated domestic and family violence cost the Australian economy $13.9 billion, which would rise to $15.6 billion by 2015.

International human rights law requires that governments take effective measures to prevent and respond to prevent, investigate, punish and remedy domestic violence.

In June 2014, domestic violence in Australia was referred to the Finance and Public Administration References Committee for inquiry.

The committee was due to report in October 2014. After three extensions its findings are now due later this month.

Meanwhile the Council of Australian Governments (COAG) agreed to a national cooperative effort to reduce family violence this year, including $30 million for a national campaign to reduce violence against women and their children and potentially for increased services to support women seeking assistance. The campaign is aimed to build on efforts already underway by states and territories.

Former Governor General Quentin Bryce delivered a Queensland taskforce report Not Now, Not Ever: Putting an End to Domestic and Family Violence to Premier Annastacia Palaszcuzuk in early March. A response to the report is due after the state budget.

Bryce says: “Family violence is the ‘insidious unspoken evil that has been in our midst for too long. It crosses all socioeconomic boundaries. It causes lasting emotional and economic damage to victims and families and the future of our children. Australia must have zero tolerance to family violence.”

Perhaps as Jann in her submission to the Senate Inquiry said it best: “... this is a personal issue to each and every one of us - because if one person accepts violence against women in our society then we all fail.”

COAG’s commitment by the end of 2015: • A national domestic violence order (DVO) scheme will be agreed where DVOs will be recognised and enforceable in any state or territory of Australia.

• Progress on a national information system for courts and police in different states and territories to share information on active DVOs (NSW, QLD and Tasmania to trial the system).

• COAG to consider national standards to ensure perpetrators of violence against women are held accountable at the same standard across Australia: for implementation in 2016.

• COAG will consider strategies to tackle the increased use of technology to facilitate abuse against women, and to ensure women have adequate legal protections against this form of abuse.

22 August 2015 Volume 23, No. 2

anmf.org.au

PROFESSIONAL

‘Diseases don’t need visas’

With only 12,000 nurses at the opening ceremony and 7,000 registered delegates, numbers were lower than expected at the recent International Council of Nurses (ICN) conference in Seoul, South Korea.

This was due to an outbreak of MERS (Middle East Respiratory Syndrome Coronavirus) and as a consequence, many that were registered to attend elected not to travel to Korea to participate. At the conference the large Korean delegation were kept at a distance from the other participants attending.

Despite this, the World Health Organization (WHO) advised it was safe to travel to the Republic of Korea. WHO Director General, Dr Margaret Chan, who gave the opening keynote address to the nurse delegates from 130 countries representing the 16 million nurses worldwide, spoke about the disease.

Dr Chan talked about the conference theme of global challenges to global health with reference to MERS, stating that “diseases don’t need visas when we travel”. She also urged the public to “support the health professionals who have worked tirelessly to control the outbreak”.

MERS CoV, is a disease caused by a new virus that has a rapid onset of severe respiratory disease. Camels are suspected to be the primary source of infection, but the exact means of transmission to humans is not known and further research is needed. Transmission in healthcare settings has been a feature of the outbreak. Most of the severe cases have occurred in people with underlying health conditions that increase susceptibility to respiratory infections. All cases of MERS have occurred in people who have lived in, or travelled to the Middle East, mainly Saudi Arabia, have had close contact with people who acquired the infection in the Middle East, or anmf.org.au

can be linked to an initial imported case. There have been no cases in Australia to date.

As of 1 July 2015, WHO has reported 182 confirmed cases of MERS in South Korea, including more than 30 health workers. Thirty three people have died - a casefatality rate of 16%.

According to Dr Chan, early prevention must be the cornerstone of any future successful health systems. For this to succeed, nursing, as the the most accessible and abundant member of the health workforce internationally, must become more central in planning, policy and decision making at all levels of healthcare and community.

This requires tertiary educated nurses who practice autonomously, implement treatments and analyse investigations, otherwise global health will not improve.

We couldn’t agree with her more.

That is exactly what is needed at this very moment in Seoul. However, the reality there is quite different.

In Korea, we had the opportunity to meet with our nursing colleagues representing Public Services International and two Korean Public Service and Health Worker unions.

We shared stories of healthcare in our countries with a particular focus on the MERS epidemic. The Koreans felt it was most important nurses and healthcare workers around the world were made aware of the root causes of the MERS outbreak in Korea, in order to learn the key lessons.

Initial confirmation of the outbreak in Korea by the Korean government was slow and important information kept from the public.

Hospitals were not adequately staffed, equipped or prepared for such a crisis. This led to widespread infection inside hospitals.

According to our Korean colleagues, more than 10,000 people have been quarantined due to the risk of infection. The number of infected nurses, health professionals and hospital workers is high and continues to grow. Although difficult to ascertain, nurse: patient ratios seem to be somewhere between 1:30 and 1:50 depending on the hospital. Due to inadequate staffing, patients and their families hire informal care workers. These subcontracted workers have not been provided with proper safety equipment or training as they aren’t permanent hospital employees.

There are no restrictions to visiting and it is customary to have many visitors or family members staying in the room to assist with caring for the patient; so more people are exposed to infection with no proper safety equipment or training.

There is an acute shortage of nursing staff at small hospitals, mainly due to low wage levels. There is no standard wage rate for nurses or assistants in nursing. All healthcare is provided in hospitals as there is no community care in South Korea.

When unwell, people have no choice but to present to an emergency department. And, as was the case for the first person with MERS in Seoul, people often seek care at multiple hospitals due to crowded emergency departments.

Julianne Bryce

Elizabeth Foley

Julie Reeves ANMF Federal Professional Officers

ACCORDING TO OUR KOREAN COLLEAGUES, MORE THAN 10,000 PEOPLE HAVE BEEN QUARANTINED DUE TO THE RISK OF INFECTION. This experience in South Korea provides a salient lesson to us in Australia, that such infectious outbreaks can easily run rampant when there are inadequate numbers of qualified nurses and insufficient resources.

As Dr Chan told us, we should speak up and push back about the importance of nursing in keeping the world healthy. “Why are you so quiet,” she asked in her address.

So we aren’t being quiet!

We’re sharing our Korean nursing colleagues’ story with Australian nurses.

JULIANNE BRYCE AND JULIE REEVES WITH KOREAN NURSING COLLEAGUES

August 2015 Volume 23, No. 2 23

RESEARCH

Researchers identify higher risk of stillbirth Women who have suffered a stillbirth are four times more likely to experience the tragedy again, according to a new study of more than three million pregnant women from Australia, the UK, US, Denmark, Israel, and the Netherlands.

The study, undertaken by researchers from the University of Aberdeen, collated information from 3.4 million women with pregnancies beyond 20 weeks, 24,541 of them having suffered a stillbirth.

A total of 14,283 stillbirths occurred in subsequent pregnancies, including 606 out of the 24,541 (2.5%) with a history of stillbirth, and 13,677 (0.4%) out of the 3.3 million women with no such history.

The figures, published in the British Medical Journal, indicate that women with a history of stillbirth are almost 4.8 times more likely to experience a repeat stillbirth.

The study recommends providing pre-pregnancy counselling to women who have had a stillbirth, as well as advice on changing lifestyle factors such as smoking and obesity.

Pregnancies should be also

closely monitored and care offered at the first sign of increased risk.

Stillbirth has a variety of causes such as placental insufficiency or umbilical cord occlusions, but a substantial number of stillbirths (20%) remain unexplained.

Dr Alexander Heazell, from the St Mary’s Hospital in Manchester said the death of a child was a lifechanging event that might occur without warning or symptoms.

“Women can believe their body has let them down, and also feel guilty that they had not protected their child, or given their family member another child.”

Careers in mental health nursing driven by exposure Students are more likely to embark on a career in mental health nursing if they have been exposed to mental health through relatives and friends, new research shows.

A joint study conducted by nursing academics from Australia and the UK set out to determine the motivations behind nursing students pursuing a career working in mental health.

The study recruited UK student nurses enrolled in diploma or degree programs leading to registration as a mental health nurse. The Australian nursing students recruited for the study were enrolled in the Bachelor of Nursing degree where mental health education was only delivered as a stand-alone subject.

24 August 2015 Volume 23, No. 2

Dr Heazell said being treated by the same healthcare provider and additional ultrasounds alleviated some anxiety but cannot prepare for the worst. “Even these interventions do not remove the anxiety associated with a late stillbirth because there are no thresholds to reach, no point at which a stillbirth can be ruled out. Rather than trying to prevent or hide anxiety, care in a service dedicated to parents with a history of stillbirth exposes parents to other families with similar experiences and emotions, avoids awkward questions, and helps reduce feelings of isolation.”

Overall, the study found prior exposure to mental illness in both UK and Australian participants appeared to have a direct impact on a decision to consider a career in mental health nursing.

In the UK, 54% of participants indicated they had previous experience of mental health issues, either personal or professional, and 48% said the main motivational factor in choosing or not choosing a career in mental health nursing was based upon personal experience.

Approximately 61% of the Australian cohort had never had previous experience of mental health issues either personally or professionally. However 24% said personal experience was the major motivation factor for choosing a career in mental health nursing once registered.

Lead author for the study, Australian Catholic University’s Associate Professor of Nursing Research Karen-leigh Edward

24,541 THE STUDY, UNDERTAKEN BY RESEARCHERS FROM THE UNIVERSITY OF ABERDEEN, COLLATED INFORMATION FROM 3.4 MILLION WOMEN WITH PREGNANCIES BEYOND 20 WEEKS, 24,541 OF THEM HAVING SUFFERED A STILLBIRTH.

said the study’s finding had implications for the way Australia educated its undergraduate students moving forward with regards to making a career in mental health nursing more desirable.

She said while there was a push for Australia to introduce a separate mental health nursing course, this was not necessarily the conclusion from the study, but rather that a greater exposure to mental health nursing in undergraduate programs via career immersion or simulation could trigger positive impacts.

Senior lecturer in nursing at Federation University Dr Philip Warelow, who co-authored the paper, said he hoped the study would provide a framework for recruiting more nurses in the mental health field. He said Australia should shift to a similar model to the UK and adopt a speciality course for mental health nursing, as currently, many graduates did not feel prepared enough to tackle the job. anmf.org.au

LEGAL

Best interests of the child: who decides?

Linda Starr

Being told your child has a terminal illness would be shattering news for any parent. Navigating the best treatment plan to cure your child would no doubt be all consuming. However, this can be even more treacherous when there is disagreement between the treating practitioner and the parents as to what is in the best interests of the child.

The Inquest into the Death of Tamar Stitt (2014) considered this very matter. Tamar had been a healthy 10 year old girl when she was diagnosed with liver cancer early in August 2009. Her treating oncologist having considered the results of various tests and investigations concluded that the best course of action would be to commence chemotherapy as soon as possible looking at a prognosis of a 50-60% chance of a longer term cure.

IT IS CLEAR THAT THE PARENTS WERE FRIGHTENED AND FELT THAT THEY WERE BEING GIVEN NO CHOICE BUT TO ACCEPT CONVENTIONAL TREATMENT FOR THEIR DAUGHTER’S CANCER.

Reference Inquest into the Death of Tamar Stitt (2014) Western Australia Australian Doctor ` Naturopath charged by child abuse squad’ accessed on line 10July 2015 at http://www. australiandoctor.com. au/News/Latest-News/ Naturopath-charged-bychild-abuse-squad

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

Tamar’s parents however, decided to treat her cancer with natural therapies. The treating oncologist was aware of the distress the parents were experiencing and that they felt vulnerable and fearful.

As such a number of attempts were made to reassure and engage them in further discussion to allay their concerns with respect to the proposed treatment. The parents and their extended family were also offered the services of the hospitals clinical ethics service in the hope that this would resolve their differences.

However, none of these offers were accepted.

On 25 August the oncologist wrote to the parents following their failure to engage with the treating team, outlining the proposed course of treatment that would provide Tamar with the greatest chance of long term survival. She also made it clear that she did not support alternative therapies to treat this cancer and that she had a legal and ethical duty to act in Tamar’s best interests. An extract of the pertinent points was included in the Coroner’s report: “I understand that this type of therapy is extremely daunting

for parents and their children. We would never embark on such therapy without good cause. It is, however, the only known therapy that would provide Tamar with any chance of long-term survival. Without it, in my opinion, and those of my colleagues at PMH, she will die. I understand that you may not agree with this statement, but it is supported by extensive medical literature. While I would never aim to usurp your place as parents in the care of your daughter, once she presented to PMH I became ethically, professionally and legally obliged to seek the best medical care for Tamar.

This is my sole motivation in writing this letter and outlining the plan for Tamar’s treatment.” 60 (p 29-30) The parents were nonetheless committed to pursuing a program of natural therapies and had been given the name of a GP who had a reputation for working with cancer patients using alternative remedies.

An appointment was made for 1 September for the purposes of obtaining a medical opinion as to whether Tamar was fit to fly to El Salvador for further natural therapy treatment and to assess Tamar’s tumour for any signs of shrinkage.

This doctor ordered numerous tests including an ultrasound of the liver which he used to compare the size of the liver tumour with a CT scan done by the hospital one month earlier. For unknown reasons the doctor advised Tamar’s parents that the tumour was smaller despite no evidence before him to support this. Unfortunately this convinced Tamar’s parents that their choice of natural therapies was correct and proceeded with their plan to take Tamar overseas having been given medical clearance to do so.

At this time, an urgent application to the Supreme Court of Western Australia under its Parens Patrie powers was made by the Minister of Health seeking orders for Tamar’s parents to bring Tamar to the hospital for chemotherapy to treat her liver cancer, metastatic disease and all other necessary supportive treatments. This

application did not proceed as Tamar left Australia the day before it was set down for hearing.

Tamar continued to receive alternative treatments but by 21 October it was clear that her clinical condition had deteriorated. Ironically she began the same course of chemotherapy as prescribed in Australia, on 22 and 23 of October.

Unfortunately as her condition was now so advanced she died three weeks later. The cause of death was multiple organ failure and septic shock due to complications of advance metastatic liver cancer.

It is clear that the parents were frightened and felt that they were being given no choice but to accept conventional treatment for their daughter’s cancer. They were worried that she would be made a ward of the state and that the chemotherapy would kill her, in their minds natural therapy was going to cure her.

On the other hand, the oncology team with considerable experience in paediatric oncology believed that the chemotherapy plan they had devised was the best possible course of action to give Tamar the greatest chance of survival. Both parties it seems were working at odds with each other and yet both believed they were working in the best interests of the child. Who should decide?

Just this week a young mother and a naturopath were arrested and charged in Sydney following a young boy’s admission to hospital after being almost starved and on the ‘brink of death’. It is alleged that the boy’s mother was looking for natural therapies to treat her son’s eczema when the naturopath gave her advice that police say almost starved the young baby and advised her to stop all medical and dermatological treatments that had been prescribed for him. Rather than the parent’s Patrie Power of the court being invoked, it was detectives from the Child Abuse Squad who took action.

The mother has been charged with recklessly causing grievous bodily harm whilst the naturopath has been charged with two offences one of which is aiding and abetting a mother in failing to provide for the child. At this point there is limited information as both parties are to appear in court at a later date.

However, on what little information is available there as yet has been no mention of any argument based on the child’s best interests (Australian Doctor 9 July 2015).

August 2015 Volume 23, No. 2 25

CLINICAL UPDATE

26 August 2015 Volume 23, No. 2

Risk of Injury

anmf.org.au

Risk of Injury

Nurses at risk of injuries Risk of injury is one of the major concerns in the healthcare industry. Studies have found that nurses are the most common victims of needlestick injuries and workrelated musculoskeletal injuries (WMSIs) to the neck, shoulder and back (Smith, 2012).The intricacy and combination of different tasks involved in patient care may lead to higher risk of injuries. The risk factors which may contribute in causing occupational injuries include, manual lifting of heavy loads on back and shoulder, fatigue due to shift work or working long hours, uncomfortable posture and extra forces required in moving clients and objects.

To prevent increased number of injuries and to outline the role of employers and workers in order to maintain a safe workplace environment, the Australian government has set out a system of laws, legislations and policies known as the Occupational Health and Safety Act (OHS). This Act originally came into effect in 1986 and was frequently reformed until 2011 to ensure a risk free, healthier and safer working environment for workers in Australia (Australian Government ComLaw, 2011).

According to WorkSafe Victoria (2009), approximately 71% of nurses suffered from WMSIs, followed by 13% injuries caused by needle sticks. Back pain was found as one of the most common musculoskeletal disorders, triggered by the manual handling of patients (Burdorf, Koppelaar & Evanoff, 2013). The occupational injuries often become chronic, not only affecting nurses’ quality of life but also impacting on their organisation’s productivity.

Additionally, evidence shows nurses with WMSIs will often either take long leaves or quit the profession permanently, which contributes to shortages in the nursing profession (Gropelli & Corle 2011).

In response to this and other workplace injuries Australian anmf.org.au

occupational health and safety (OHS) laws seek to prevent work place injuries, as well as compensate and rehabilitate injured workers. The regulatory framework consists of the OHS Act which originally came into effect in 1986 and then was frequently reviewed and reformed by Federal Parliament. This Act, currently known as the Work Health and Safety (WHS) Act 2011, consists of administrative and legislative measures designed to promote risk free working environment in Australia (Australian Government ComLaw, 2011). Similarly, the OHS Act 2004 is the keystone in promoting occupational health and safety in Victoria. Part of the Act also enforces duty on the employers to ensure risk management.

(WorkSafe Australia, 2013).

ADDITIONALLY, EVIDENCE SHOWS NURSES WITH WMSIS WILL OFTEN EITHER TAKE LONG LEAVES OR QUIT THE PROFESSION PERMANENTLY, WHICH CONTRIBUTES TO SHORTAGES IN THE NURSING PROFESSION

The fundamental principles include: • establishment of risk free work environments; • protection of workers and others from potential hazards at the workplace; • equip working individuals with industry related information; • education and training and provide a structure of everlasting improvements, and • to increase higher standards of work, health and safety (WorkSafe Australia, 2013).

The Victorian Nurses Back Injury Prevention Project (VNBIPP), which is currently in force, also carries out initiatives to counteract injuries based on ‘No Lifting’ principles.

The VNBIPP was established in 1998 due to increased numbers of nurses who suffered from WMSIs

CLINICAL UPDATE

and the significant amount of financial and human cost related to such injuries (Department of Health, 2011). The project is funded by the Department of Human Services.

Occupational Health and Safety policies have played a significant role in minimising occupational injuries in order to establish a safe working environment for healthcare workers including nurses.

Consequently, the risk context is diverging depending on the nature of work, position of the worker and the workplace itself (Smith 2012).

Research indicates that the main causes of WMSIs are lifting and repositioning heavy objects and prolonged standing. Employers in Australian healthcare industries are obliged to be compliant with the Occupational Health and Safety Management System (OHSMS) and have legal obligations to accomplish the goal of safe working practice (Smith, 2012). According to the current WorkSafe OHS Regulations 2007, manual handling of patients must be eliminated and patients should be encouraged to bear their own weight during transfers (WorkSafe, 2009).

Nurses are encouraged to be involved in customising the patient handling environment, including use of preferred methods and equipment. Nurses must be supplied with electronically handled equipment, along with the sufficient space for safe movements and patient transfers (ANF Vic Branch, 2009).

Assessments should be carried out and documented prior to the patient’s admission stating the risk factors to the carer and patient’s ability to move independently.

Risk assessments should include physical environment (furniture, space and equipment), working practices (training, work hours, staff numbers) and patient’s ability to assist. Measures should be taken to minimize or eliminate risk factors (ANF Vic Branch, 2009).

It has been estimated that nurses carry large weights, which coupled with the restrictions constrained on body movements by the physical environment, may contribute to the greater risk of injury for nurses (Wyk, et al, 2010).

The environmental factors that contribute to the potentially risky postures and movements are hospital equipment and furniture, assistive devices and presence of other hospital staff. Non-neutral

References Australian Government ComLaw. 2011. Work Health and Safety Act 201. Retrieved From www.comlaw.gov.au/ Details/C2011A00137 Australian Nursing Federation. 2009. No lifting Policy. Retrieved from www.anmfvic. asn.au Burdorf, A., Koppelaar, E., Evanoff, B. (2013).

Assessment of the impact of lifting device use on low back pain and musculoskeletal injury claims among nurses. Journal of Occupational& Environmental Medicine, 70(9), 491-497.

Department of Health.

2011. Victorian Nurses Back Injury Prevention Project. Retrieved from www.health.vic.gov. au/nursing/promoting/ back_injury Gropelli, T., Corle, K. (2011). Assessment of Nurses’ and Therapist’ Occupational Musculoskeletal Injuries.

Medsurg Nursing, 20(6), 297-304.

Gershon, R, M., Pogorzelska, M., Qureshi, K, A & Sherman, M. (2008).

Home healthcare registered nurses and the risk of percutaneous injuries : A pilot study.

American Journal of Infection Control, 36(3), 165-170.

August 2015 Volume 23, No. 2 27

CLINICAL UPDATE

Risk of Injury

and awkward body postures places an increased force on body tissues which can lead to fatigue and musculoskeletal injuries. Stress of time restriction also intensifies the pressure on nurses while performing greater number of tasks in limited amount of time and therefore leads to an overexertion WPMIs (Wyk, et al. 2010). In such situations, completion of tasks with safety becomes less important. While overextension, time restriction and awkward posture are some of the contributing factors to the high number of WMSIs in nursing, the focus on literature regarding training has also been absent. In order to integrate with these substantially challenging tasks, it is crucial that nurses receive sufficient training in proper manual patient transfer techniques which may include lifting, relocating and lowering a patient, (Wyk, et al, 2010).

Even though, ‘No lifting’ policies has come into effect in healthcare settings Australian wide , research reveals that manual patient handling must be completely phased out to comply with the policy.

However, there are barriers in implementing lifting devices at healthcare settings, (Burdorf et al, 2013). Despite this measures can be taken to overcome issues, such as: motivating employees to use lifting devices and abide by no lifting policies, an environment where the management is encouraging of its policies, opportunity for employees to make decisions and easy attainability of devices (Burdorf 28 August 2015 Volume 23, No. 2

et al, 2013). Adequate information and training on handling electronic devices and lifting machines is also important for safe working practice.

Needlestick injury is another issue faced by the nursing profession. Nurses come in contact with sharps more frequently than the general public, which leads to a higher risk of exposure to bodily fluids and blood, therefore causing an increased risk of pathogens exposure (Gershon, et al, 2008).

A system of work and disposal techniques should be adopted accordingly to eliminate the hazards. Recent surveys, however, have pointed to a decline in needlestick injuries which indicates an effective control and increased awareness in healthcare settings (Smith, 2012).

The above discussion highlights that the work related musculoskeletal Injuries (WMSIs) are the most common type of occupational injuries nurses experience in Australia. An injured workforce of nurses can negatively impact organisational productivity and delivery of care as well as lead to professional shortage by reducing the number of employable nurses. The Australian occupational health and safety laws have established guidelines and policies for both the employers and employees to ensure safe working practices. A safety focused environment will not only address the issues easily as they arise but will also develop the best practice models.

EVEN THOUGH, ‘NO LIFTING’ POLICIES HAS COME INTO EFFECT IN HEALTHCARE SETTINGS AUSTRALIA WIDE RESEARCH REVEALS THAT MANUAL PATIENT HANDLING MUST BE COMPLETELY PHASED OUT TO COMPLY WITH THE POLICY. Ambreen Zubair is a Bachelor of Nursing student at the Victoria University, St Albans Campus, Victoria

Smith, E, M. (2012).

How are nurses at Risk?

Journal of Work. 41, 1911-1919.

Work safe Victoria.

2008. A hand book for workers. Transferring people safely. Retrieved from www.worksafe.vic. gov.au Wyk, P, M., Andrews, D, M., Weir, P, l. (2010).

Nurse perception of manual patient transfer training: Implications for Injury. Journal of Work, 37, 361-373.

WorkSafe. 2009.

Transferring People Safely. Retrieved from; www.worksafe.vic. gov.au/__data/assets/ pdf_file/0011/12224/ Transferring_People_ Safely_-_Web.pdf WorkSafe. 2013.

Victorian Occupational Health and Safety Compliance Framework Handbook. Retrieved from www.worksafe.vic. gov.au/__data/assets/ pdf_file/0006/63285/VicCompliance-FrameworkHandbook_26June-2013.pdf

anmf.org.au

WORLD

Lack of sanitation for 2.4 billion people undermining health progress A lack of sustained progress on sanitation threatens to undermine the child survival and health benefits gained from access to safe drinking water, warns the World Health Organization (WHO) in a report tracking access to drinking water and sanitation against the Millennium Development Goals.

The Joint Monitoring Programme report, Progress on sanitation and drinking water: 2015 update and MDG assessment, found one in three people, or 2.4 billion, still live without sanitation facilities – including 946 million people who defecate in the open.

Head of UNICEF’s global water, sanitation and hygiene programs, Sanjay Wijesekera, said the data illustrated more needs to be done to reach universal access to sanitation by 2030.“The global model so far has been that the wealthiest move ahead first, and only when they have access do the poorest start catching up.”

Access to improved drinking water has been one of the major achievements across the international community, with some 2.6 billion people gaining access since 1990, and 91% of the global population now enjoying improved drinking water. For example, in SubSaharan Africa, 427 million people have gained access, or an average of 47,000 people per day every day for

FOUND ONE IN THREE PEOPLE STILL LIVE WITHOUT SANITATION FACILITIES

25 years.

Child survival rates have also improved significantly, with fewer than 1,000 children under five dying each day from diarrhoea caused by inadequate water, sanitation, and hygiene compared to over 2,000 15 years ago.

Despite the inroads, progress on sanitation has been stalled by insufficient investment in behavioural change campaigns to curb social norms which accept or even encourage open defecation.

Although more than 2 million people have gained access to improved sanitation since 1990, the world has fallen 700 million short of the MDG target. Today, just 68% of the world’s population uses an improved sanitation facility, 9% below the projected target.

Nurses and midwives oppose Trans-Pacific Partnership The New South Wales Nurses and Midwives’ Association (NSWNMA ANMF NSW Branch) has joined healthcare workers from across the Pacific, Latin America, and North America, in condemning the contentious Trans-Pacific Partnership (TPP) trade deal.

The NSWNMA, along with other nursing bodies, has signed on to an open letter to trade ministers and government leaders, in a bid to highlight the threat the TPP poses to equitable and accessible healthcare.

NSWNMA (ANMF NSW Branch) General Secretary Brett Holmes said thousands of nurses and midwives across the country shared significant concern about the deal.

“We’ve been given assurances from the Minister for Trade that our healthcare system will be unaffected but these assurances don’t stack up to academic rigour.”

“As healthcare professionals, we base our actions on evidence not hearsay. That’s why we’re imploring the Abbott Government not to sign onto the TPP until the text is anmf.org.au

released in full and the community can have an open debate,” he said. We’re not opposed to trade, but we do oppose the profits of multinationals being put before our community’s health needs.”

The open letter details how the TPP will result in the cost of medicines rising, as access to generic medicines is delayed and pharmaceutical manufacturers are given easy access to government decision-making bodies. The letter also raises concerns regarding limits on the government’s ability to regulate healthcare providers, including restrictions on adequate food labelling, and giving the green light to private healthcare multinationals having a greater influence on healthcare policy.

Nursing shortage tipped to hit Canada Employers may attempt to fill looming gaps in Canada’s nursing workforce by turning to overtime to meet growing workload demands.

For the first time in two decades, more regulated nurses across the nation left the profession than entered it, according to data released from the Canadian Institute of Health Information (CIHI).

Regulated nurses include registered nurses (RNs), licensed practical nurses (LPNs), and registered psychiatric nurses (RPNs).

In 2014, the supply of regulated nurses dropped by 0.3% from the past year.

The decline occurred because fewer nurses applied for registration or chose to renew their registration.

Retirement is considered a major contributor to Canada’s declining workforce and the amount of regulated nurses approaching retirement age continues to grow.

According to CIHI’s report, almost 26% of regulated nurses are aged 55 or older and 40% are aged 50 or older.

The CIHI report also noted that the number of students enrolling in Entry-to-Practice (ETP) RN programs has been falling since 2009-2010.

The shortage could prompt employers to fall back on increased overtime to meet workload demands.

The Canadian Federation of Nurses Unions (CFNU) latest overtime and absenteeism report for 2015 revealed that nurses worked more than 19 million hours of overtime in 2014, triggering a cost of almost $872 million.

More than 20% of overtime worked was undertaken by nurses without being paid.

The excessive overtime and workload situation is blamed for nurses’ absenteeism rates rising in 2014 and placing further strain on Canada’s already stretched healthcare system.

The CFNU, which represents almost 200,000 nurses, has expressed its concern about the retention and recruitment of nurses for many years and says the data needs to be acted upon.

“The decrease in the nursing supply combined with an ageing workforce and fewer students admitted to ETP programs is a sign that our health care workforce is in transition,” CFNU president Linda Stiles said.

August 2015 Volume 23, No. 2 29

ISSUES

Perceived difference of roles between the registered nurse and enrolled nurse Deborah Armitage, Sally Milson-Hawke, Tracey Payne and Ann Williams An investigation of perceived differences in roles of registered nurses (RN) and enrolled nurses (EN) from the perspective of novice and experienced RNs in a New South Wales tertiary referral hospital was recently undertaken.

In New South Wales an EN is a person who has completed an approved vocational education program and an RN is a person who has completed an approved tertiary qualification. Both are licensed under the Health Practitioner Regulation National Law (NSW) Act, 2009.

The EN is an associate of the RN, practicing with RN support and professional supervision (NSWNMA, 2013). Enhancement to EN education in Australia from certificate to diploma has led to a significant increase in skill and knowledge and ‘the enhanced scope of practice has seen the role of the enrolled nurse extend into what have traditionally been domains of practice of RNs’ (Jacob et al 2012).

Delegation ‘Delegation is a multi-level activity involving rational decision making and risk assessment which takes into consideration the education and training of ENs and healthcare workers and the context of care’ (Australian Nursing and Midwifery Council 2007). RNs retain accountability for delegated tasks and for the overall standard of care.

An RN in charge may delegate care to an EN however once delegated this may not be re-delegated by the EN to another person (Nursing and Midwifery Board of Australia 2007).

The Board differentiates delegation from allocation or assignment of care which only occurs if the care required by the patient is within that person’s responsibility and scope of practice. Both the Council and the Board are clear that factors regarding competence assessment and supervision relevant to delegation must also be considered in allocation or assignment. While competency standards define a minimum set of skills for registration, the scope of nursing practice is that which nurses are educated, competent 30 August 2015 Volume 23, No. 2

and authorised to perform and is influenced by: ‘the context in which they practice, clients’ health needs, and level of competence, education and qualifications of the individual nurse/midwife’ (cited in Queensland Nursing Council, 2008). Hence, role differentiation relates less to task and more to accountability, delegation and supervision. Observation of clinical practice in the context in which the study was undertaken, suggested that role differentiation was not well understood evidenced on occasion when the care and clinical decision making for the most acutely unwell patients was undertaken by an EN with no evidence of collaboration with an RN. This situation can arise if an EN assumes practice independence or an RN is unaware or chooses to abdicate their supervisory/delegatory role.

The method Between November 2014 and February 2015, RNs were asked to provide written responses to the question: What is the difference between an RN and an EN? In total 153 responses were received, primarily from nurses working in surgical and medical wards, representing 21.1% of the 725 nurses employed in these areas.

Seventy-seven novice RNs (less than two years clinical experience) and 76 experienced RNs (two or more years’ clinical experience) participated.

Findings Three major themes arose from the data: role differentiation, practice issues, and professional issues.

Role differentiation Very few respondents, (four novice and five experienced RNs), reported ‘little difference’, ‘no difference’ or ‘didn’t know the difference’ in roles.

Practice issues Ninety-one percent of both groups identified S8 medication management and/or carrying the S8 medication keys as a difference between an RN and an EN, and five novice RNs and eight experienced RNs identified this as the only difference. ‘An EN can do everything that an RN can do except carry the medication keys’ (novice RN), and ‘I

feel that both RN and EN are doing the same work other than carrying the S8 drug keys’ (experienced RN).

Professional issues Sixty two novice RNs and 67 experienced RNs identified differences in professional issues citing ‘in charge’, ‘responsibilities’, and ‘accountability’, reflected in the following statements: ‘The RN tends to be in charge of the ward’ (novice RN), ‘RNs are held more accountable than ENs’ (experienced RN) and ‘The buck falls with the RN’ (novice RN). There was some confusion about the professional regulation and role of ENs2, highlighted by the following statements: ‘ENs don’t register through AHPRA’ (novice RN), ‘An RN is registered with the NMBA and an EN is not’ (novice RN), and ‘An EN doesn’t take on clinical responsibility’ (experienced RN).

Discussion While experienced RNs were almost twice as likely as novice RNs to identify the in-charge role as a role difference, over 90% of both groups identified S8 medication administration and/or carrying the S8 keys as role differences. If task is considered by nurses as the only way to differentiate scope of RN and EN practice then this task, mandated by legislation, is really the only one that is consistent across Australia. It is not surprising therefore that these two are the only tasks identified by both groups in large numbers closely followed by educational preparation identified equally in both groups.

Lack of reference to delegation which was only mentioned by five participants was surprising however delegation may have been implied when citing ‘in-charge’ a term provided by 50% of participants.

Conclusion All nurses have a professional responsibility to understand and work within their scope of practice.

These findings indicate that ongoing education on the different roles and scope of practice of ENs and RNs is required both at the undergraduate level to ensure new graduates enter the workforce with sufficient understanding of scope of practice and in continuing professional development education.

References on request

Deborah Armitage, CNC (Older Person Acute Care) Medical & Interventional Service, Sally Milson-Hawke is Director of Nursing and Midwifery, Tracey Payne is Acting Nurse Educator, Surgical Services, Ann Williams is a Nurse Educator, Medical & Interventional Service. All are at John Hunter Hospital anmf.org.au

WORKING LIFE

Healthcare on the inside

By Robert Fedele Victoria’s Dhurringile Prison’s close-knit team of nurses is committed to improving the health of inmates without judgement.

“What we find is that we make a difference in a lot of these guys’ lives,” said Dhurringile Prison’s Health Services Manager and registered nurse Dianne Orr. “We have to because they may come from homelessness, or off the street, or really heavy drug use. We get them healthy.”

Dhurringile Prison is a minimum security jail located in Murchison, just south of Shepparton, in country Victoria. The facility holds 320 male prisoners aged from 20 to 75, said Dianne. “[Including] some that have been in the system for forever and a day”.

Dianne manages a team of 13 nurses, which includes three mental health nurses that provide everyday healthcare to inmates.

Most arrive at Dhurringile by way of minor charges or at the last third of their sentence.

“We’re not only minimum security but we’re what they call a discharge prison,” Dianne explains.

“We prepare them to release them back into the community.”

Dianne began nursing at 17 in Melbourne at the Heidelberg Repatriation Hospital. She spent many years working as a nurse before moving to country Victoria and taking a break. It wasn’t long before she undertook a re-entry program in Benalla and resumed the job.

“I didn’t want to go back into nursing because I thought I was a bit burnt out. But I don’t think the passion really dies. Once you’re a nurse you’re always going to be a nurse,” she said.

Dianne was working at the Shepparton Private Hospital when an opportunity presented to take on a shift as the HSM at Dhurringile for one day a week. It turned into a fulltime role and Dianne has now been at the prison for seven years.

Dianne said she never felt frightened working at the prison. “It’s not a dangerous job. “They are [the prisoners] not fuelled with drugs or alcohol. They’re here in prison doing their time. I would be more scared of anmf.org.au

what might come through the door at an emergency department.”

Dhurringile’s medical unit is facilitated by Correct Care Australasia, which supplies health care to 12 out of 14 prisons across Victoria. The prison population covers a whole gamut of people and cultures.

about working in a prison environment had made it difficult to recruit new nurses.

Most positions were filled from word of mouth, she said, adding that she found it disappointing more people were not giving the job a go.

“It’s fear of the unknown and the

DIANNE ORR (LEFT) AND CHRIS FLOWER

EVERYTHING YOU WOULD FIND IN THE COMMUNITY WE HAVE HERE. WE DO EMERGENCY AND PRIMARY CARE. WE HAVE HEALTH PROMOTION. WE HAVE CHRONIC DISEASE MANAGEMENT. “Everything you would find in the community we have here. We do emergency and primary care. We have health promotion. We have chronic disease management. We treat injuries,” Dianne said. “The community expects us to release these guys healthy and not a burden on society and we try really hard to assist them to get to that place.”

Dianne said correctional nursing presents unique challenges, but is adamant the benefits are profound.

“Sometimes they get a bit mouthy here but they don’t generally harass the health staff because we’re not part of the prison.”

Dhurringile is a working prison and inmates spend their days carrying out jobs like woodwork, maintenance, or getting their hands dirty out on the 300 cow dairy farm.

According to Dianne there is a mix of health issues, but some of the more common include dislocations and fractures from playing football or lifting weights.

On one occasion a prisoner was kicked twice in the jaw by a cow at the dairy farm, she said.

Emergency situations were rare but stabbings and assaults did occur from time to time, said Dianne.

Dianne said ongoing stigma

concept the general public has and even the health profession has about prison nursing, Dianne said. “It’s hard because people don’t know what it’s like. It’s a great job. It’s safe and you feel like you’re making a difference.”

One of the nurses at the prison Chris Flower echoed Dianne’s sentiment. “We probably develop quite a good rapport with our clients here. We do get to spend one-onone time with them,” she said. “I like the ability to be able to think independently. We have a boss, of course, but we all have to make our own decisions based on our experience and knowledge.”

There are no walls or fences at Dhurringile and prisoners meander about in their stock standard dark green uniforms. Dianne chats jovially to them and it is clear there’s a level of trust and respect on both sides.

“The frustrating thing will be when the guys, you do what you can for them, and they get out and come back. And we have a lot of those.

“You can measure how long you’ve been in the system by the number of people that you see come back. This is not necessarily that they’re bad. A lot of these guys don’t have anywhere to go.”

DHURRINGILE PRISON: THE FACTS DHURRINGILE PRISON IS A MINIMUM SECURITY JAIL LOCATED IN MURCHISON, JUST SOUTH OF SHEPPARTON, IN COUNTRY VICTORIA.

320

MALE PRISONERS

THE FACILITY HOLDS 320 MALE PRISONERS

20-75 AGED FROM 20 TO 75

August 2015 Volume 23, No. 2 31

VIEWPOINT

Nurse initiated hospital greening Patricia Schwerdtle Concern about climate change is no longer considered a passing fad.

Climate change is well recognised to be the defining challenge of our generation (Horton et al. 2015).

Environmentally sustainable practice is not necessarily regarded innovative either, but rather an expectation of large organisations.

The environmental movement that began in the 1960’s is now less concerned with convincing the sceptical minority and more concerned with moving forward in recognition that we are the last generation who can mitigate climate change.

Green culture has grown exponentially with increasing recognition that we are global citizens who have a responsibility to future generations to sustain our physical environment (Flannery et al, 2014). Increasing international attention is also being paid to our planet in political, economic, social and health sectors alike.

Ironically, the very industry charged with preventing illness, preserving health and treating disease is one of the most serious contributors to environmental degradation.

And we as nurses are the largest professional group within this industry.

First do no harm: The health sector as a major polluter The World Health Organization (WHO) labelled the health sector as one of the biggest energy and water consumers and sources of greenhouse gas emissions (WHO, 2009). Hospitals commonly use 2.5 times more energy and water than commercial buildings (HEA, 2009). While some Australian hospital networks have committed to addressing energy and water use, more attention needs to be paid to energy efficiency including low energy consuming medical equipment and sustainable energy sources. Water consumption can be inefficient with routine high use and disposal of water containing detergent, bleach and disinfectant by cleaning, kitchen and laundry staff. Although healthcare

networks are required to audit, measure and track energy and water consumption, their commitment to reducing, reusing and recycling is varied and inconsistently enforced.

Victorian public healthcare services generate 42,000 tonnes of solid waste annually, the cost of which to dispose was $17 million (DOH, 2011). While Australian homes manage to recycle an average of 60%, hospital recycling rates are closer to 20% (DOH, 2011; Sustainability Victoria, 2011). Furthermore, inappropriate and over-use of infectious waste bins can lead to inappropriate incineration. Most concerning is incineration of mercury: a neurotoxin that accumulates in the food chain (Topf, 2005). When vinyl and latex is incinerated it releases dioxin, a known carcinogen, into the air and waterways (Topf, 2005). Use of disposable products in hospitals continues to increase exponentially despite limited landfill space and dwindling natural resources (Gilden, 1992). A systematic method for recycling print cartridges and disposal of small batteries used for cardiac devices is absent in many hospitals (Sattler, 2002).

Polystyrene cups tossed by the truckload, do not biodegrade and have toxic byproducts (EPA, 2000).

The link and the paradox: The environment and health Climate Change is known to be the biggest global health threat of our time and is already contributing to increasing public health problems, including measureable increases in malaria, diarrhoea and malnutrition (Pinkerton & Rom, 2014; Ezzati et al, 2004). Injury and death related to extreme weather, worsening chronic illness, the spread of infectious and vector borne disease, resource conflict, deteriorating food quality and availability, declining air quality and the displacement of populations: All are a result of climate change and all impact on human health and well-being (Costello et al, 2009; AMA, 2008). Unfortunately, this is coupled with a widespread lack of awareness of climate change as a health issue (Horton et al. 2015).

Yet we are in the midst of a great paradox. When nurses stop to reflect, we realise that we are addressing the healthcare needs of individuals

today, at great expense to the health of future generations. Nurses realise that hospitals are more than employers and businesses. They are made up of benevolent healthcare professionals who commit to first doing no harm and have a wider responsibility for the health of populations, not just individuals and not just today, but also those of the future.

Why nurses?

The key to addressing this paradox may rest with the largest profession in the health sector: nurses. More than 257,200 nurses practise in Australia, therefore roughly every 87th Australian is a nurse (ABS, 2011). There is strength, wisdom and safety in numbers. Nurses are at the forefront of healthcare, trialing, ordering, using and disposing of products, performing procedures requiring energy and water, identifying and acting on environmental hazards and nurses also create the most waste (Munoz, 2012).

Nurses commit to first doing no harm, they engage in holistic care and have a responsibility to serve the public. Nurses are highly represented in most levels of management, governance and quality control, putting them in an ideal position to advocate for green programs. The Lancet Commission into Health and Climate recently asserted that health professionals have a vital role to play in tackling the health impacts of climate change and calls on them to lead the response and advocate for environmentally sustainable change (Horton et al. 2015).

Having clarified the threat and the potential, how can we initiate change?

Nurses need to ‘become the change they want to see in the world’ and that is not as difficult as you may think. Table 1: ‘Nurse initiated Hospital Greening’ contain a list of actions nurses can take in their own workplaces. They are within hospital policy and don’t require many resources.

Big changes often start simply with someone motivated and informed starting a new conversation. Change can begin with you and it can begin today.

References on request

Patricia Schwerdtle is a Lecturer at Monash University School of Nursing and Midwifery Faculty of Medicine, Nursing and Health Sciences

Table 1: ‘Nurse Initiated Hospital Greening’ INFORM • Look into existing green infrastructure; projects, committees & policy • Discover where your rubbish goes • Intranet search: Environmental Management Plan • Find out who is responsible for ordering. Ask them about Environmental considerations 32 August 2015 Volume 23, No. 2

NETWORK AND RECRUIT • Start a ‘Green Team’.

Nominate a ‘Green Champion’ • Connect and recruit volunteers using social media and email • Link up with other wards and departments

ACT • Add ‘recycling’ to the nurse meeting agenda • Aim for small wins. Keep messages positive and inclusive • Post simple signage: ‘Consider the planet before you print’ • Run an in-service on correct waste disposal

COMMUNICATE • Communicate and celebrate achievements • Add a ‘Green Story’ to the hospital newsletter • Talk to your managers about your ideas • Discuss paper/battery recycling with clerical staff anmf.org.au

WELLBEING

Shifting the perspective on sleep Robert Fedele The field of nursing and midwifery often requires the flexibility and capacity to undertake shift work across all hours of the day to ensure patients are cared for around the clock.

This necessity, however, presents increasing challenges when it comes to getting enough quality sleep in order to carry out required duties at a satisfactory level.

A study investigating fatigue and performance impairment found staying awake for 17 hours straight was the equivalent to registering a blood alcohol concentration of .05 (Dawson and Reid 1997).

The alarming finding illustrates the importance of nurses getting sufficient sleep in order to have the confidence to maintain a consistent standard of care.

Professor Sally Ferguson, from the Appleton Institute at Central Queensland University, has examined the subject of sleep and circadian challenges in shift work and has drawn numerous recommendations from her studies.

Speaking at the ANMF Victorian Branch delegates’ conference last month, Professor Ferguson said sleep was broken down into five stages, ranging from lighter or more disrupted sleep, to dreaming sleep.

All sorts of things are occurring during sleep, including tissue growth and repair, energy being restored, and blood supply being increased to muscles.

Professor Ferguson said the optimum amount of sleep is at least seven hours in order to maintain the ability to work productively.

Studies have shown that levels of performance drop dramatically when a person has five hours of sleep or less.

Our physiological functions are generated by the clock in our brain and as humans we are tuned to a 24 hour cycle and wired to wake up in the morning, cued by the light of day.

“You will tick along on whatever time it is on your clock and that is determined by our genetics,” Professor Ferguson said. anmf.org.au

ALL SORTS OF THINGS ARE OCCURRING DURING SLEEP, INCLUDING TISSUE GROWTH AND REPAIR, ENERGY BEING RESTORED, AND BLOOD SUPPLY BEING INCREASED TO MUSCLES.

Working outside these boundaries is obviously unnatural but for nurses, sleeping during the day or less than seven hours overnight is part and parcel of the job.

Unfortunately, the ripple effect is disrupted sleeping patterns, less quality sleep, and potentially, spiralling fatigue.

Professor Ferguson described fatigue as the decreased capability to perform mental or physical work due to inadequate sleep.

The core consequences of fatigue include: • Deterioration of mood • Speed and accuracy suffer with more errors • Reduced vigilance and impaired concentration • More risk taking In a study into fatigue in 2005, Professor Ferguson found numerous sources who reported fatigue related issues had impacted adversely on patient safety.

The evidence ranged from minor incidents such as “I was standing by the bed of a patient and almost fell on them when I went to sleep” to “death of a baby that was supposed to be fasting. I gave permission for the mother to feed…”

Professor Ferguson found 18% of fatigue related incidents occurred on a night shift and a further 17%

occurred while driving home.

She says managing fatigue requires more than just prescriptive rules about sleep.

“The work hours aren’t the problem. The problem is that they haven’t had enough sleep.”

Some crucial points to consider managing fatigue include:

Fatigue management • discussions about fatigue and

safety need to take place as part of workplace Occupational Health & Safety; • work hour limits are necessary but not sufficient as it’s about sleep too; • assess risk with appropriate response; • a shared duty of care for managing fatigue related risk.

Control strategies to reduce fatigue

18% FATIGUE RELATED INCIDENTS OCCURRED ON A NIGHT SHIFT

17% OCCURRED WHILE DRIVING HOME

• Double checks by self or

someone else; • advise someone if you are

feeling tired; • monitor individual performance • • • •

and that of colleagues; task rotation; breaks within shift; naps and caffeine; increase communication at workplace and share the responsibility for managing risk.

Reference

Drew Dawson and Kathryn Reid, 1997.

Fatigue, alcohol, and performance impairment. The Centre for Sleep Research, University of South Australia

August 2015 Volume 23, No. 2 33

FOCUS

Education: Part 2

BP measurement: practice without evidence. Are we teaching it wrong?

By Sara Geale and Elisabeth Jacob

References Alexis O. (2009).

Providing best practice in manual blood pressure measurement.

BJN. 18(7), 410-415.

We would like to throw down the gauntlet or in this case the blood pressure cuff. Blood pressure (BP) assessment is reportedly the most frequently done of the vital sign measurements in healthcare.

The importance of accuracy in BP measurements is well recognised (Rabbia et al. 2013).

Measuring BP is usually taught to student nurses early in their education program. Mastering the skills required to measure BP with accuracy is demanding for nursing students. Taking a BP requires the development of new psychomotor skills, an understanding of what they are measuring and an ability to achieve a level of accuracy (Alexis, 2009).

Historically in Australian schools of nursing, students are taught to do a preliminary palpatory systolic determination (PPSD) prior to a complete BP reading (Tollefson, 2010). Students are directed to palpate a brachial pulse with the BP cuff insitu. They then pump up the cuff until they cannot longer feel a brachial pulse. The student is advised that they have now palpated the systolic BP. They lower the cuff, wait two to three minutes and reinflate the cuff to 30 to 40mmHg above the systolic BP that they had initially palpated. The 34 August 2015 Volume 23, No. 2

AS SUPPORTERS OF EVIDENCE BASED PRACTICE WE, THE ACADEMICS TEACHING THIS PROCESS, NEED TO QUESTION WHY WE ARE TEACHING A PRACTICE THAT SEEMS TO BE BASED ON ‘DOING WHAT WE HAVE ALWAYS DONE’ student then takes and documents the systolic and diastolic BP. They have now pumped the cuff up occluding blood flow to the periphery, lowered it slowly to produce the turbulent flow required to hear Korotkoff sounds and they have done this twice within a short period of time.

While there may be an argument for the PPSD helping to increase reading accuracy by enabling identification of an auscultatory gap (Blank et al.

1991) to date there is no research to show that the gap is being recognised or documented

by nurses or that it makes any difference to patient outcomes.

Current recommendations from The Joanna Briggs Institute, (2014) exclude the use of PPSD or use it in conjunction with the first BP reading. It is questionable that this practice is carried into the clinical area especially given nursing time management issues associated with large patient loads in most healthcare areas and the need to wait for one to two minutes between cuff inflation for traditional PPSD (Tollefson, 2010). It is also questionable if this procedure leads to improved patient outcomes and satisfaction.

As supporters of evidence based practice we, the academics teaching this process, need to question why we are teaching a practice that seems to be based on ‘doing what we have always done’.

We need to ask if by doing what we have always done we are actually improving the student experience and improving patient care. We should be asking if there is a better way to teach BP measurement that would encourage accuracy and reduce risk.

Dr Sara Geale is a Lecturer and Dr Elisabeth Jacob is a Senior Lecturer in the School of Nursing and Midwifery at Edith Cowan University in WA

Blank, S. G., West, J. E., Muller, F. B., Pecker, M. S., Laragh, J. H., & Pickering, T. G. (1991), Characterization of auscultatory Gaps with Wideband External Pulse Recording, Hypertension, 17(2), 225-233. doi: 10.1161/01.

HYP.17.2.225 Gordon, C.J. Frotjold, A., Fethney, J., Green, J.; Hardy, J., Maw, M., Buckley, T. (2013, October).

The Effectiveness of Simulation-Based Blood Pressure Training in Preregistration Nursing Students.

Journal of Simulation in Healthcare. 8(5), 335-340. doi: 10.1097/ SIH.0b013e3182a15fa7 Rabbia, F., Testa, E., Rabbia, S., Praticò, S., Colasanto, C., Montersino, F., Veglio, F. (2013). Effectiveness of blood pressure educational and evaluation program for the improvement of measurement accuracy among nurses.

High Blood Pressure & Cardiovascular Prevention, 20(2), 77-80.

Retrieved from http:// ezproxy.ecu.edu.au/ login?url=http://search. proquest.com/ docview/1462385739? accountid=10675 The Joanna Briggs Institute. (2014). Vital signs. Retrieved 29 April 2015 from http:// ovidsp.tx.ovid.com. ezproxy.ecu.edu.au/ sp-3.15.1b/ovidweb. cgi?&S=LDEFFPOP HBDDAMCANCKK AHIBKEDMAA00& Link+Set=S. sh.21|12|sl_190 Tollefson, J. (2010).

Clinical Psychomotor Skills: Assessment tools for nursing students (4th Ed.). South Melbourne, Vic: CENGAGE Learning

anmf.org.au

Education: Part 2

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References Algoso, M., & Peters, K. (2012). The experiences of undergraduate Assistants in Nursing (AIN). Nurse Education Today, 32(3), 197-202.

Beckett, A., Gilbertson, S., & Greenwood, S. (2007). Doing the right thing: Nursing students, relational practice, and moral agency. Journal Of Nursing Education, 46(1), 28-32.

Beecroft, P.C., Dorey, F., & Wenten, M. (2008).

Turnover intention in new graduate nurses: a multivariate analysis.

Journal of Advanced Nursing, 62(1), 41-52.

Clark, T., & Holmes, S. (2007). Fit for practice?

An exploration of the development of newly qualified nurses using focus groups.

International Journal of Nursing Studies, 44(7), 1210-1220.

El Haddad, M., Moxham, L., & Broadbent, M. (2013).

Graduate registered nurse practice readiness in the Australian context: An issue worthy of discussion. The Australian Journal of Nursing Practice.

Undergraduate Assistant in Nursing (AIN) employment in aged care: Does this prepare new graduates for the clinical work environment?

By Maricris Algoso Nursing education made the transition from hospitalbased training to the tertiary sector over 20 years ago.

However, grave concerns about the quality and quantity of undergraduate nurses’ clinical experiences prior to graduation remains (Clark & Holmes, 2007; Ong, 2013; Spence, et al, 2012), raising issues surrounding new graduate preparedness for practice (Beckett, et al, 2007; Beecroft, et al, 2008; Mannix, et al, 2006).

In 2001, New South Wales (NSW) Health developed and implemented an incentive where Bachelor of Nursing students were actively recruited to work as Assistants in Nursing (AINs) whilst completing their undergraduate nursing program. The aim of this incentive was to support further development of clinical skills for anmf.org.au

Bachelor of Nursing students.

Most undergraduate AIN positions are in aged care settings, which are perceived to provide limited opportunities to practice a narrow set of nursing skills (Algoso & Peters, 2012; Stombaugh & Judd, 2014). However, previous research has not determined whether undergraduate AIN employment prior to graduation assists in work readiness for this group.

The aim of the proposed study is to explore the perceptions of new graduate (NG) nurses regarding whether undergraduate AIN employment in aged care assisted in preparing them for the clinical work environment. Exploring undergraduate AIN employment in preparing nursing students for the clinical work environment has the potential to unite the service and education sector, a relationship that is crucial to providing quality nursing education.

The author is seeking NG nurses

with at least three months RN, experience who were previously employed as undergraduate AIN in aged care facilities. Participants will be required to complete an online survey and/or be willing to participate in one-to-one interviews. To complete an online survey, please follow the link: www. surveymonkey.com/r/Preparation_ for_Clinical_Practice Alternatively, a paper copy of the survey can be requested from the author and will be mailed out.

If you are interested in participating in this study (either in completing a survey or participating in an interview) or require more information, please contact Maricris Algoso (m.algoso@uws.edu.au).

HREC Approval Number: H10915 Maricris Algoso is a PhD candidate from the School of Nursing and Midwifery at the University of Western Sydney.

Mannix, J., Faga, P., Beale, B., & Jackson, D. (2006). Towards sustainable models for clinical education in nursing: An ongoing conversation. Nurse Education in Practice, 6, 3 - 11.

Ong, G.L. (2013). Using final placements to prepare student nurses.

Nursing Times, 109(3), 12-14.

Spence, D., Vallant, S., Roud, D., & Aspinall, C. (2012). Preparing registered nurses depends on “us and us and all of us”. Nursing Praxis in New Zealand, 28(2), 5-13.

Stombaugh, A., & Judd, A. (2014). Does nursing assistant certification increase nursing student’s confidence level of basic nursing care when entering a nursing program?

Journal Of Professional Nursing, 30(2), 162-167.

Wolff, A.C., Pesut, B., & Regan, S. (2010). New graduate nurse practice readiness: perspectives on the context shaping our understanding and expectations. Nurse Education Today, 30(2), 187-191.

August 2015 Volume 23, No. 2 35

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Education: Part 2

Flexible learning in midwifery and nursing education

By Sara Stelfox In undergraduate courses a challenge exists to improve both students’ access and engagement. This has been countered with the use of various technologies to best meet the needs of both professional practice preparation and students’ need for improved access and flexibility.

Midwifery and nursing students now access information online, complete teamwork activities in virtual classrooms, submit assessments online and practice clinical skills using virtual environments, in addition to more traditional face to face learning.

In 2011, students in the combined Bachelor of Nursing/ Bachelor of Midwifery at Deakin

University were surveyed regarding their use of and satisfaction following the introduction of flexible education technologies.

The redesign of courses to include flexible learning, was underpinned by assumptions of students’ capacity to engage and succeed within a different learning environment. Students’ ability to succeed with online learning has been extensively considered and is influenced by a number of factors including, perception of technology, learning style, previous experiences, time available and support for studies and learning motivation (Drennan et al. 2005 & Muilenburg & Berge, 2005).

Although many undergraduate students can be described by their year of birth as ‘digital natives’ and are considered to be skilled with the online world (Prensky, 2001), this study found that some students experienced difficulty with access and use of online education technologies and did not always consider that it afforded them an improved education experience.

Incorporating emotional intelligence in nursing and midwifery education

By Dolores Dooley, Cate Nagle and Leah East Emotional intelligence (EI) is defined as the ability to monitor one’s own and others’ feelings and emotions, discriminate between the positive and negative effects of emotions and use this information to guide one’s thinking and actions (Salovey & Mayer, 1990).

Emotions permeate nursing and midwifery practice, understanding one’s own emotions is the basis of understanding the emotions of others, a critical skill for healthcare professionals (Freshwater & Stickley, 2004).

Historically, the emotional aspects of clinical practice were deemed far too perilous for the nursing and midwifery student which resulted in a task orientated approach to the delivery of care (Menzies, 1960).

More recently, the attributes of EI have been deemed central to nursing practice, influencing 36 August 2015 Volume 23, No. 2

the quality of student learning, ethical decision-making, critical thinking, leadership abilities, quality patient care and improved patient outcomes (Akerjordet & Severinsson, 2007; Patterson & Begley, 2011). Indeed, EI has been considered especially important within nursing and midwifery where developed interpersonal skills are required (Freshwater & Stickley, 2004; Patterson & Begley, 2011). Yet, Harrison and Fopma-Loy (2010, p 644) remark that “Nurse Educators often speak of preparing “safe practitioners” and “critical thinkers” but it is relatively rare to hear a conversation in which faculty speak of preparing a student who is emotionally intelligent” adding that emotions are often overlooked in nursing education.

The emotional cost of caring among student nurses and midwives grappling with managing their emotions in the clinical arena is well documented (Akerjordet & Severinsson, 2007; Harrison & Fopma-Loy, 2010). This has

Students self-rated their information technology (IT) confidence at lower than expected levels (35% ‘limited’ or ‘average’).

Many students reported that they had never before used online educational technologies such as virtual classrooms (60%) and had limited or no experience with online lectures (55%).

Despite these challenges 60% of students reported that online education technologies allowed them more flexibility to better manage their time and incorporate study with other competing responsibilities such as paid work and family responsibilities.

These findings highlight that despite the proliferation of technologies used by students’ in their social world, their competence with educational IT and related characteristics needs to be carefully considered when designing innovative courses.

Sara Stelfox is a Lecturer in the School of Nursing and Midwifery at Deakin University

prompted calls for the explicit inclusion of EI within undergraduate nursing and midwifery curricula to prepare students for the complexities of their clinical roles including the social and emotional demands of clinical practice.

(Freshwater & Stickley, 2004; Patterson & Begley, 2011).

While, EI cannot be considered a general panacea, the literature suggests that it could impart new ways of thinking and being for students as it considers their emotional needs and how these impact on their education and clinical practice. As the clinical environment becomes more complex, academics and educators are challenged to embed EI in curricula in meaningful ways with appropriate evaluative frameworks.

Dolores Dooley is a lecturer and Dr Leah East is a Senior Lecturer in the School of Nursing and Midwifery at Deakin University Cate Nagle is Associate Professor in the School of Nursing and Midwifery at Deakin University and Sunshine Hospital, Women’s and Children’s Division, Western Health

References Drennan, J, Kennedy, J & Pisarski, A. (2005), Factors affecting student attitudes toward flexible online learning in management education.

The Journal of Education Research, Vol. 98, No. 6, pp. 331-338 Muilenburg, L & Berge, Z. (2005), Student barriers to online learning; a factor analytic study. Distance Education, Vol. 26, No.1, pp. 29-48 Prensky, M. (2001), Digital natives, digital immigrants. On the Horizon, Vol. 9, No. 5, pp 1–6

References Akerjordet, K & Severinsson, E 2007.

Emotional intelligence: a review of the literature with specific focus on empirical and epistemological perspectives, Journal of Clinical Nursing.

16(8):1405-1416.

Freshwater, D & Stickley, T 2004. The heart of the art: Emotional Intelligence in Nurse education. Nursing Inquiry. 11(2):91-98.

Harrison, P & Fopma-Loy, J 2010. Reflective Journal Prompts: A Vehicle for Stimulating Emotional Competence in Nursing.

Journal of Nursing Education. 49(11):644-652.

Menzies, I 1960. A CaseStudy in the Functioning of Social Systems as a Defence against Anxiety: A Report on a Study of the Nursing Service of a General Hospital. Human Relations. 13(2):95-121.

Patterson, D & Begley, AM 2011. An exploration of the importance of emotional intelligence in midwifery.

Evidence Based Midwifery.

9(2):53-60.

Salovey, P & Mayer, JD 1990. Emotional intelligence. Imagination, Cognitation and Personality. 9(3):185-211.

anmf.org.au

Education: Part 2

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References Bond, M. & Holland, S. (2010). Skills of clinical supervision for Nurses: a practical guide for supervisees, clinical supervisors and managers, (2nd ed).

New York, McGraw-Hill

Clinical supervision as a means of professional development in nursing

By Lorna Moxham and Alex Gagan Ongoing professional development is a mandatory component of a nurse’s license to practice. One such opportunity to engage in professional development is through clinical supervision.

Clinical supervision is a formal arrangement embedded within a structure aimed at supporting staff and enhancing outcomes for both clinicians and service users.

It has a long and established history in many healthcare professions, including social work, psychology and mental health nursing. Lyth (2000) describes clinical supervision as a: “support mechanism for practising professionals within which they can share clinical, organisational, developmental and emotional experiences with another professional in a secure confidential environment in order to enhance knowledge and skills”.

Engaging in this process is thought to lead to increased awareness of other concepts integral to nursing such as accountability and reflective practice. It has also been suggested that clinical supervision has “been developed as a strategy to address the challenges, stresses and opportunities facing the nursing profession of the 21st century” (Lynch et al. 2008). anmf.org.au

Clinical supervision is conceptualised as having four goals. Corey et al. (2014) describes these as that which: 1. promotes supervisee growth and development; 2. protects the welfare of the client; 3. monitors supervisee performance and act as a gatekeeper for the profession, and 4. is a process that empowers the supervisee to self-supervise and carry out these goals as an independent professional.

The goals illustrate the value that clinical supervision has with regard to professional development in nursing. They also synergise with the Proctor Model of clinical supervision (Proctor, 1986) which has become one of the most influential models to be adopted in nursing contexts.

The Proctor Model comprises three domains: 1. Normative: to address the promotion of standards and clinical audit issues.

2. Restorative: to develop the personal wellbeing of the supervisee.

3. Formative: to develop knowledge and clinical skills.

The growth and development of nurses who receive clinical supervision is achieved through a structured process of facilitated

practice reflection. This professional development strategy is thought to increase practitioner wellbeing and self-awareness but also contributes to an improvement in the quality of clinical care. Such an approach could in turn improve outcomes for clients (Winstanley & White, 2010).

Looking abroad, clinical supervision for nurses was introduced in the late 1980s in the UK, and has since become an integral part of the public health system in terms of clinical governance and quality assurance.

This is not so in the broader context of Australian nursing practice. The exception is mental health nursing.

Given that clinical supervision can bring benefits not only to practitioners but also healthcare organisations and its clients when it fulfils the aim of improving and developing clinical practice (Bond & Holland, 2010), Australian healthcare organisations should consider formally and consistently supporting nursing staff to access clinical supervision as part of ongoing professional development.

Lorna Moxham is Professor of Mental Health Nursing at the University of Wollongong Ms Alex Gagan is a Nurse Educator at the Illawarra Shoalhaven Local Health District Mental Health Service

Corey, G., Haynes, R., Moulton, P. & Muratori, M. (2010). Clinical supervision in the helping professions: a practical guide (2nd ed).

American Counselling Association, Wiley Lynch, L., Hancox, K., Happell, B. & Parker, J. (2008). Clinical Supervision for Nurses.

Wiley Blackwell, United Kingdom.

Lyth, G. (2000). Clinical supervision: a concept analysis. Journal of Advanced Nursing, vol 31(3), 722-729.

Proctor B. (1986).

Supervision: a cooperative exercise in accountability, Enabling and Ensuring, In, M. Marken & M. Payne (eds), Leicester National Youth Bureau and Council for Education and Training in Youth Work, Leicester.

White, E. & Winstanley, J. (2010) A randomised controlled trial of clinical supervision: selected findings from a novel Australian attempt to establish the evidence base for causal relationships with quality of care and patient outcomes as an informed contribution to mental health nursing practice development.

Journal of Research in Nursing, vol 15(2), 151-167.

Winstanley J, & White E. (2003). Clinical supervision: models, measures and best practice. Nurse Researcher, vol 10(4), 7-38.

August 2015 Volume 23, No. 2 37

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Education: Part 2

Defining recency of practice – place

Taking knowledge to new levels

By Michelle Gray The introduction of national registration for health practitioners in Australia in 2010 standardised reregistration regulations and created the opportunity for registrants to cross borders to practice anywhere in Australia.

National registration also introduced separate registers for nurses and midwives (Australian Health Practitioner Regulatory Agency, 2010).

This means that dual practitioners when renewing registration need to demonstrate registration standards for each register (Nursing and Midwifery Board of Australia, 2010). Research findings show some practitioners have used practice places to define how they met the registration standards (Gray et al. 2015).

A longitudinal case study followed 20 midwives over two AHPRA registration periods to investigate their responses to the national statutory requirements for renewal of registration. In conversational interviews with a purposive sample of midwives from four states, registrants shared their decision making around continuing professional development and recency of practice. The findings of this study were then presented to a focus group of four midwives from an additional state for verification of the findings.

In this study, participants used

their place of practice, to infer assumptions about their roles.

Thus, place was used to imply the extent or limit of their competence to demonstrate recency of practice for renewal of registration.

Competence was demonstrated through activities in either nursing or midwifery practice.

Practice places were used to imply possession of certain knowledge and skills; such as what activities were performed in that space, and the type of interactions with women or patients; for example, Neme demonstrated her nursing competence: ‘I worked in emergency, and surgical nursing…looking after all those sick people’ (Neme) In this sample practitioners made decisions about registration requirements based on their place of practice, and the required knowledge and skilled expertise needed in each area. This line of reasoning shared by this sample illuminated different clinical priorities, and values attached to different areas of practice.

This study exemplified how the participants used place and space to define their role/s and how place inferred the skills and knowledge that were used in that space and consequently used for proving recency of practice.

Michelle Gray is a Lecturer in Midwifery and Nursing at the University of the Sunshine Coast

By Anna Walsh When I started my job as Clinical Facilitator at RDNS (Royal District Nursing Service) I came with a preconceived idea of what nursing education was. My idea was that a nurse who is experienced in certain areas teaches other nurses all the things she or he has learned over the years.

References Australian Health Practitioners Regulation Agency (AHPRA). National Boards: Registration Requirements. 2014.

Available at: www.aphra. gov.au/Registration/ Registration-Process/ RegistrationRequirements.aspx (cited 27/04/14).

Gray, M. Rowe, J. and Barnes, M. 2015.

Australian midwives’ interpretation of the re-registration, recency of practice standard.

Australian Health Review. http://dx.doi. org/10.1071/AH14070 Nursing and Midwifery Board of Australia.

2010. Registration Standards. www. nursingmidwiferyboard. gov.au/RegistrationStandards.aspx (review 04/03/15, cited 21/04/15)

As RDNS is a community organisation I envisaged myself going out in the field helping other nurses in their practice and perhaps holding hour-long inservices to update nurses in various practices in line with local policies.

It is the traditional way of gaining and sharing nursing knowledge where oral traditions and didactic training go a long way back and little seemed to have changed in my past experience prior to starting at RDNS.

THE FOCUS IS ON ACHIEVABLE AND MEASURABLE LEARNING OBJECTIVES. However the development of nursing education has come a long way at RDNS where the philosophy of education is not necessarily embedded in nursing philosophies and practices it takes focus from adult education principles. The RDNS team

Geneva Healthcare

Education: Part 2 is a mix of nurses and instructional designers and although our clinical training is evidence-based, the emphasis is on knowledge retention and learning gained from sessions.

It is no longer just enough to regurgitate past experiences; there needs to be a reason for attending training and some knowledge gained from being there with evidence of this occurring. There also needs to be some control of what is being facilitated. One expert’s opinion can be very different from another – and being an expert does not necessarily make you a good educator. Transition of knowledge is a skill that can be difficult to master. For me it is a continual progress.

The courses at RDNS are written by a team of people that comprise clinical experts, adult education experts and instructional designers.

The focus is on achievable and measurable learning objectives. It enables me as the facilitator to be focussed on the learning needed as opposed to being an expert sharing any knowledge that may be the focus for that particular day, something that often occurs.

I have also learned that nursing education needs to be more contemporary and include other important aspects such as communication skills, healthy minds and mindfulness. I feel privileged to be working with a team of people passionate for both clinical nursing and nurse’s health in order to achieve improved client outcomes.

Anna Walsh RN is a Clinical Education and Learning Facilitator at RDNS in Melbourne

“Why do I have to know all this – I am not a doctor, just a nurse”

By Barbara Loessl This student’s statement triggered my effort to make clinical sciences more relevant, exciting, interesting and understandable. Students obviously regarded nursing as a profession below that of medical practitioners requiring less in-depth knowledge.

There seemed to be no understanding of the importance for clinical practice. I had to provide a link between the duty of care to patients, which requires a deep understanding of pathophysiology and pharmacology, and the fact that knowledge alone will not make an excellent nurse; it has to be mixed with a good dose of caring and connection with the patient and awareness and pride of the vital role nurses play in healthcare.

The nursing curriculum at Edith Cowan University has three scaffolded clinical sciences units.

Tutorials in the first two units are designed as case based learning (CBL) which is an active learning approach, encompassing both collaborative and individual learning (Yew, Chng & Schmidt, 2011).

Activities are initially guided by the tutor with groups presenting a case study of a disorder and addressing questions for each of the scenarios.

Eventually the tutorials become fully

student-led. Students introduce a case study and design learning activities and assessments for their peers. The final clinical sciences tutorials revolve around researching current health issues and presenting results back to the class in various formats, eg. podium discussions, poster sessions and role plays.

Student comments: “I love the activities in the tutorials. Sometimes we can be tired and not feel like doing them, however, they are really helpful in getting us to think and fully grasp the topic.”

“The best aspect of the units was the depth of knowledge and relevance it had to our clinical skills.”

“The nurses on the ward wanted me to present my poster to them as well.”

The students really surprised me with the enthusiasm, fantastic activities, knowledge and creativity they display. They seem to appreciate and understand the clinical sciences much more and can see the clinical relevance for a sound theoretical knowledge base. I think that will turn them into confident and competent nurses who are an integral part within healthcare teams.

Reference

Barbara Loessl is a Nursing Lecturer in the Faculty of Regional Professional Studies at Edith Cowan University

THE NATIONAL NURSING FORUM Advancing nurse leadership

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Yew, E.H.J., Chng, E. & Schmidt, H.G. 2011. Is learning in problem-based learning cumulative? Advances in Health Sciences Education. 16:449-464.

14–16 October 2015

Brisbane Convention & Exhibition Centre

REGISTER YOUR PLACE NOW For more information visit: www.acn.edu.au/forum_2015

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Education: Part 2

Education options

By Pauline Wong and Jacqui McGregor La Trobe is an Australian pioneer in nursing and midwifery education. In 1974, La Trobe became the first provider of tertiary-based education for nurses. Our experience has helped us build an innovative curriculum that produces highly respected graduates. We offer education programs including undergraduate, postgraduate, research higher degrees and continuing professional development (CPD) programs.

CPD short courses and single subjects Our short courses, workshops and webinars will help you stay current in a constantly changing environment and earn you CPD hours. With the standards for registration as a nurse in Australia and the professional contexts and roles for nurses evolving, we maintain a proactive approach to ensuring our nursing courses meets current best practice standards.

Our suite of CPD short courses, webinars and workshops are practical and engaging, relevant 40 August 2015 Volume 23, No. 2

to today’s nursing practice environment and delivered via a variety of flexible modes to suit busy working nurses. We can also customise sessions for groups and deliver them at your workplace.

Our short courses include: • Arterial blood gas interpretation • ECG fundamentals • Introduction to breast care nursing • Nurse immuniser program • Prostate nursing care • Wound management training For more information visit latrobe.edu.au/short-courses/ nursing

Postgraduate courses If you are looking for something more substantial to build your career, we have a range of postgraduate coursework programs. With Masters level courses you can develop the knowledge and skills to be an expert clinical practitioner.

Our Master of Nursing helps registered nurses build their careers by qualifying in one of our 14 specialisations including emergency care, intensive care, neonatal care and urology. You would enrol in Masters of Nursing in your chosen specialty area and can exit with either a grad cert grad diploma or Masters.

We also offer child family and

community for qualified midwives who want advanced training to qualify as a maternal and child health nurse. Our postgraduate midwifery programs are for those with a nursing degree who want to work as midwives and for qualified midwives wishing to advance their practice.

With our Master of Nursing (Nurse Practitioner) specialist nurses can build on their knowledge and clinical skills to practice at an advanced level of contemporary clinical and professional nursing specialties and provide leadership.

Our fully online Masters of Nursing Science provides nurses with the knowledge and skills in research and their chosen area of professional practice. It is delivered via a flexible online mode which comprises learning modules over six week blocks. The flexibility of the course structure allows the student to complete their degree in just 20 months, or pause their studies and re-join during one of our seven yearly intakes.

Our programs are taught using a variety of approaches, including onsite workshops and lectures, and online study. We also offer parttime, full-time and flexi-modes so you decide how much you take on.

To discuss your study options, book a one-on-one consultation.

Call 1300 135 045 or visit latrobe.edu.au/consult

Pauline Wong is Coordinator, Professional Development and Jacqui McGregor is Postgraduate Course Coordinator, Master of Nursing. Both are at La Trobe University anmf.org.au

Education: Part 2

Embedding health informatics skills into an undergraduate curriculum Carol Piercey

Carol Piercey is a Senior Lecturer in the School of Nursing and Midwifery at the University of Notre Dame Australia

By Carol Piercey The concept of health informatics has been around for some time. It was born the first day that clinicians wrote their impressions about the patient and communicated this information to somebody else. It is only in recent years, however, that information technology has been introduced into nursing.

Communication systems in healthcare have grown exponentially with the innovations in computer science.

So how do we prepare students to face the world of health informatics?

Nursing students are information technology (IT) savvy. Most learnt how to use a computer at high school and now in university they can be seen using their smart phones, tablets and laptops. Such devises can be useful in a learning situation, but students need to learn appropriate, ethical and safe use in patient care.

An overloaded curriculum can be unburdened if informatics is taught

Developments in education/ongoing professional development Pauline Hill Pauline Hill

Pauline Hill is Continuing Professional Development Coordinator in the School of Nursing & Midwifery at Flinders University anmf.org.au

The School of Nursing and Midwifery (SONM) at Flinders University was the original tertiary School of Nursing in South Australia and is celebrating its 40th anniversary this year.

For more than half of this time, the SONM has also offered seminars, workshops and short courses to nursing and midwifery professionals to assist them to continue their education as their professional lives and careers develop. Registered nurses and midwives have had access to these continuing

alongside or embedded in units that already contain concepts integral to communication technology.

For example foundation studies centred on communication could include knowledge and skills regarding the role of nurses in informatics. Already communication studies stress the importance of documenting nursing care in legible and appropriate format, demonstrating the same process, but in a digital format, could be a complimentary teaching strategy.

SO HOW DO WE PREPARE STUDENTS TO FACE THE WORLD OF HEALTH INFORMATICS? From a theoretical perspective competencies such as: learning to communicate in a professional language; questioning techniques including self-reflection; problem solving; and decision-making, are embedded in the curriculum.

Underlying all these competencies is the notion of evidence-based practice (EBP). Providing information on EBP and facilitating students learning means demonstrating how to find information electronically.

This involves discriminating professional development (CPD) opportunities to “maintain, improve and broaden their knowledge, expertise and competence” (Australian Health Practitioner Regulation Agency – AHPRA website) through face to face and online courses.

These continuing professional development opportunities have been driven by academics with specific expertise and passion for particular professional areas of practice.

The SONM at Flinders University has recently responded to the industry need for health professionals to continue their education, intensified by the AHPRA requirement for health professionals to complete a minimum number of hours of CPD each year for registration. The SONM offers a range of workshops and short courses, many of which can be considered for credit in

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between valid and reliable data for implementing into clinical practice. It also means understanding the legal aspects of ownership, copyright and plagiarism. These concepts are integral to understanding the research process.

Practical lessons can be drawn from the clinical practicum, since every encounter with a patient requires communication and documentation. This information can be entered into a data base system supervised by the students’ preceptor. While students may be proficient in computer skills, they need to learn the correct terminology and professional language. Additionally, they need to access and interpret diagnostic reports to provide quality care.

Nurses new to practice are obliged to practice safely, accurately and compassionately in a variety of settings where knowledge and innovation increase at an astonishing rate. They also need to manage care in an ever-changing technological environment and work collaboratively with other health professionals. In preparing students for their transition into the workplace as new graduates, concepts related to health informatics can be taught in the classroom and followed through into the clinical practicum.

Classroom and clinical instruction need to be a seamless experience to ensure that graduates can make astute clinical judgements. postgraduate programs and addressing professional areas of practice such as: • International disaster nursing • Cognitive decline through dementia, delirium and depression • Skin cancer screening assessment and identifications • Fundamentals of forensic healthcare (online, one semester) • Facilitating clinical based learning (two day workshop) • Obstetrics and neonatal short course for overseas registration • Mental health first aid.

Further information about courses is available from the CPD coordinator Pauline Hill at sonm.profdev@flinders.edu.au or via the website: www.flinders. edu.au/nursing/professionaldevelopment/professionaldevelopment.cfm August 2015 Volume 23, No. 2 41

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Education: Part 2

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42 August 2015 Volume 23, No. 2

IPL: A new way for education

By Josephine Perry A student must have completed a scrub competency, to a prescribed standard as set out by national guidelines prior to being able to scrub in to observe surgical procedures whilst on clinical placement. While the scrub competency has historically been part of the student orientation to their surgical placement, several major hospitals are discontinuing this portion of the program.

As such, the onus is now on tertiary institutions to facilitate the scrub competency of students prior to their placement. The medical and nursing schools at the University of Adelaide believe it is part of their core business to prepare students adequately for clinical placement ensuring that quality is not affected, consistent standards are taught and that students will be able to participate entirely during their placement.

The schools have identified an interprofessional learning (IPL) opportunity since the scrub competency is identical for medical and nursing students. As operating theatre culture has moved into a team model of care, roles have evolved within theatres, and this is also vital to explore on an

interdisciplinary level. The schools believed that the plan to combine medical and nursing students into a simulation exercise whilst doing their scrub competency was an optimal outcome as it would serve to bring the two together in a common space and introduce the main aspects of an unfamiliar environment.

The schools developed small vignettes which are uploaded to MyUni (the student learning platform) for students to view prior to the “hands on” workshop. Being primed with the vignettes and scenarios help students of both disciplines to contextualise the IPL activity. Timetabling some 350 students prior to their surgical placements has been deemed problematic as they have been impacted by other clinical placements, availability of staff and the demands of the current full timetables.

The schools will be looking to grow this IPL activity and other similar IPL activities between its medical and nursing students in the new state-of-the-art $206 million 13-storey building currently under construction in Adelaide city’s west end precinct.

Josephine Perry is Specialty Coordinator (Perioperative) at the University of Adelaide. anmf.org.au

Education: Part 2

FOCUS PROFESSOR ALISON HUTCHINSON AND EDUCATOR DAVID MCMILLAN, WITH STAFF MEMBER ALICIA MCKERRAL RECEIVING HER TRI-FOCAL MODEL OF CARE CERTIFICATE OF COMPLETION ON 20 JUNE 2014

References

The Tri-focal Model of Care: building staff capacity for partnership-centred, evidence-based residential aged care

By Alison Hutchinson, Beverly O’Çonnell, Helen Rawson and Helen Walker Building an appropriately skilled and well-qualified workforce is essential to delivering highquality residential aged care (RAC) to meet the increasingly complex needs of older Australians. To address unmet demands for services, recent government aged care policy reforms will lead to an increase in the number of RAC facilities (Butler, 2013; Productivity Commission, 2013).

As a result, significantly more staff, educated with specific knowledge and skills, will be required (Productivity Commission, 2011).

Currently, 6.4% of all direct RAC workers have no post-secondary qualifications and almost 20% do not undertake continuing professional development (Department of Social Services, 2014a). The importance of bespoke education for staff in RAC facilities cannot be underestimated.

The Tri-focal Model of Care education program is designed to respond to the challenges of developing and retaining trained staff. The model promotes ‘partnership-centred care’, a ‘positive environment’ and ‘evidence-based practice’ (O’Connell et al. 2008), and focuses on translating knowledge to enhance workforce development and quality of life for residents.

Consisting of three professional and six clinical modules addressing Australian Accreditation Standards anmf.org.au

(Department of Social Services, 2014b) and aspects of care, the model enables all staff to engage in ongoing professional development and promotes care delivery based on the best available evidence.

The model has recently been implemented as a workplacebased program in seven Victorian RAC facilities. Mixed methods research was undertaken to measure the process and outcomes of implementation. Staff evaluated the education sessions. Additionally, residents, family members, formal care providers and support staff participated in individual and focus group interviews.

Content of the education sessions was perceived by 84.9% of staff as very or extremely relevant to residents’ care needs; 62.9% perceived they were very or extremely likely to utilise the education to improve practice; and 67.4% of staff perceived it was very or extremely likely they would improve their work environment using knowledge acquired from the education. Although staff acknowledged the existence of a challenging work environment, they reported improved communication, greater work satisfaction and motivation, increased skills to care based on evidence, and a strong desire to continue education to improve currency of practice. A significant number of environmental and clinical process changes, implemented to benefit residents, were also reported.

Available online as a free resource (Centre for Innovation and Education in Aged Care, 2015), the program promotes integration of research, education and practice, providing opportunities for RAC staff education and professional development to promote evidencebased practice.

Professor Alison Hutchinson is Professor/Chair in Nursing, Centre for Nursing Research Deakin University and Monash Health Partnership, School of Nursing and Midwifery, Faculty of Health, Deakin University, College of Nursing, Faculty of Health Services, University of Manitoba, Winnipeg, Canada Professor Beverly O’Connell is Dean/Honorary Professor, College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada, School of Nursing and Midwifery, Faculty of Health, Deakin University Dr Helen Rawson is Research Fellow, Centre for Nursing Research - Deakin University and Monash Health Partnership, School of Nursing and Midwifery, Faculty of Health, Deakin University Dr Helen Walker is Research Fellow, Centre for Nursing Research - Deakin University and Monash Health Partnership, School of Nursing and Midwifery, Faculty of Health, Deakin University

Butler, M. (Minister for M.H. and A.) 2013, Aged Care Legislation Passes Both Houses of Parliament, www. health.gov.au/internet/ ministers/ publishing. nsf/Content/mryr13-mb-mb059.htm Accessed 11 May 2013.

CIEAC 2015 Centre for Innovation and Education in Aged Care. Deakin University, Melbourne. www.deakin. edu.au/health/nursing/ cieac/ Accessed 15 May 2015.

Department of Social Services 2014a. 2012 National Aged Care Workforce Census and Survey – The Aged Care Workforce, 2012 – Final Report. Canberra, Department of Social Services. www.dss.gov. au/our-responsibilities/ ageing-and-aged-care/ publications-articles/ ageing-and-aged-carereports/2012-nationalaged-care-workforcecensus-and-survey-theaged-care-workforce2012-final-report.

Accessed 12 May 2015.

Department of Social Services 2014b.

Standards: Residential Aged Care. Canberra, Department of Social Services. www.aacqa. gov.au/for-providers/ accreditation-standards Accessed 14 May 2015.

O’Connell, Beverly, Joan Ostaszkiewicz, Khalil Sukkar, and Kay Plymat.

“The Tri-focal model of care: Advancing the teaching-nursing home concept.” International Journal of Nursing Practice 14, no. 6 (2008): 411-417.

Productivity Commission 2011, Caring for Older Australians, Report No. 53, Final Inquiry Report, Canberra: Australian Government.

Productivity Commission 2013, An Ageing Australia: Preparing for the Future, Commission Research Paper, Canberra: Australian Government.

August 2015 Volume 23, No. 2 43

POSTGRADUATE DEGREES INFORMATION SESSION Deakin University School of Nursing and Midwifery invites you to an information session to hear about our innovative postgraduate degrees: • Diabetes education • Midwifery • Perioperative care • Intensive care • Cardiac care • Critical care

• Interventional cardiac nursing • Emergency care • Nursing Practice • Nurse Practitioner • Perianaesthesia care • Research degrees

Melbourne Burwood Campus, 221 Burwood Highway Burwood. Building BC, Level 2.

Tuesday 8 September, 5.00–6.30 pm. A short presentation will begin at 5.15 pm after light refreshments. There will be an opportunity to move to breakout rooms with course leaders to discuss specific courses and answer your questions.

To register your attendance at the information session please email nursinfo@deakin.edu.au.

For more information 9244 6102 deakin.edu.au/nursing Deakin University CRICOS Provider Code: 00113B

Education: Part 2

EFFECTIVE CLINICAL LEADERSHIP INVOLVES INDIVIDUALS WITH THE APPROPRIATE SKILLS AND ATTRIBUTES, AT ALL LEVELS OF AN ORGANISATION FOCUSSING ON MULTIDISCIPLINARY/ INTERDISCIPLINARY SERVICE DELIVERY.

Clinical leadership and nursing

By Rajna Ogrin and Elizabeth Barrett Health systems around the world are grappling with the task of providing system-wide evidence based, personcentred, efficient and effective care. Clinical leadership, particularly of nursing staff, is proposed to be integral in reaching this goal ( NHS Leadership Academy, 2013; NHS Institute for Innovation and Improvement, 2011).

Work within RDNS from the organisation’s learning development department and the RDNS Institute, is examining the issue of clinical leadership, how to define it and facilitate it in practice.

There is no one clear definition of clinical leadership, with a number of definitions proposed by various organisations. We suggest that the following clinical leadership definition provides a good summary: “.... the process of developing a culture and leading a set of tasks to continually improve the quality and safety of service delivery to consumers. Effective clinical leadership involves individuals with the appropriate skills and attributes, at all levels of an organisation, focussing on multidisciplinary/ interdisciplinary service delivery.”

(VHA, 2009) Up until fairly recently, clinical leadership in nursing has tended to focus on nursing leaders who are in formal leadership positions, such as nurse managers. While nurse anmf.org.au

managers may be clinical leaders, this is usually in the context of their management activities, such as the planning and organisation of services (Davidson, et al. 2006).

With the increasing urgency to improve efficiency and effectiveness of care, leadership is being proposed as part of the role of every nurse (Pepin, et al. 2011). Work currently underway in the National Health Service (NHS) in the United Kingdom is focusing on empowering clinicians and front line staff to build their decision-making capabilities to encourage a broader practice of leadership by clinicians and other frontline staff, rather than by designated managers alone (West et al. 2015).

The NHS extends on this concept by promoting a collective leadership approach– where leadership is shared and changes based on the needs at the time and dependent on the skill set of the available team members (West et al. 2015).

So what does it take to be a clinical leader? At this stage, there is limited knowledge and understanding of clinical leadership among front line clinicians who provide direct patient care.

Current work underway at RDNS is progressing the concept of collective leadership and acts of leadership at all levels to sustain and adapt to the changing healthcare landscape. In addition, research completed at RDNS has drawn on the existing literature in leadership, then asked nurses who were in a clinical leadership position what they needed to translate evidence into practice (Ogrin, et al. 2014). Nurses stated that the clinical leadership attributes they needed in their roles fell under three areas:

Personal attributes: Having confidence in your ability to provide best practice, being able to communicate effectively and emotional intelligence.

Team attributes: Encouraging trust and commitment in others, team focus, valuing the skills and expertise of others.

Capabilities: Building and maintaining relationships, encouraging contribution from others, creating clear direction and the ability to be a role model.

Organisations are beginning to embrace clinical leadership as a way to improve quality of care. The work at RDNS adds to our understanding of what current clinical leaders attributes are, and the fundamental need for collaboration and collective action at all levels.

Further work will need to build on these attributes to build a clinical leadership framework for how training programs can incorporate developing clinical leaders – an exciting time for nurses, where they can play a key role in leading the way in system-wide translation of evidence into practice.

RDNS received funding from the Commonwealth and Victorian Governments under the HACC program and from the Australian Government Department of Social Services as part of Encouraging Better Practice in Aged Care (EBPAC) initiative.

Dr Rajna Ogrin is Senior Research Fellow at the RDNS Institute Elizabeth Barrett is RDNS National Manager – RDNS Education and Training

FOCUS DR RAJNA OGRIN (LEFT) AND ELIZABETH BARRETT: DEFINING AND REFINING CLINICAL LEADERSHIP

References Davidson, P. M., Elliott, D., & Daly, J. (2006).

Clinical leadership in contemporary clinical practice: implications for nursing in Australia.

Journal of Nursing Management, 14(3), 180-187. doi: 10.1111/j.13652934.2006.00555.x NHS Institute for Innovation and Improvement. (2011).

Clinical Leadership Competency Framework. Coventry: NHS Institute for Innovation and Improvement.

NHS Leadership Academy. (2013). The Healthcare Leadership Model, version 1.0.

Leeds: NHS Leadership Academy.

Ogrin, R., Moss, C., & Willets, G. (2014).

Clinical Leadership - Leading the way to translate evidence into practice. Paper presented at the National Health and Medical Research Council 3rd Annual Symposium on Research Translation, Melbourne, Australia.

Pepin, J., Dubois, S., Girard, F., Tardif, J., & Ha, L. (2011).

A cognitive learning model of clinical nursing leadership. Nurse Education Today, 31(3), 268-273.

VHA. (2009). Clinical Leadership in Community Health Victorian Healthcare Association (pp. 1-24).

West, M., Armit, K., Loewenthal, L., Eckert, R., West, T., & Lee, A. (2015). Leadership and leadership development in healthcare: the evidence base. London: The Kings Fund.

August 2015 Volume 23, No. 2 45

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AUGUST DonateLife week 2-9 August. www.donatelife.gov.au/ donatelife-week-2015 Health Informatics Conference Driving reform: Digital health is everyone’s business 3-5 August, Brisbane Convention and Exhibition Centre, Qld. www.hisa.org.au/hic2015/ National Aboriginal and Torres Strait Islander Children’s Day 4 August Theme: Little Kids, Big Futures. http://aboriginalchildrensday.com.au/ Lung Health Promotion Centre at The Alfred 7 August -Theory & Practice of Non Invasive Ventilation – Bi-Level & CPAP Management 20-21 August - Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au International Day of the World’s Indigenous Peoples 9 August. http://matsiti.edu.au/events/ indigenous/ Drug and Alcohol Nurses of Australasia’s (DANA) Annual Conference Many Faces of Addiction 13-14 August, Novotel Sydney Central, NSW. www.danaconference.com.au Gurindji Land Rights Anniversary 16 August. http://matsiti.edu.au/ events/indigenous/ 12th International Family Nursing Conference Improving Family Health Globally through Research, Education, and Practice 18-21 August, The Radisson Blue Hotel, Odense, Denmark. http://internationalfamilynursing. org/2013/07/11/2015-conference/ 2015 Scientific Meeting of Flight Nurses Australia and Aeromedical Society of Australasia 19-21 August, Darwin Convention Centre. www.flightnursesaustralia. com.au/conference 25th Meeting of the International Society for Neurochemistry 23-27 August, Cairns Qld. www.neurochemistry.org/biennialmeeting.html Endocrine Nurses Society of Australasia Symposium 24 August, The Adelaide Convention Centre, SA. www.ensa.org.au/ensa-2015/ anmf.org.au

6th Annual Correctional Services Healthcare Summit 24-25 August, Rendezvous Grand Hotel, Melbourne. Addressing the gaps, promoting multidisciplinary care and improving the continuum of care into the community. www.informa.com.au/conferences/ TheMHS Conference Translating Best Practice into Reality 25-28 August Canberra. www.themhs.org 3rd Annual National Forensic Nursing Forum Addressing the issues surrounding clinical forensic nursing and forensic mental health 26 August Rendezvous Grand Hotel Melbourne. www.informa.com.au/conferences/ health-care-conference/nationalforensic-nursing-conference Australian Diabetes Educators Association Annual Scientific Meeting 26-28 August, Adelaide Convention Centre, South Australia. www.adea.com.au/ 4th Annual International Emergency Care Conference 26-28 August, AMREP Lecture Theatre, Alfred Hospital, Melbourne. http://alfredetc-professionaldevelopment.cvent.com/events/ international-emergency-careconference-2015/event-summaryde3298352b47ffac653eab18bad52e. aspx

SEPTEMBER Australian Disease Management Association 11th Annual Conference Count me in: Partnerships in chronic care?

9–11 September Brisbane Convention Centre. www.adma.org.au/ E: b.shen@alfred. org.au P: (03) 9076 4125 Brisbane Practice Nurse Clinical Education Queensland’s leading event for nurses working in General Practice.

Earn 18 CPD hours.

11–13 September. www.pnce.com.au Lung Health Promotion Centre at The Alfred 16-18 September/14-15 October - Respiratory Course (Mod A & B) 16-18 September - Respiratory Course (Module A) P: (03) 9076 2382 E: lunghealth@alfred.org.au Australasian HIV&AIDS Conference 16-18 September, Brisbane Queensland. This conference is the major forum for the presentation of HIV research in Australasia. It is the annual conference of the Australasian Society for HIV Medicine (ASHM) which has represented medical practitioners working in the

HIV sector since its incorporation in 1990. www.hivaidsconference.com. au - to be launched soon 17th Annual CATSINaM Conference The only way is up 22-24 September Doubletree Hilton Hotel, Darwin. www.catsinam.org.au Nurses Christian Fellowship Australia - Victoria and Tasmania 25-26 September - Spiritual Care Course, Ashburton Baptist Church, Melbourne. For more information E: ncfavictoria@gmail.com or M: 0412 328 672

NETWORK Box Hill Hospital, Group 99, 30-year reunion For further information contact Clare D’Arcy-Evans E: clarebears21@icloud.com or M: 0416 399 881.

OCTOBER Lung Health Promotion Centre at The Alfred 5-6 October - Spirometry Principles & Practice 14-15 October - Respiratory Course (Module B) 22-23 October - Managing COPD P: (03) 9076 2382 E: lunghealth@alfred.org.au

Queen Victoria Hospital, Melbourne, Midwifery Group Aug 1970–1971, 45-year reunion 29 August at Glen Iris.

Contact Lyn Kirby E: lynmkirby@gmail.com M: 0407320824

12th Biennial National Enrolled Nurse Association of Australia (ANMF SIG) Conference 21 October InterContinental, Adelaide SA. P: 1300 972 315 E: info@nena.org.au www.nena.org au/2015NENA Conference.html

The Alfred Hospital, group 3/75 40-year reunion 10 October. Contact Jann Griffin (nee Serpell) M: 0417 036 311 or Penny McCarthy (nee Jaffray) E: p.mccarthy@alfred.org.au

NOVEMBER Lung Health Promotion Centre at The Alfred 11–13 November - Asthma Educator’s Course 19-20 November - Smoking Cessation Facilitator’s Course P: (03) 9076 2382 E: lunghealth@alfred.org.au Hospital In The Home Society, 8th Scientific Meeting HITH at 21: Maturity, Responsibility and Quality 11-13 November, Rydges World Square, Sydney. Abstract submission is now open and the deadline is 14 August. Early bird registration is now open and closes 25 September. http://conference.hithsociety.org.au/

2016 NETNEP 2016: The 6th International Nurse Education Conference 3-6 April 2016 Brisbane, Australia. Abstracts invited by 15 September 2015. www.netnep-conference.elsevier.com/ The NETNEP series of conferences are designed to facilitate the sharing of knowledge and experience of nursing, midwifery and healthcare workforce education worldwide.

Royal Hobart Hospital, 4/75 PTS, 40-year reunion 30 October, 6.30pm, Janne Gordon’s, 94 Nelson Road, Mount Nelson, Tasmania 7007. BYO drinks and $20 towards pizzas, nibbles and cake.

Contact: Janne E: gordies@ southernphone.com.au, Alex E: therandalls3@netspace. net.au, Heather E: hknichols@ gmail.com or Sue E: susan. cunningham57@hotmail.com by 30 September (let us know of any special dietary needs) LaTrobe University, LaTrobe/Bendigo Campus nursing group (19881991), 25-year reunion 20 February 2016, Bendigo. Contact Steven Graham E: sgraham@ bendigohealth.org.au or Sarah Shipp (nee Prudham) E: sshipp@bendigohealth. org.au or search Facebook page LaTrobe 1991 reunion Email cathy@anmf.org.au if you would like to place a reunion notice

August 2015 Volume 23, No. 2 47

ANNIE

Standing up against domestic violence Annie Butler, Assistant Federal Secretary

MORE THAN 20,000 PEOPLE HAVE SUPPORTED THE NEVER ALONE CAMPAIGN. TO JOIN THE CAMPAIGN GO TO HTTP:// ANMF.ORG.AU/ CAMPAIGN/ ENTRY/ NEVER-ALONECAMPAIGN

Many of you may have read about the ANMF becoming a foundation partner of the Luke Batty Foundation and joining with Rosie Batty to launch the Never Alone campaign in last month’s copy of the ANMJ.

In Australia, family violence is reported to be the most common form of violence against women, with estimates suggesting that over one third of women in Australia have experienced some form of family violence.

The costs of this are significant.

This refers not just to the devastating effects on the victims themselves and their personal losses but also to the Australian community. In 2012, KPMG analysis of costs into violence in Australia estimated that family violence cost the Australian community $14.7 billion in health costs, service provision costs and loss of opportunity and productivity costs.

This equates to $6,500 for every man, woman and child per year.

This followed a resolution from the ANMF’s Federal Executive, which is made up of the secretaries from each state and territory branch of the ANMF, to become a founding partner of the Foundation. The members of the Federal Executive agreed that family violence is a critical issue, which we must address and that the Foundation and the Never Alone campaign should have our full support.

This of course is undeniable.

Family violence is devastating to our community and has detrimental physical, emotional, psychological and social effects on those who experience it. Tragically, it affects a wide range of people, including men, women and children but overwhelmingly (almost 80%) of family violence is experienced by women. The World Health Organization reported in 2013 that around the globe, one in three women are the victims of violence.

These statistics make it patently clear that family violence is an issue of such proportions it must be dealt with. But we have probably had these figures and known about these effects for some time and still not dealt with them.

This is because family violence is a difficult and challenging issue to face. It’s difficult to discuss and even more difficult to deal with. More than 50% of victims, particularly women, feel unable to report incidences of violence. The victims, whether they’re men, women or children, are frequently powerless and fearful.

Services are often unresponsive and healthcare professionals are not always equipped to manage victims of family violence appropriately.

Nurses and midwives are often the people who encounter victims of family violence in hospitals and EDs as well as in the community.

They are frequently the ones who can start the difficult and

On one of Melbourne’s icier mornings in June, I went to the Medibank building in Docklands (a well-known area of Melbourne) to launch the Never Alone campaign with Rosie Batty and the Luke Batty Foundation Board.

48 August 2015 Volume 23, No. 2

challenging conversations: they have a unique and important role to play in the prevention, identification and mitigation of violence - but it’s not easy.

For so long now, family violence has been swept under the carpet, it has been either not discussed or only in hushed tones and it has been regarded as a social issue rather than a healthcare and public health issue. Therefore the training of health professionals in Australia does not routinely include, as it does in areas of the UK, management of victims of family violence.

This is why our work with Rosie Batty is so important. Through her devastating experience, the loss of her son, she has managed to make the discussion of family violence public. She has drawn the attention of our community to the actions of governments and highlighted the serious gaps that exist in our responses to violence and, critically, in our prevention of violence.

Both because of the work that we do and our connection with the community and the nature of our workforce, it makes sense that nurses and midwives would join the Never Alone campaign and support the work of Rosie Batty. But as I said above, it doesn’t mean it’s easy.

When I went on that frosty morning in June to launch the campaign with Rosie, I went with some trepidation. That morning on 20 June, was the anniversary of her son Luke’s birthday – he would have been thirteen. I have a son who will be 21 this year, I cannot imagine what it would have been like to lose him before he even had the chance to be a teenager.

But as I stood with Rosie we spoke about this and despite the enormous difficulty of the issue, everything her strength, her commitment and her love for her son is achieving. I realised that the strength and commitment of nurses and midwives is also significant and that much has been achieved because of it. And that while speaking up on issues that matter is never easy, sometimes the issues that are the most difficult to speak about are the ones that matter the most.

It felt completely natural to be standing with Rosie Batty and to formally launch the ANMF’s partnership with the Luke Batty Foundation and the Never Alone campaign on behalf of nurses and midwives and to commit to dealing with the issue of family violence. anmf.org.au

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Caring for the people who care

2014 winners, left to right: Outstanding Graduate: Zoe Sabri, Nurse of the Year: Stephen Brown, and Team Innovation: Prof Jeanine Young representing the Pepi-pod® Program.

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